The influence of the airway driving pressure on pulsed pressure variation as a predictor of fluid responsiveness.
OBJECTIVE
Assessing pulse pressure variation (PPV) to predict fluid responsiveness in mechanically ventilated patients with tidal volume (VT) and the impact of VT and airway driving pressure (P(plat) - PEEP) on the ability of PPV for predicting fluid responsiveness.


METHODS
Prospective interventional study.


METHODS
ICU of a university hospital.


METHODS
Fifty-seven mechanically ventilated and sedated patients with acute circulatory failure requiring cardiac output (CO) measurement.


METHODS
Fluid challenge was given in patients with signs of hypoperfusion (oliguria <0.5 ml kg(-1) h(-1), attempt to decrease vasopressor infusion rate). Fluid responsiveness was defined as an increase in the stroke index (SI) >or=15%. Receiver-operating characteristic (ROC) curves were generated for PPV and central venous pressure (CVP).


RESULTS
The stroke index was increased >or=15% in 41 patients (71%). At baseline, CVP was lower and PPV was higher in responders. The areas under the ROC curves of PPV and CVP were 0.77 (95% CI 0.65-0.90) and 0.76 (95% CI 0.64-0.89), respectively (P = 0.93). The best cutoff values of PPV and CVP were 7% and 9 mmHg, respectively. In 30 out of 41 responders, PPV was <13%. Using a polytomic logistic regression (P(plat)--PEEP) was the sole independent factor associated with a PPV value <13% in responders. In these responders, (P(plat)--PEEP) was <or=20 cmH(2)O.


CONCLUSIONS
In patients mechanically ventilated with low VT, PPV values <13% do not rule out fluid responsiveness, especially when (P(plat)--PEEP) is <or=20 cmH(2)O.
Division Anesthésie Réanimation Douleur Urgences, Groupe Hospitalo-Universitaire Caremeau, CHU Nîmes, Place du Professeur Robert Debré, 30029, Nîmes Cedex 9, France.
Laurent
L
Muller
Guillaume
G
Louart
Philippe-Jean
PJ
Bousquet
Damien
D
Candela
Lana
L
Zoric
Jean-Emmanuel
JE
de La Coussaye
Samir
S
Jaber
Jean-Yves
JY
Lefrant
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000502:physiology*; D002302:Cardiac Output; D003422:Critical Care; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011175:Positive-Pressure Respiration; D012372:ROC Curve; D012769:Shock / Q000503:physiopathology; D013318:Stroke Volume / Q000502:physiology