title: Predictive value of pulse pressure variation for fluid responsiveness in septic patients using lung-protective ventilation strategies.
abstract: BACKGROUND
  The applicability of pulse pressure variation (ΔPP) to predict fluid responsiveness using lung-protective ventilation strategies is uncertain in clinical practice. We designed this study to evaluate the accuracy of this parameter in predicting the fluid responsiveness of septic patients ventilated with low tidal volumes (TV) (6 ml kg(-1)).
  
  
  METHODS
  Forty patients after the resuscitation phase of severe sepsis and septic shock who were mechanically ventilated with 6 ml kg(-1) were included. The ΔPP was obtained automatically at baseline and after a standardized fluid challenge (7 ml kg(-1)). Patients whose cardiac output increased by more than 15% were considered fluid responders. The predictive values of ΔPP and static variables [right atrial pressure (RAP) and pulmonary artery occlusion pressure (PAOP)] were evaluated through a receiver operating characteristic (ROC) curve analysis.
  
  
  RESULTS
  Thirty-four patients had characteristics consistent with acute lung injury or acute respiratory distress syndrome and were ventilated with high levels of PEEP [median (inter-quartile range) 10.0 (10.0-13.5)]. Nineteen patients were considered fluid responders. The RAP and PAOP significantly increased, and ΔPP significantly decreased after volume expansion. The ΔPP performance [ROC curve area: 0.91 (0.82-1.0)] was better than that of the RAP [ROC curve area: 0.73 (0.59-0.90)] and pulmonary artery occlusion pressure [ROC curve area: 0.58 (0.40-0.76)]. The ROC curve analysis revealed that the best cut-off for ΔPP was 6.5%, with a sensitivity of 0.89, specificity of 0.90, positive predictive value of 0.89, and negative predictive value of 0.90.
  
  
  CONCLUSIONS
  Automatized ΔPP accurately predicted fluid responsiveness in septic patients ventilated with low TV.
authors.affiliation: Departamento de Anestesiologia, Dor e Terapia Intensiva, Universidade Federal de São Paulo, Rua Napoleão de Barros 715-5° andar, 04024-900 São Paulo, SP, Brazil. flaviogrf@yahoo.com.br
authors.forename: F G R
authors.initials: FG
authors.lastname: Freitas
authors.forename: A T
authors.initials: AT
authors.lastname: Bafi
authors.forename: A P M
authors.initials: AP
authors.lastname: Nascente
authors.forename: M
authors.initials: M
authors.lastname: Assunção
authors.forename: B
authors.initials: B
authors.lastname: Mazza
authors.forename: L C P
authors.initials: LC
authors.lastname: Azevedo
authors.forename: F R
authors.initials: FR
authors.lastname: Machado
mesh_terms: D055371:Acute Lung Injury / Q000517:prevention & control*; D000368:Aged; D000399:Air Pressure; D001331:Automation; D001794:Blood Pressure / Q000502:physiology*; D002302:Cardiac Output / Q000502:physiology; D005260:Female; D005440:Fluid Therapy; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011669:Pulmonary Wedge Pressure / Q000502:physiology; D012372:ROC Curve; D012121:Respiration, Artificial / Q000009:adverse effects / Q000379:methods*; D015656:Respiratory Mechanics / Q000502:physiology; D012151:Resuscitation; D018805:Sepsis / Q000503:physiopathology* / Q000628:therapy*; D012772:Shock, Septic / Q000503:physiopathology / Q000628:therapy; D013990:Tidal Volume / Q000502:physiology