title: Prevalence of Ventilatory Conditions for Dynamic Fluid Responsiveness Prediction in 2 Tertiary Intensive Care Units.
abstract: BACKGROUND
  Dynamic parameters for fluid responsiveness obtained from heart-lung interaction during invasive mechanical ventilation require specific conditions not always present in intensive care unit (ICU) patients. The aim of this study was to examine the prevalence of these conditions in critically ill patients.
  
  
  METHODS
  We conducted a prospective observational study in 2 medical-surgical ICUs. We evaluated whether it would be possible to measure dynamic indices of fluid responsiveness when fluid expansion was administered. We recorded whether the patients were in controlled invasive mechanical ventilation with tidal volume >8 mL/kg and without arrhythmias. The proportion of patients who fulfilled these conditions was recorded. A post hoc subgroup analyses by terciles of Simplified Acute Physiology Score 3 (SAPS3) were performed.
  
  
  RESULTS
  A total of 826 fluid challenges were undertaken in 424 patients during the study. The use of controlled mechanical ventilation with tidal volume > 8 mL/kg and without arrhythmias occurred in only 2.9% of the patients at the time of fluid challenge episodes. There was an increase in the prevalence of these conditions as the severity of the patients also increased: lower tercile of SAPS3 (0%), intermediate tercile (2%), and higher tercile (6.9%; P < .01 Pearson chi-square test).
  
  
  CONCLUSIONS
  Respiratory-dependent dynamic parameters for predicting fluid responsiveness in ICU may have restricted applicability in daily practice, even in more severe patients, due to low prevalence of required conditions.
authors.affiliation: Emergency Medicine Discipline, Intensive Care Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil Education and Research Institute, Hospital Sírio Libanês, São Paulo, Brazil.
authors.forename: Pedro V
authors.initials: PV
authors.lastname: Mendes
authors.affiliation: Education and Research Institute, Hospital Sírio Libanês, São Paulo, Brazil.
authors.forename: Bruno N
authors.initials: BN
authors.lastname: Rodrigues
authors.affiliation: Emergency Medicine Discipline, Intensive Care Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil Department of Surgery, Intensive Care Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Leandro C
authors.initials: LC
authors.lastname: Miranda
authors.affiliation: Emergency Medicine Discipline, Intensive Care Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil Intensive Care Unit, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil.
authors.forename: Fernando G
authors.initials: FG
authors.lastname: Zampieri
authors.affiliation: Education and Research Institute, Hospital Sírio Libanês, São Paulo, Brazil.
authors.forename: Eduardo L
authors.initials: EL
authors.lastname: Queiroz
authors.affiliation: Education and Research Institute, Hospital Sírio Libanês, São Paulo, Brazil.
authors.forename: Guilherme
authors.initials: G
authors.lastname: Schettino
authors.affiliation: Emergency Medicine Discipline, Intensive Care Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil Education and Research Institute, Hospital Sírio Libanês, São Paulo, Brazil.
authors.forename: Luciano C
authors.initials: LC
authors.lastname: Azevedo
authors.affiliation: Emergency Medicine Discipline, Intensive Care Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil Education and Research Institute, Hospital Sírio Libanês, São Paulo, Brazil.
authors.forename: Marcelo
authors.initials: M
authors.lastname: Park
authors.affiliation: Emergency Medicine Discipline, Intensive Care Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil Education and Research Institute, Hospital Sírio Libanês, São Paulo, Brazil leandrout@hotmail.com.
authors.forename: Leandro U
authors.initials: LU
authors.lastname: Taniguchi
mesh_terms: D000368:Aged; D016638:Critical Illness / Q000628:therapy; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000379:methods*; D012128:Respiratory Distress Syndrome / Q000503:physiopathology*; D013990:Tidal Volume / Q000502:physiology
keywords: fluid therapy; hemodynamics; mechanical ventilators; patient monitoring