Pulse pressure variation to predict fluid responsiveness in spontaneously breathing patients: tidal vs. forced inspiratory breathing.
We evaluated whether pulse pressure variation can predict fluid responsiveness in spontaneously breathing patients. Fifty-nine elective thoracic surgical patients were studied before induction of general anaesthesia. After volume expansion with hydroxyethyl starch 6 ml.kg(-1) , patients were defined as responders by a ≥ 15% increase in the cardiac index. Haemodynamic variables were measured before and after volume expansion and pulse pressure variations were calculated during tidal breathing and during forced inspiratory breathing. Median (IQR [range]) pulse pressure variation during forced inspiratory breathing was significantly higher in responders (n = 29) than in non-responders (n = 30) before volume expansion (18.2 (IQR 14.7-18.2 [9.3-31.3])% vs. 10.1 (IQR 8.3-12.6 [4.8-21.1])%, respectively, p < 0.001). The receiver-operating characteristic curve revealed that pulse pressure variation during forced inspiratory breathing could predict fluid responsiveness (area under the curve 0.910, p < 0.0001). Pulse pressure variation measured during forced inspiratory breathing can be used to guide fluid management in spontaneously breathing patients.
Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea.
D M
DM
Hong
J M
JM
Lee
J H
JH
Seo
J J
JJ
Min
Y
Y
Jeon
J H
JH
Bahk
D001794:Blood Pressure / Q000502:physiology*; D002302:Cardiac Output / Q000502:physiology; D005260:Female; D005440:Fluid Therapy; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000008:administration & dosage; D007320:Inspiratory Capacity / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D010952:Plasma Substitutes / Q000008:administration & dosage; D011237:Predictive Value of Tests; D012372:ROC Curve; D012016:Reference Values; D012119:Respiration; D012121:Respiration, Artificial / Q000379:methods*; D013318:Stroke Volume / Q000502:physiology; D013990:Tidal Volume / Q000502:physiology*
D006895:Hydroxyethyl Starch Derivatives; D010952:Plasma Substitutes