title: Pulse pressure variations to guide fluid therapy in donors: a multicentric echocardiographic observational study.
abstract: OBJECTIVE
  Preload responsiveness parameters could be useful in the hemodynamic management of septic shock.
  
  
  METHODS
  A multicentric prospective echocardiographic observational study was conducted from March 2009 to August 2011. Clinically brain-dead subjects were included. Pulse pressure variations (ΔPPs) were recorded. Cardiac index, variation of the maximum flow velocity of aortic systolic blood flow, and right ventricular function parameters were evaluated via transthoracic echocardiography. Fluid responsiveness was defined by at least 15% cardiac index increase, 30 minutes after a 500-mL colloid solution infusion. The number of organs harvested was recorded.
  
  
  RESULTS
  Twenty-five subjects were included. Pulse pressure variation could not discriminate responders (n=15) from nonresponders (n=10). The best ΔPP threshold (20%) could discriminate responders with a sensitivity of 100% and a specificity of 40%. Variation of the maximum flow velocity of aortic systolic blood flow, tricuspid annular plane systolic excursion, and right ventricle dilation could not discriminate responders from nonresponders. Eighteen subjects underwent organ harvesting. The number of organs harvested was higher in responders (3.5 [3-5]) than in nonresponders (2.5 [2-3]; P=.03).
  
  
  CONCLUSIONS
  A ΔPP threshold of 13% is insufficient to guide volume expansion in donors. The best threshold is 20%. Fluid responsiveness monitoring could enhance organ harvesting.
authors.affiliation: Service Anesthésie-Réanimation chirurgicale, Hôtel Dieu, 1 place Alexis Ricordeau, CHU de Nantes, Nantes 44093 cedex, France. Electronic address: raphael.cinotti@chu-nantes.fr.
authors.forename: Raphaël
authors.initials: R
authors.lastname: Cinotti
authors.affiliation: Service Anesthésie-Réanimation chirurgicale, Hôtel Dieu, 1 place Alexis Ricordeau, CHU de Nantes, Nantes 44093 cedex, France; Laboratoire UPRES EA 3826 «Thérapeutiques cliniques et expérimentales des Infections», Faculté de médecine, Université de Nantes, Nantes, France. Electronic address: antoine.roquilly@chu-nantes.fr.
authors.forename: Antoine
authors.initials: A
authors.lastname: Roquilly
authors.affiliation: Service Anesthésie-Réanimation chirurgicale, Hôtel Dieu, 1 place Alexis Ricordeau, CHU de Nantes, Nantes 44093 cedex, France. Electronic address: pierrejoachim.mahe@chu-nantes.fr.
authors.forename: Pierre-Joachim
authors.initials: PJ
authors.lastname: Mahé
authors.affiliation: EA 4275 "Biostatistique, recherche clinique et mesures subjectives en santé," Faculté de Pharmacie, Université de Nantes, 1 rue Gaston Veil, 44035 Nantes Cedex 1, France; Plateforme de Biométrie, Cellule de promotion de la recherche clinique, CHU de Nantes, Nantes, France. Electronic address: fanny.feuillet@univ-nantes.fr.
authors.forename: Fanny
authors.initials: F
authors.lastname: Feuillet
authors.affiliation: Service de Réanimation médicale, Centre Hospitalier Départemental Les Oudairies, 85925 La Roche-sur-Yon Cedex 9, France. Electronic address: ahiem.yehia@chd-vendee.fr.
authors.forename: Ahiem
authors.initials: A
authors.lastname: Yehia
authors.affiliation: Service de Réanimation, Centre Hospitalier de Bretagne Sud, 27 rue du docteur Lettry, 56100 Lorient, France. Electronic address: g.belliard@ch-bretagne-sud.fr.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Belliard
authors.affiliation: Service Anesthésie-Réanimation chirurgicale, Hôtel Dieu, 1 place Alexis Ricordeau, CHU de Nantes, Nantes 44093 cedex, France. Electronic address: corinne.lejus@chu-nantes.fr.
authors.forename: Corinne
authors.initials: C
authors.lastname: Lejus
authors.affiliation: Service Anesthésie-Réanimation chirurgicale, Hôpital Guillaume et René Laennec, 1 place Alexis Ricordeau, CHU Nantes, Nantes 44093 cedex, France. Electronic address: yvonnick.blanloeil@chu-nantes.fr.
authors.forename: Yvonnick
authors.initials: Y
authors.lastname: Blanloeil
authors.affiliation: Service de Réanimation médicale, Centre Hospitalier Universitaire de Bicêtre, 78 rue du Général Leclerc, 94275 Le Kremlin-Bicêtre, France. Electronic address: jlteboul.bicetre@invivo.edu.
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Teboul
authors.affiliation: Service Anesthésie-Réanimation chirurgicale, Hôtel Dieu, 1 place Alexis Ricordeau, CHU de Nantes, Nantes 44093 cedex, France; Laboratoire UPRES EA 3826 «Thérapeutiques cliniques et expérimentales des Infections», Faculté de médecine, Université de Nantes, Nantes, France. Electronic address: karim.asehnoune@chu-nantes.fr.
authors.forename: Karim
authors.initials: K
authors.lastname: Asehnoune
mesh_terms: D000328:Adult; D001783:Blood Flow Velocity / Q000502:physiology; D001794:Blood Pressure / Q000502:physiology*; D001926:Brain Death / Q000503:physiopathology*; D004452:Echocardiography; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012121:Respiration, Artificial; D012680:Sensitivity and Specificity; D012772:Shock, Septic / Q000503:physiopathology / Q000628:therapy*; D013599:Systole; D020858:Tissue and Organ Harvesting / Q000706:statistics & numerical data; D016278:Ventricular Function, Right / Q000502:physiology
keywords: Brain death; Brain injuries; Donors; Echocardiography; ΔPP