title: Decrease in pulse pressure and stroke volume variations after mini-fluid challenge accurately predicts fluid responsiveness†.
abstract: BACKGROUND
  Dynamic indices, such as pulse pressure variation (PPV), are inaccurate predictors of fluid responsiveness in mechanically ventilated patients with low tidal volume. This study aimed to test whether changes in continuous cardiac index (CCI), PPV, and stroke volume variation (SVV) after a mini-fluid challenge (100 ml of fluid during 1 min) could predict fluid responsiveness in these patients.
  
  
  METHODS
  We prospectively studied 49 critically ill, deeply sedated, and mechanically ventilated patients (tidal volume <8 ml kg(-1) of ideal body weight) without cardiac arrhythmias, in whom a fluid challenge was indicated because of circulatory failure. The CCI, SVV (PiCCO™; Pulsion), and PPV (MP70™; Philips) were measured before and after 100 ml of colloid infusion during 1 min, and then after the additional infusion of 400 ml during 14 min. Responders were defined as subjects with a ≥15% increase in cardiac index (transpulmonary thermodilution) after the full (500 ml) fluid challenge. Areas under the receiver operating characteristic curves (AUCs) and the grey zones were determined for changes in CCI (ΔCCI100), SVV (ΔSVV100), and PPV (ΔPPV100) after 100 ml fluid challenge.
  
  
  RESULTS
  Twenty-two subjects were responders. The ΔCCI100 predicted fluid responsiveness with an AUC of 0.78. The grey zone was large and included 67% of subjects. The ΔSVV100 and ΔPPV100 predicted fluid responsiveness with AUCs of 0.91 and 0.92, respectively. Grey zones were small, including ≤12% of subjects for both indices.
  
  
  CONCLUSIONS
  The ΔSVV100 and ΔPPV100 predict fluid responsiveness accurately and better than ΔCCI100 (PiCCO™; Pulsion) in patients with circulatory failure and ventilated with low volumes.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Centre Hospitalier du Dr. Schaffner de Lens, France mallatjihad@gmail.com.
authors.forename: J
authors.initials: J
authors.lastname: Mallat
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Centre Hospitalier du Dr. Schaffner de Lens, France.
authors.forename: M
authors.initials: M
authors.lastname: Meddour
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Centre Hospitalier du Dr. Schaffner de Lens, France.
authors.forename: E
authors.initials: E
authors.lastname: Durville
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Centre Hospitalier du Dr. Schaffner de Lens, France.
authors.forename: M
authors.initials: M
authors.lastname: Lemyze
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Centre Hospitalier du Dr. Schaffner de Lens, France.
authors.forename: F
authors.initials: F
authors.lastname: Pepy
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Centre Hospitalier du Dr. Schaffner de Lens, France.
authors.forename: J
authors.initials: J
authors.lastname: Temime
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Centre Hospitalier du Dr. Schaffner de Lens, France.
authors.forename: N
authors.initials: N
authors.lastname: Vangrunderbeeck
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Centre Hospitalier du Dr. Schaffner de Lens, France.
authors.forename: L
authors.initials: L
authors.lastname: Tronchon
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Centre Hospitalier du Dr. Schaffner de Lens, France.
authors.forename: D
authors.initials: D
authors.lastname: Thevenin
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Centre Hospitalier Universitaire de Lille, France.
authors.forename: B
authors.initials: B
authors.lastname: Tavernier
mesh_terms: D000328:Adult; D000368:Aged; D019540:Area Under Curve; D001794:Blood Pressure / Q000502:physiology*; D002302:Cardiac Output / Q000502:physiology; D016638:Critical Illness; D005260:Female; D005440:Fluid Therapy / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results; D012121:Respiration, Artificial; D013318:Stroke Volume / Q000502:physiology*; D013990:Tidal Volume / Q000502:physiology
keywords: cardiac output; fluid therapy; goal-directed therapy; haemodynamics; monitoring; pulse pressure