title: The Changes in Pulse Pressure Variation or Stroke Volume Variation After a "Tidal Volume Challenge" Reliably Predict Fluid Responsiveness During Low Tidal Volume Ventilation.
abstract: Stroke volume variation and pulse pressure variation do not reliably predict fluid responsiveness during low tidal volume ventilation. We hypothesized that with transient increase in tidal volume from 6 to 8 mL/kg predicted body weight, that is, "tidal volume challenge," the changes in pulse pressure variation and stroke volume variation will predict fluid responsiveness.
  
  
  
  Prospective, single-arm study.
  
  
  
  Medical-surgical ICU in a university hospital.
  
  
  
  Adult patients with acute circulatory failure, having continuous cardiac output monitoring, and receiving controlled low tidal volume ventilation.
  
  
  
  The pulse pressure variation, stroke volume variation, and cardiac index were recorded at tidal volume 6 mL/kg predicted body weight and 1 minute after the "tidal volume challenge." The tidal volume was reduced back to 6 mL/kg predicted body weight, and a fluid bolus was given to identify fluid responders (increase in cardiac index > 15%). The end-expiratory occlusion test was performed at tidal volumes 6 and 8 mL/kg predicted body weight and after reducing tidal volume back to 6 mL/kg predicted body weight.
  
  
  
  Thirty measurements were obtained in 20 patients. The absolute change in pulse pressure variation and stroke volume variation after increasing tidal volume from 6 to 8 mL/kg predicted body weight predicted fluid responsiveness with areas under the receiver operating characteristic curves (with 95% CIs) being 0.99 (0.98-1.00) and 0.97 (0.92-1.00), respectively. The best cutoff values of the absolute change in pulse pressure variation and stroke volume variation after increasing tidal volume from 6 to 8 mL/kg predicted body weight were 3.5% and 2.5%, respectively. The pulse pressure variation, stroke volume variation, central venous pressure, and end-expiratory occlusion test obtained during tidal volume 6 mL/kg predicted body weight did not predict fluid responsiveness.
  
  
  
  The changes in pulse pressure variation or stroke volume variation obtained by transiently increasing tidal volume (tidal volume challenge) are superior to pulse pressure variation and stroke volume variation in predicting fluid responsiveness during low tidal volume ventilation.
authors.affiliation: 1Department of Anesthesiology, Critical Care and Pain, Tata Memorial Hospital, Mumbai, India. 2AP-HP, Hôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Service de réanimation médicale, Le Kremlin-Bicêtre, France.
authors.forename: Sheila Nainan
authors.initials: SN
authors.lastname: Myatra
authors.forename: Natesh R
authors.initials: NR
authors.lastname: Prabu
authors.forename: Jigeeshu Vasishtha
authors.initials: JV
authors.lastname: Divatia
authors.forename: Xavier
authors.initials: X
authors.lastname: Monnet
authors.forename: Atul Prabhakar
authors.initials: AP
authors.lastname: Kulkarni
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Teboul
mesh_terms: D000368:Aged; D019540:Area Under Curve; D001794:Blood Pressure; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D012121:Respiration, Artificial / Q000379:methods; D012772:Shock, Septic / Q000503:physiopathology* / Q000628:therapy*; D013318:Stroke Volume; D013990:Tidal Volume