Changes in pulse pressure variation to assess preload responsiveness in mechanically ventilated patients with spontaneous breathing activity: an observational study.
cardiac output
echocardiography
passive leg raising
preload responsiveness
pulse pressure variation
tidal volume challenge
Journal
British journal of anaesthesia
ISSN: 1471-6771
Titre abrégé: Br J Anaesth
Pays: England
ID NLM: 0372541
Informations de publication
Date de publication:
10 2021
10 2021
Historique:
received:
08
02
2021
revised:
03
05
2021
accepted:
28
05
2021
pubmed:
12
7
2021
medline:
16
11
2021
entrez:
11
7
2021
Statut:
ppublish
Résumé
Pulse pressure variation (PPV) is not reliable in predicting preload responsiveness in patients receiving mechanical with spontaneous breathing (SB) activity. We hypothesised that an increase in PPV after a tidal volume (V This prospective observational study was performed in two ICUs and included patients receiving mechanical ventilation with SB, for whom the treating physician decided to test preload responsiveness. Transthoracic echocardiography was used to measure the velocity-time integral (VTI) of the left ventricular outflow tract. Patients exhibiting an increase in VTI ≥12% during PLR were defined as PLR+ patients (or preload responders). Then, a TVC was performed by increasing V Fifty-four patients (Simplified Acute Physiology Score II: 60 (25) ventilated with a V In patients undergoing mechanical ventilation with SB activity, PPV does not predict preload responsiveness. However, the decrease in PPV during PLR and the increase in PPV during a TVC help discriminate preload responders from non-responders with moderate accuracy. NCT04369027 (ClinicalTrials.gov).
Sections du résumé
BACKGROUND
Pulse pressure variation (PPV) is not reliable in predicting preload responsiveness in patients receiving mechanical with spontaneous breathing (SB) activity. We hypothesised that an increase in PPV after a tidal volume (V
METHODS
This prospective observational study was performed in two ICUs and included patients receiving mechanical ventilation with SB, for whom the treating physician decided to test preload responsiveness. Transthoracic echocardiography was used to measure the velocity-time integral (VTI) of the left ventricular outflow tract. Patients exhibiting an increase in VTI ≥12% during PLR were defined as PLR+ patients (or preload responders). Then, a TVC was performed by increasing V
RESULTS
Fifty-four patients (Simplified Acute Physiology Score II: 60 (25) ventilated with a V
CONCLUSION
In patients undergoing mechanical ventilation with SB activity, PPV does not predict preload responsiveness. However, the decrease in PPV during PLR and the increase in PPV during a TVC help discriminate preload responders from non-responders with moderate accuracy.
CLINICAL TRIAL REGISTRATION
NCT04369027 (ClinicalTrials.gov).
Identifiants
pubmed: 34246460
pii: S0007-0912(21)00364-0
doi: 10.1016/j.bja.2021.05.034
pii:
doi:
Banques de données
ClinicalTrials.gov
['NCT04369027']
Types de publication
Journal Article
Multicenter Study
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
532-538Informations de copyright
Copyright © 2021 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.
Déclaration de conflit d'intérêts
Declarations of interest OH is a member of the medical advisory board of AMOMED. J-LT and XM are members of the medical advisory board of Pulsion/Getinge.