Inspiratory effort impacts the accuracy of pulse pressure variations for fluid responsiveness prediction in mechanically ventilated patients with spontaneous breathing activity: a prospective cohort study.

Acute circulatory failure Fluid responsiveness Inspiratory effort Pulse pressure variation

Journal

Annals of intensive care
ISSN: 2110-5820
Titre abrégé: Ann Intensive Care
Pays: Germany
ID NLM: 101562873

Informations de publication

Date de publication:
17 Aug 2023
Historique:
received: 16 02 2023
accepted: 01 08 2023
medline: 18 8 2023
pubmed: 18 8 2023
entrez: 17 8 2023
Statut: epublish

Résumé

Pulse pressure variation (PPV) is unreliable in predicting fluid responsiveness (FR) in patients receiving mechanical ventilation with spontaneous breathing activity. Whether PPV can be valuable for predicting FR in patients with low inspiratory effort is unknown. We aimed to investigate whether PPV can be valuable in patients with low inspiratory effort. This prospective study was conducted in an intensive care unit at a university hospital and included acute circulatory failure patients receiving volume-controlled ventilation with spontaneous breathing activity. Hemodynamic measurements were collected before and after a fluid challenge. The degree of inspiratory effort was assessed using airway occlusion pressure (P Among the 189 included patients, 53 (28.0%) were defined as responders. A PPV > 9.5% enabled to predict FR with an AUROC of 0.79 (0.67-0.83) in the whole population. The predictive performance of PPV differed significantly in groups stratified by the median value of P PPV is reliable in predicting FR in patients who received controlled ventilation with low spontaneous effort, defined as P

Sections du résumé

BACKGROUND BACKGROUND
Pulse pressure variation (PPV) is unreliable in predicting fluid responsiveness (FR) in patients receiving mechanical ventilation with spontaneous breathing activity. Whether PPV can be valuable for predicting FR in patients with low inspiratory effort is unknown. We aimed to investigate whether PPV can be valuable in patients with low inspiratory effort.
METHODS METHODS
This prospective study was conducted in an intensive care unit at a university hospital and included acute circulatory failure patients receiving volume-controlled ventilation with spontaneous breathing activity. Hemodynamic measurements were collected before and after a fluid challenge. The degree of inspiratory effort was assessed using airway occlusion pressure (P
RESULTS RESULTS
Among the 189 included patients, 53 (28.0%) were defined as responders. A PPV > 9.5% enabled to predict FR with an AUROC of 0.79 (0.67-0.83) in the whole population. The predictive performance of PPV differed significantly in groups stratified by the median value of P
CONCLUSIONS CONCLUSIONS
PPV is reliable in predicting FR in patients who received controlled ventilation with low spontaneous effort, defined as P

Identifiants

DOI: 10.1186/s13613-023-01167-0 PMID: 37592166 PMC: PMC10435426
pubmed: 37592166
doi: 10.1186/s13613-023-01167-0
pii: 10.1186/s13613-023-01167-0
pmc: PMC10435426
doi:

Banques de données

ClinicalTrials.gov
['NCT04802668']

Types de publication

Journal Article

Langues

eng

Pagination

72

Subventions

Organisme : Clinical Science and Technology Specific Projects of Jiangsu Province
ID : BE2020786
Organisme : Key Technology Research and Development Program of Shandong
ID : 2022YFC2504405
Organisme : National Natural Science Foundation of China
ID : 81870066
Organisme : National Natural Science Foundation of China
ID : 82270083
Organisme : National Natural Science Foundation of China
ID : 81901945
Organisme : the Second Level Talents of the "333 High Level Talents Training Project" in the sixth phase in Jiangsu
ID : LGY2022025

Informations de copyright

© 2023. La Société de Réanimation de Langue Francaise = The French Society of Intensive Care (SRLF).

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Auteurs

Hui Chen (H)

Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, No. 87, Dingjiaqiao Road, Gulou District, Nanjing, 210009, People's Republic of China.
Department of Critical Care Medicine, The First Affiliated Hospital of Soochow University, Soochow University, No. 899 Pinghai Road, Suzhou, 215000, People's Republic of China.

Meihao Liang (M)

Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, No. 87, Dingjiaqiao Road, Gulou District, Nanjing, 210009, People's Republic of China.
Department of Critical Care Medicine, Changsha central hospital, University of South China, No. 161, South Shaoshan Road, Changsha, 410000, Hunan, People's Republic of China.

Yuanchao He (Y)

Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, No. 87, Dingjiaqiao Road, Gulou District, Nanjing, 210009, People's Republic of China.
Department of Critical Care Medicine, Wuhan first hospital of Hubei Province, No 215 Zhongshan Avenue, Qiaokou District, Wuhan, 430000, People's Republic of China.

Jean-Louis Teboul (JL)

Service de médecine intensive-réanimation, Hôpital de Bicêtre, Université Paris-Saclay, AP-HP, Inserm UMR S_999, Le Kremlin-Bicêtre, France.

Qin Sun (Q)

Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, No. 87, Dingjiaqiao Road, Gulou District, Nanjing, 210009, People's Republic of China.

Jianfen Xie (J)

Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, No. 87, Dingjiaqiao Road, Gulou District, Nanjing, 210009, People's Republic of China.

Yi Yang (Y)

Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, No. 87, Dingjiaqiao Road, Gulou District, Nanjing, 210009, People's Republic of China.

Haibo Qiu (H)

Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, No. 87, Dingjiaqiao Road, Gulou District, Nanjing, 210009, People's Republic of China.

Ling Liu (L)

Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, No. 87, Dingjiaqiao Road, Gulou District, Nanjing, 210009, People's Republic of China. liulingdoctor@126.com.

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