Intensive Care Medicine

, Volume 34, Issue 5, pp 888–894

Respiratory variations in aortic blood flow predict fluid responsiveness in ventilated children

  • Philippe Durand
  • Laurent Chevret
  • Sandrine Essouri
  • Vincent Haas
  • Denis Devictor
Pediatric Original

DOI: 10.1007/s00134-008-1021-z

Cite this article as:
Durand, P., Chevret, L., Essouri, S. et al. Intensive Care Med (2008) 34: 888. doi:10.1007/s00134-008-1021-z

Abstract

Objective

To investigate whether respiratory variations in aortic blood flow velocity (ΔVpeak ao), systolic arterial pressure (ΔPS) and pulse pressure (ΔPP) could accurately predict fluid responsiveness in ventilated children.

Design and setting

Prospective study in a 18-bed pediatric intensive care unit.

Patients

Twenty-six children [median age 28.5 (16–44) months] with preserved left ventricular (LV) function.

Intervention

Standardized volume expansion (VE).

Measurements and main results

Analysis of aortic blood flow by transthoracic pulsed-Doppler allowed LV stroke volume measurement and on-line ΔVpeak ao calculation. The VE-induced increase in LV stroke volume was > 15% in 18 patients (responders) and < 15% in 8 (non-responders). Before VE, the ΔVpeak ao in responders was higher than that in non-responders [19% (12.1–26.3) vs. 9% (7.3–11.8), p = 0.001], whereas ΔPP and ΔPS did not significantly differ between groups. The prediction of fluid responsiveness was higher with ΔVpeak ao [ROC curve area 0.85 (95% IC 0.99–1.8), p = 0.001] than with ΔPS (0.64) or ΔPP (0.59). The best cut-off for ΔVpeak ao was 12%, with sensitivity, specificity, and positive and negative predictive values of 81.2%, 85.7%, 93% and 66.6%, respectively. A positive linear correlation was found between baseline ΔVpeak ao and VE-induced gain in stroke volume (rho = 0.68, p = 0.001).

Conclusions

While respiratory variations in aortic blood flow velocity measured by pulsed Doppler before VE accurately predict the effects of VE, ΔPS and ΔPP are of little value in ventilated children.

Keywords

Aortic blood flow velocityCardiac outputSeptic shockMechanical ventilationFluid responsivenessChildren

Abbreviations

CVP

central venous pressure

DAP

diastolic arterial pressure, ΔPS respiratory changes in systolic arterial pressure

ΔPP

respiratory changes in arterial pulse pressure

ΔVpeak

ao respiratory changes in aortic peak velocity

HR

heart rate

LV

left ventricle

LVETi

left ventricular ejection time index

MAP

mean arterial pressure

NE

norepinephrine, NR non-responders to VE

R

responders to VE

SAP

systolic arterial pressure

VE

volume expansion

PAPO

pulmonary artery occlusion pressure

VTIao

aortic velocity time integral

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Philippe Durand
    • 1
  • Laurent Chevret
    • 1
  • Sandrine Essouri
    • 1
  • Vincent Haas
    • 1
  • Denis Devictor
    • 1
  1. 1.Pediatric Intensive Care UnitBicêtre HospitalLe Kremlin BicêtreFrance