Intensive Care Medicine

, Volume 35, Issue 6, pp 1004–1010

Pulse pressure variations adjusted by alveolar driving pressure to assess fluid responsiveness

  • Fabrice Vallée
  • Jean Christophe M. Richard
  • Arnaud Mari
  • Thomas Gallas
  • Eric Arsac
  • Pascale Sanchez Verlaan
  • Benjamin Chousterman
  • Kamran Samii
  • Michèle Genestal
  • Olivier Fourcade
Original

DOI: 10.1007/s00134-009-1478-4

Cite this article as:
Vallée, F., Richard, J.C.M., Mari, A. et al. Intensive Care Med (2009) 35: 1004. doi:10.1007/s00134-009-1478-4

Abstract

Objective

To evaluate the ability of ∆PP/∆P [pulse pressure variations (∆PP) adjusted by alveolar pressure variations (∆P = Pplat-PEEPtot)] in predicting fluid responsiveness, to compare its accuracy to that of ∆PP used alone and to evaluate the influence of tidal volume (Vt) on these two indices.

Design

Prospective study.

Setting

A 22-bed general intensive care unit (ICU).

Patients

Eighty-four surgical or medical ventilated patients requiring fluid challenge.

Intervention

A 6 ml/kg colloid fluid challenge in 30 min.

Measurements and results

Hemodynamic measurements taken before and after fluid challenge. Patients separated into responders and nonresponders according to a 15% increase in their cardiac output. Thirty-nine patients found to be responders and 45 nonresponders. ∆PP/∆P and ∆PP were both higher in responders than in nonresponders. ∆PP/∆P was a better predictor of fluid responsiveness than ∆PP, especially for patients ventilated with Vt ≥ 8 ml/kg [area under the curve (AUC) 0.88 (0.77–0.98) versus 0.75 (0.60–0.89), P < 0.01)]. In this population ∆PP/∆P higher than 0.9 predicted fluid response with positive predictive value of 87% and negative predictive value of 78%. Overall ∆PP and ∆PP/∆P reliability was poor for patients ventilated with Vt < 8 ml/kg [AUC 0.63 (0.45–0.81) and 0.72 (0.55–0.88), respectively].

Conclusion

In this mixed ICU population ∆PP adjusted by ∆P is a simple index which outperforms ∆PP for patients ventilated with Vt ≥ 8 ml/kg. However, correcting ∆PP by ∆P still fails to predict fluid response reliably in patients ventilated with low tidal volume.

Keywords

Fluid responsivenessDelta PPPositive respiratory pressureARDS

Supplementary material

134_2009_1478_MOESM1_ESM.doc (220 kb)
Supplementary material 1 (DOC 220 kb)

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Fabrice Vallée
    • 1
    • 4
  • Jean Christophe M. Richard
    • 2
  • Arnaud Mari
    • 1
  • Thomas Gallas
    • 1
  • Eric Arsac
    • 1
  • Pascale Sanchez Verlaan
    • 1
  • Benjamin Chousterman
    • 3
  • Kamran Samii
    • 1
  • Michèle Genestal
    • 1
  • Olivier Fourcade
    • 1
  1. 1.Pôle Anesthésie et Réanimation, Unité de Réanimation Polyvalente de PurpanGRCB 48, Université Paul SabatierToulouseFrance
  2. 2.Service de Réanimation MédicaleHôpital Charles NicolleRouenFrance
  3. 3.Département d’Anesthésie –Réanimation -SMURHôpital Lariboisière, AP-HP & Université Paris 7 Denis Diderot Equipe d’Accueil EA 322ParisFrance
  4. 4.Réanimation polyvalente adulteHôpital Purpan, Place du Dr BaylacToulouse Cedex 9France