Intensive Care Medicine

, Volume 36, Issue 3, pp 496–503

The influence of the airway driving pressure on pulsed pressure variation as a predictor of fluid responsiveness

  • Laurent Muller
  • Guillaume Louart
  • Philippe-Jean Bousquet
  • Damien Candela
  • Lana Zoric
  • Jean-Emmanuel de La Coussaye
  • Samir Jaber
  • Jean-Yves Lefrant
Original

DOI: 10.1007/s00134-009-1686-y

Cite this article as:
Muller, L., Louart, G., Bousquet, P. et al. Intensive Care Med (2010) 36: 496. doi:10.1007/s00134-009-1686-y

Abstract

Objective

Assessing pulse pressure variation (PPV) to predict fluid responsiveness in mechanically ventilated patients with tidal volume (VT) and the impact of VT and airway driving pressure (Pplat − PEEP) on the ability of PPV for predicting fluid responsiveness.

Design

Prospective interventional study.

Setting

ICU of a university hospital.

Patients

Fifty-seven mechanically ventilated and sedated patients with acute circulatory failure requiring cardiac output (CO) measurement.

Intervention

Fluid challenge was given in patients with signs of hypoperfusion (oliguria <0.5 ml kg−1 h−1, attempt to decrease vasopressor infusion rate). Fluid responsiveness was defined as an increase in the stroke index (SI) ≥15%. Receiver-operating characteristic (ROC) curves were generated for PPV and central venous pressure (CVP).

Results

The stroke index was increased ≥15% in 41 patients (71%). At baseline, CVP was lower and PPV was higher in responders. The areas under the ROC curves of PPV and CVP were 0.77 (95% CI 0.65–0.90) and 0.76 (95% CI 0.64–0.89), respectively (P = 0.93). The best cutoff values of PPV and CVP were 7% and 9 mmHg, respectively. In 30 out of 41 responders, PPV was <13%. Using a polytomic logistic regression (Pplat − PEEP) was the sole independent factor associated with a PPV value <13% in responders. In these responders, (Pplat − PEEP) was ≤20 cmH2O.

Conclusion

In patients mechanically ventilated with low VT, PPV values <13% do not rule out fluid responsiveness, especially when (Pplat − PEEP) is ≤20 cmH2O.

Keywords

Critical careFluid challenge

Copyright information

© Copyright jointly hold by Springer and ESICM 2009

Authors and Affiliations

  • Laurent Muller
    • 1
    • 2
    • 3
  • Guillaume Louart
    • 1
    • 2
    • 3
  • Philippe-Jean Bousquet
    • 2
    • 4
  • Damien Candela
    • 1
    • 2
    • 3
  • Lana Zoric
    • 1
    • 2
    • 3
  • Jean-Emmanuel de La Coussaye
    • 1
    • 2
    • 3
  • Samir Jaber
    • 5
  • Jean-Yves Lefrant
    • 1
    • 2
    • 3
  1. 1.Division Anesthésie Réanimation Douleur UrgencesGroupe Hospitalo-Universitaire Caremeau, CHU NîmesNîmes Cedex 9France
  2. 2.Faculté de MédecineUniversité Montpellier 1MontpellierFrance
  3. 3.Equipe d’Accueil 2992, Laboratoire de Physiologie Cardiovasculaire et d’Anesthésie Expérimentale, Faculté de MédecineGroupe Hospitalo-Universitaire CaremeauNîmes Cedex 9France
  4. 4.Département d’Information médicaleCHU NîmesNîmes Cedex 9France
  5. 5.Service d’Anesthésie Réanimation B (SAR B)MontpellierFrance