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Accuracy of pulse pressure variations for fluid responsiveness prediction in mechanically ventilated patients with biphasic positive airway pressure mode

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Abstract

The accuracy of pulse pressure variation (PPV) to predict fluid responsiveness using pressure-controlled (PC) instead of volume-controlled modes is under debate. To specifically address this issue, we designed a study to evaluate the accuracy of PPV to predict fluid responsiveness in severe septic patients who were mechanically ventilated with biphasic positive airway pressure (BIPAP) PC-ventilation mode. 45 patients with sepsis or septic shock and who were mechanically ventilated with BIPAP mode and a target tidal volume of 7–8 ml/kg were included. PPV was automatically assessed at baseline and after a standard fluid challenge (Ringer’s lactate 500 ml). A 15% increase in stroke volume (SV) defined fluid responsiveness. The predictive value of PPV was evaluated through a receiver operating characteristic (ROC) curve analysis and “gray zone” statistical approach. 20 (44%) patients were considered fluid responders. We identified a significant relationship between PPV decrease after volume expansion and SV increase (spearman ρ = − 0.5, p < 0.001). The area under ROC curve for PPV was 0.71 (95%CI 0.56–0.87, p = 0.007). The best cut-off (based on Youden’s index) was 8%, with a sensitivity of 80% and specificity of 60%. Using a gray zone approach, we identified that PPV values comprised between 5 and 15% do not allow a reliable fluid responsiveness prediction. In critically ill septic patients ventilated under BIPAP mode, PPV appears to be an accurate method for fluid responsiveness prediction. However, PPV values comprised between 5 and 15% constitute a gray zone that does not allow a reliable fluid responsiveness prediction.

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Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

We thank Mr. Evan Meegan for linguistic corrections to the manuscript.

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Authors and Affiliations

  1. Service de Réanimation Polyvalente, Centre Hospitalier de Narbonne, Bd Dr Lacroix, 11100, Narbonne, France

    Benoît Bataille, David Le Moal, Thomas Renault, Pierre Cocquet & Jade de Selle

  2. Réanimation URM, Centre Hospitalier Universitaire, CHU Purpan, Place du Dr Baylac, 31059, Toulouse Cedex 9, France

    Stein Silva

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  1. Benoît Bataille
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Contributions

BB takes responsibility for the integrity of the data and the accuracy of the analysis. BB, JS, and PC contributed to the study concept and data acquisition; DM and TR contributed to the study design. BB and SS contributed to data analysis and interpretation, and writing of the manuscript. The full study protocol can be accessed by request to the corresponding authors.

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Correspondence to Benoît Bataille.

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Conflict of interest

We disclose no conflict of interest, past or future, from all the authors. Our work has not been funded by any source in addition to our regular and independent salary. We have no financial interest in the subject, in the materials or equipment used in the manuscript, or its competitors. All authors are in complete agreement with the contents of the manuscript.

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The study was approved by the institutional review board of Narbonne Hospital (Comité d’éthique local, centre hospitalier de Narbonne, SIFO-D2-2019).

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Written consent prior to enrolment or in permitted instances, delayed participant or legal surrogate written consent following enrolment was obtained.

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Bataille, B., Le Moal, D., Renault, T. et al. Accuracy of pulse pressure variations for fluid responsiveness prediction in mechanically ventilated patients with biphasic positive airway pressure mode. J Clin Monit Comput 36, 1479–1487 (2022). https://doi.org/10.1007/s10877-021-00789-8

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  • DOI: https://doi.org/10.1007/s10877-021-00789-8

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