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Arterial pressure changes during the Valsalva maneuver to predict fluid responsiveness in spontaneously breathing patients

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Abstract

Objective

To evaluate whether arterial pressure response during a Valsalva maneuver could predict fluid responsiveness in spontaneously breathing patients.

Design and setting

Prospective clinical study in a 17-bed multidisciplinary intensive care unit.

Patients

Thirty patients without mechanical ventilation and equipped with a radial arterial catheter for whom the decision to give fluids was taken due to suspected hypovolemia.

Intervention

A 10-s Valsalva maneuver was performed before and after volume expansion (VE). Patients were classified as responders if stroke volume index (SVi) increased ≥15% after VE.

Measurements and results

Pulse pressure changes during the Valsalva maneuver (∆VPP) were calculated as the difference between maximal pulse pressure during phase 1 and minimal pulse pressure during phase 2 of the Valsalva maneuver divided by the mean of the two values and expressed as a percentage. Valsalva changes in systolic pressure (∆VSP) were calculated in similar way. SVi changes induced by VE was correlated with baseline values of ∆VPP and ∆VSP (r 2 = 0.71 and r 2 = 0.60; P < 0.0001, respectively), and with VE-induced changes in ∆VPP and ∆VSP (r 2 = 0.56 and r 2 = 0.44; P < 0.0001 and P < 0.001, respectively). A ∆VPP value of 52% and ∆VSP of 30% predicted fluid responsiveness with a sensitivity of 91% and 73% and a specificity of 95 and 90%, respectively.

Conclusions

Arterial response during the Valsalva maneuver is a feasible tool for predicting fluid responsiveness in patients without mechanical ventilatory support.

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Acknowledgments

Part of this work was presented in the twenty-eighth International Symposium on Intensive Care and Emergency Medicine, 2008, Brussels, Belgium, and published as abstract [38].

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Authors and Affiliations

  1. Servicio de Cuidados Críticos y Urgencias, Unidad de Investigación Experimental, Hospital del SAS Jerez, C/ Circunvalación s/n, 11407, Jerez de la Frontera, Spain

    Manuel Ignacio Monge García, Anselmo Gil Cano & Juan Carlos Díaz Monrové

Authors
  1. Manuel Ignacio Monge García
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  2. Anselmo Gil Cano
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  3. Juan Carlos Díaz Monrové
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Correspondence to Manuel Ignacio Monge García.

Additional information

This article is discussed in the editorial available at: doi:10.1007/s00134-008-1294-2.

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Arterial pressure changes during the Valsalva maneuver to predict fluid responsiveness in spontaneously breathing patients (DOC 1223 kb)

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Monge García, M.I., Gil Cano, A. & Díaz Monrové, J.C. Arterial pressure changes during the Valsalva maneuver to predict fluid responsiveness in spontaneously breathing patients. Intensive Care Med 35, 77–84 (2009). https://doi.org/10.1007/s00134-008-1295-1

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  • DOI: https://doi.org/10.1007/s00134-008-1295-1

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