Pulse pressure variation and prediction of fluid responsiveness in patients ventilated with low tidal volume
Autor(a) principal: | |
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Data de Publicação: | 2012 |
Outros Autores: | , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Institucional da UFRGS |
Texto Completo: | http://hdl.handle.net/10183/108658 |
Resumo: | OBJECTIVE: To determine the utility of pulse pressure variation (DRESPPP) in predicting fluid responsiveness in patients ventilated with low tidal volumes (VT) and to investigate whether a lower DRESPPP cut-off value should be used when patients are ventilated with low tidal volumes. METHOD: This cross-sectional observational study included 37 critically ill patients with acute circulatory failure who required fluid challenge. The patients were sedated and mechanically ventilated with a VT of 6-7 ml/kg ideal body weight, which was monitored with a pulmonary artery catheter and an arterial line. The mechanical ventilation and hemodynamic parameters, including DRESPPP, were measured before and after fluid challenge with 1,000 ml crystalloids or 500 ml colloids. Fluid responsiveness was defined as an increase in the cardiac index of at least 15%. ClinicalTrial.gov: NCT01569308. RESULTS: A total of 17 patients were classified as responders. Analysis of the area under the ROC curve (AUC) showed that the optimal cut-off point for DRESPPP to predict fluid responsiveness was 10% (AUC = 0.74). Adjustment of the DRESPPP to account for driving pressure did not improve the accuracy (AUC = 0.76). A DRESPPP$10% was a better predictor of fluid responsiveness than central venous pressure (AUC = 0.57) or pulmonary wedge pressure (AUC = 051). Of the 37 patients, 25 were in septic shock. The AUC for DRESPPP$10% to predict responsiveness in patients with septic shock was 0.84 (sensitivity, 78%; specificity, 93%). CONCLUSION: The parameter DRESPPP has limited value in predicting fluid responsiveness in patients who are ventilated with low tidal volumes, but a DRESPPP.10% is a significant improvement over static parameters. A DRESPPP$10% may be particularly useful for identifying responders in patients with septic shock. |
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Costa, Clarisse Daniele Alves de OliveiraFriedman, GilbertoVieira, Silvia Regina RiosFialkow, Léa2014-12-25T02:10:06Z20121807-5932http://hdl.handle.net/10183/108658000874070OBJECTIVE: To determine the utility of pulse pressure variation (DRESPPP) in predicting fluid responsiveness in patients ventilated with low tidal volumes (VT) and to investigate whether a lower DRESPPP cut-off value should be used when patients are ventilated with low tidal volumes. METHOD: This cross-sectional observational study included 37 critically ill patients with acute circulatory failure who required fluid challenge. The patients were sedated and mechanically ventilated with a VT of 6-7 ml/kg ideal body weight, which was monitored with a pulmonary artery catheter and an arterial line. The mechanical ventilation and hemodynamic parameters, including DRESPPP, were measured before and after fluid challenge with 1,000 ml crystalloids or 500 ml colloids. Fluid responsiveness was defined as an increase in the cardiac index of at least 15%. ClinicalTrial.gov: NCT01569308. RESULTS: A total of 17 patients were classified as responders. Analysis of the area under the ROC curve (AUC) showed that the optimal cut-off point for DRESPPP to predict fluid responsiveness was 10% (AUC = 0.74). Adjustment of the DRESPPP to account for driving pressure did not improve the accuracy (AUC = 0.76). A DRESPPP$10% was a better predictor of fluid responsiveness than central venous pressure (AUC = 0.57) or pulmonary wedge pressure (AUC = 051). Of the 37 patients, 25 were in septic shock. The AUC for DRESPPP$10% to predict responsiveness in patients with septic shock was 0.84 (sensitivity, 78%; specificity, 93%). CONCLUSION: The parameter DRESPPP has limited value in predicting fluid responsiveness in patients who are ventilated with low tidal volumes, but a DRESPPP.10% is a significant improvement over static parameters. A DRESPPP$10% may be particularly useful for identifying responders in patients with septic shock.application/pdfengClinics. São Paulo. Vol. 67, no. 7 (Jul. 2012), p. 773–778Débito cardíacoVolume de ventilação pulmonarPressão arterialRespiração artificialCardiac outputPulse pressure variationFluid responsivenessLow tidal volumePulse pressure variation and prediction of fluid responsiveness in patients ventilated with low tidal volumeinfo:eu-repo/semantics/articleinfo:eu-repo/semantics/otherinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da UFRGSinstname:Universidade Federal do Rio Grande do Sul (UFRGS)instacron:UFRGSORIGINAL000874070.pdf000874070.pdfTexto completo (inglês)application/pdf266007http://www.lume.ufrgs.br/bitstream/10183/108658/1/000874070.pdf5c9f2029e010ca262672fe5b72bb7e7dMD51TEXT000874070.pdf.txt000874070.pdf.txtExtracted Texttext/plain30220http://www.lume.ufrgs.br/bitstream/10183/108658/2/000874070.pdf.txte074adfd1767b4475d4ae7d6551ce613MD52THUMBNAIL000874070.pdf.jpg000874070.pdf.jpgGenerated Thumbnailimage/jpeg2007http://www.lume.ufrgs.br/bitstream/10183/108658/3/000874070.pdf.jpgb3d40094e8a11f0a6fe52f1fe0d8139eMD5310183/1086582018-10-22 09:32:30.213oai:www.lume.ufrgs.br:10183/108658Repositório de PublicaçõesPUBhttps://lume.ufrgs.br/oai/requestopendoar:2018-10-22T12:32:30Repositório Institucional da UFRGS - Universidade Federal do Rio Grande do Sul (UFRGS)false |
dc.title.pt_BR.fl_str_mv |
Pulse pressure variation and prediction of fluid responsiveness in patients ventilated with low tidal volume |
title |
Pulse pressure variation and prediction of fluid responsiveness in patients ventilated with low tidal volume |
spellingShingle |
Pulse pressure variation and prediction of fluid responsiveness in patients ventilated with low tidal volume Costa, Clarisse Daniele Alves de Oliveira Débito cardíaco Volume de ventilação pulmonar Pressão arterial Respiração artificial Cardiac output Pulse pressure variation Fluid responsiveness Low tidal volume |
title_short |
Pulse pressure variation and prediction of fluid responsiveness in patients ventilated with low tidal volume |
title_full |
Pulse pressure variation and prediction of fluid responsiveness in patients ventilated with low tidal volume |
title_fullStr |
Pulse pressure variation and prediction of fluid responsiveness in patients ventilated with low tidal volume |
title_full_unstemmed |
Pulse pressure variation and prediction of fluid responsiveness in patients ventilated with low tidal volume |
title_sort |
Pulse pressure variation and prediction of fluid responsiveness in patients ventilated with low tidal volume |
author |
Costa, Clarisse Daniele Alves de Oliveira |
author_facet |
Costa, Clarisse Daniele Alves de Oliveira Friedman, Gilberto Vieira, Silvia Regina Rios Fialkow, Léa |
author_role |
author |
author2 |
Friedman, Gilberto Vieira, Silvia Regina Rios Fialkow, Léa |
author2_role |
author author author |
dc.contributor.author.fl_str_mv |
Costa, Clarisse Daniele Alves de Oliveira Friedman, Gilberto Vieira, Silvia Regina Rios Fialkow, Léa |
dc.subject.por.fl_str_mv |
Débito cardíaco Volume de ventilação pulmonar Pressão arterial Respiração artificial |
topic |
Débito cardíaco Volume de ventilação pulmonar Pressão arterial Respiração artificial Cardiac output Pulse pressure variation Fluid responsiveness Low tidal volume |
dc.subject.eng.fl_str_mv |
Cardiac output Pulse pressure variation Fluid responsiveness Low tidal volume |
description |
OBJECTIVE: To determine the utility of pulse pressure variation (DRESPPP) in predicting fluid responsiveness in patients ventilated with low tidal volumes (VT) and to investigate whether a lower DRESPPP cut-off value should be used when patients are ventilated with low tidal volumes. METHOD: This cross-sectional observational study included 37 critically ill patients with acute circulatory failure who required fluid challenge. The patients were sedated and mechanically ventilated with a VT of 6-7 ml/kg ideal body weight, which was monitored with a pulmonary artery catheter and an arterial line. The mechanical ventilation and hemodynamic parameters, including DRESPPP, were measured before and after fluid challenge with 1,000 ml crystalloids or 500 ml colloids. Fluid responsiveness was defined as an increase in the cardiac index of at least 15%. ClinicalTrial.gov: NCT01569308. RESULTS: A total of 17 patients were classified as responders. Analysis of the area under the ROC curve (AUC) showed that the optimal cut-off point for DRESPPP to predict fluid responsiveness was 10% (AUC = 0.74). Adjustment of the DRESPPP to account for driving pressure did not improve the accuracy (AUC = 0.76). A DRESPPP$10% was a better predictor of fluid responsiveness than central venous pressure (AUC = 0.57) or pulmonary wedge pressure (AUC = 051). Of the 37 patients, 25 were in septic shock. The AUC for DRESPPP$10% to predict responsiveness in patients with septic shock was 0.84 (sensitivity, 78%; specificity, 93%). CONCLUSION: The parameter DRESPPP has limited value in predicting fluid responsiveness in patients who are ventilated with low tidal volumes, but a DRESPPP.10% is a significant improvement over static parameters. A DRESPPP$10% may be particularly useful for identifying responders in patients with septic shock. |
publishDate |
2012 |
dc.date.issued.fl_str_mv |
2012 |
dc.date.accessioned.fl_str_mv |
2014-12-25T02:10:06Z |
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http://hdl.handle.net/10183/108658 |
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1807-5932 |
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000874070 |
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http://hdl.handle.net/10183/108658 |
dc.language.iso.fl_str_mv |
eng |
language |
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dc.relation.ispartof.pt_BR.fl_str_mv |
Clinics. São Paulo. Vol. 67, no. 7 (Jul. 2012), p. 773–778 |
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