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.
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.
Authors: Xavier Monnet; Mario Rienzo; David Osman; Nadia Anguel; Christian Richard; Michael R Pinsky; Jean-Louis Teboul Journal: Crit Care Med Date: 2006-05 Impact factor: 7.598
Authors: Massimo Antonelli; Elie Azoulay; Marc Bonten; Jean Chastre; Giuseppe Citerio; Giorgio Conti; Daniel De Backer; François Lemaire; Herwig Gerlach; Goran Hedenstierna; Michael Joannidis; Duncan Macrae; Jordi Mancebo; Salvatore M Maggiore; Alexandre Mebazaa; Jean-Charles Preiser; Jerôme Pugin; Jan Wernerman; Haibo Zhang Journal: Intensive Care Med Date: 2010-01-28 Impact factor: 17.440