OBJECTIVE: To evaluate the ability of DeltaPP/DeltaP [pulse pressure variations (DeltaPP) adjusted by alveolar pressure variations (DeltaP = Pplat-PEEPtot)] in predicting fluid responsiveness, to compare its accuracy to that of DeltaPP used alone and to evaluate the influence of tidal volume (Vt) on these two indices. DESIGN: Prospective study. SETTING: A 22-bed general intensive care unit (ICU). PATIENTS: Eighty-four surgical or medical ventilated patients requiring fluid challenge. INTERVENTION: A 6 ml/kg colloid fluid challenge in 30 min. MEASUREMENTS AND RESULTS: Hemodynamic measurements taken before and after fluid challenge. Patients separated into responders and nonresponders according to a 15% increase in their cardiac output. Thirty-nine patients found to be responders and 45 nonresponders. DeltaPP/DeltaP and DeltaPP were both higher in responders than in nonresponders. DeltaPP/DeltaP was a better predictor of fluid responsiveness than PP, especially for patients ventilated with Vt > or = 8 ml/kg [area under the curve (AUC) 0.88 (0.77-0.98) versus 0.75 (0.60-0.89), P < 0.01)]. In this population DeltaPP/DeltaP higher than 0.9 predicted fluid response with positive predictive value of 87% and negative predictive value of 78%. Overall DeltaPP and DeltaPP/DeltaP reliability was poor for patients ventilated with Vt < 8 ml/kg [AUC 0.63 (0.45-0.81) and 0.72 (0.55-0.88), respectively]. CONCLUSION: In this mixed ICU population PP adjusted by P is a simple index which outperforms DeltaPP for patients ventilated with Vt > or = 8 ml/kg. However, correcting DeltaPP by DeltaP still fails to predict fluid response reliably in patients ventilated with low tidal volume.
OBJECTIVE: To evaluate the ability of DeltaPP/DeltaP [pulse pressure variations (DeltaPP) adjusted by alveolar pressure variations (DeltaP = Pplat-PEEPtot)] in predicting fluid responsiveness, to compare its accuracy to that of DeltaPP used alone and to evaluate the influence of tidal volume (Vt) on these two indices. DESIGN: Prospective study. SETTING: A 22-bed general intensive care unit (ICU). PATIENTS: Eighty-four surgical or medical ventilated patients requiring fluid challenge. INTERVENTION: A 6 ml/kg colloid fluid challenge in 30 min. MEASUREMENTS AND RESULTS: Hemodynamic measurements taken before and after fluid challenge. Patients separated into responders and nonresponders according to a 15% increase in their cardiac output. Thirty-nine patients found to be responders and 45 nonresponders. DeltaPP/DeltaP and DeltaPP were both higher in responders than in nonresponders. DeltaPP/DeltaP was a better predictor of fluid responsiveness than PP, especially for patients ventilated with Vt > or = 8 ml/kg [area under the curve (AUC) 0.88 (0.77-0.98) versus 0.75 (0.60-0.89), P < 0.01)]. In this population DeltaPP/DeltaP higher than 0.9 predicted fluid response with positive predictive value of 87% and negative predictive value of 78%. Overall DeltaPP and DeltaPP/DeltaP reliability was poor for patients ventilated with Vt < 8 ml/kg [AUC 0.63 (0.45-0.81) and 0.72 (0.55-0.88), respectively]. CONCLUSION: In this mixed ICU population PP adjusted by P is a simple index which outperforms DeltaPP for patients ventilated with Vt > or = 8 ml/kg. However, correcting DeltaPP by DeltaP still fails to predict fluid response reliably in patients ventilated with low tidal volume.
Authors: Antoine Vieillard-Baron; Karim Chergui; Roch Augarde; Sebastien Prin; Bernard Page; Alain Beauchet; François Jardin Journal: Am J Respir Crit Care Med Date: 2003-07-17 Impact factor: 21.405
Authors: Herbert P Wiedemann; Arthur P Wheeler; Gordon R Bernard; B Taylor Thompson; Douglas Hayden; Ben deBoisblanc; Alfred F Connors; R Duncan Hite; Andrea L Harabin Journal: N Engl J Med Date: 2006-05-21 Impact factor: 91.245
Authors: Daniel De Backer; Sarah Heenen; Michael Piagnerelli; Marc Koch; Jean-Louis Vincent Journal: Intensive Care Med Date: 2005-03-08 Impact factor: 17.440
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