BACKGROUND: Respiratory-induced pulse pressure variations obtained with an arterial line (ΔPP(ART)) indicate fluid responsiveness in mechanically ventilated patients. The Infinity® CNAP™ SmartPod® (Dräger Medical AG & Co. KG, Lübeck, Germany) provides noninvasive continuous beat-to-beat arterial blood pressure measurements and a near real-time pressure waveform. We hypothesized that respiratory-induced pulse pressure variations obtained with the CNAP system (ΔPP(CNAP)) predict fluid responsiveness as well as ΔPP(ART) predicts fluid responsiveness in mechanically ventilated patients during general anesthesia. METHODS: Thirty-five patients undergoing vascular surgery were studied after induction of general anesthesia. Stroke volume (SV) measured with the Vigileo™/FloTrac™ (Edwards Lifesciences, Irvine, CA), ΔPP(ART), and ΔPP(CNAP) were recorded before and after intravascular volume expansion (VE) (500 mL of 6% hydroxyethyl starch 130/0.4). Subjects were defined as responders if SV increased by ≥15% after VE. RESULTS: Twenty patients responded to VE and 15 did not. The correlation coefficient between ΔPP(ART) and ΔPP(CNAP) before VE was r = 0.90 (95% confidence interval [CI] = 0.84-0.96; P < 0.0001). Before VE, ΔPP(ART) and ΔPP(CNAP) were significantly higher in responders than in nonresponders (P < 0.0001). The values of ΔPP(ART) and ΔPP(CNAP) before VE were significantly correlated with the percent increase in SV induced by VE (respectively, r(2) = 0.50; P < 0.0001 and r(2) = 0.57; P < 0.0001). Before VE, a ΔPP(ART) >10% discriminated between responders and nonresponders with a sensitivity of 90% (95% CI = 69%-99%) and a specificity of 87% (95% CI = 60%-98%). The area under the receiver operating characteristic (ROC) curve was 0.957 ± 0.035 for ΔPP(ART). Before VE, a ΔPP(CNAP) >11% discriminated between responders and nonresponders with a sensitivity of 85% (95% CI = 62%-97%) and a specificity of 100% (95% CI = 78%-100%). The area under the ROC curve was 0.942 ± 0.040 for ΔPP(CNAP). There was no significant difference between the area under the ROC curve for ΔPP(ART) and ΔPP(CNAP). CONCLUSIONS: A value of ΔPP(CNAP) >11% has a sensitivity of at least 62% in predicting preload-dependent responders to VE in mechanically ventilated patients during general anesthesia.
BACKGROUND: Respiratory-induced pulse pressure variations obtained with an arterial line (ΔPP(ART)) indicate fluid responsiveness in mechanically ventilated patients. The Infinity® CNAP™ SmartPod® (Dräger Medical AG & Co. KG, Lübeck, Germany) provides noninvasive continuous beat-to-beat arterial blood pressure measurements and a near real-time pressure waveform. We hypothesized that respiratory-induced pulse pressure variations obtained with the CNAP system (ΔPP(CNAP)) predict fluid responsiveness as well as ΔPP(ART) predicts fluid responsiveness in mechanically ventilated patients during general anesthesia. METHODS: Thirty-five patients undergoing vascular surgery were studied after induction of general anesthesia. Stroke volume (SV) measured with the Vigileo™/FloTrac™ (Edwards Lifesciences, Irvine, CA), ΔPP(ART), and ΔPP(CNAP) were recorded before and after intravascular volume expansion (VE) (500 mL of 6% hydroxyethyl starch 130/0.4). Subjects were defined as responders if SV increased by ≥15% after VE. RESULTS: Twenty patients responded to VE and 15 did not. The correlation coefficient between ΔPP(ART) and ΔPP(CNAP) before VE was r = 0.90 (95% confidence interval [CI] = 0.84-0.96; P < 0.0001). Before VE, ΔPP(ART) and ΔPP(CNAP) were significantly higher in responders than in nonresponders (P < 0.0001). The values of ΔPP(ART) and ΔPP(CNAP) before VE were significantly correlated with the percent increase in SV induced by VE (respectively, r(2) = 0.50; P < 0.0001 and r(2) = 0.57; P < 0.0001). Before VE, a ΔPP(ART) >10% discriminated between responders and nonresponders with a sensitivity of 90% (95% CI = 69%-99%) and a specificity of 87% (95% CI = 60%-98%). The area under the receiver operating characteristic (ROC) curve was 0.957 ± 0.035 for ΔPP(ART). Before VE, a ΔPP(CNAP) >11% discriminated between responders and nonresponders with a sensitivity of 85% (95% CI = 62%-97%) and a specificity of 100% (95% CI = 78%-100%). The area under the ROC curve was 0.942 ± 0.040 for ΔPP(CNAP). There was no significant difference between the area under the ROC curve for ΔPP(ART) and ΔPP(CNAP). CONCLUSIONS: A value of ΔPP(CNAP) >11% has a sensitivity of at least 62% in predicting preload-dependent responders to VE in mechanically ventilated patients during general anesthesia.
Authors: Miguel Á Ibarra-Estrada; José A López-Pulgarín; Julio C Mijangos-Méndez; José L Díaz-Gómez; Guadalupe Aguirre-Avalos Journal: Crit Ultrasound J Date: 2015-06-26