Matthieu Biais1, Romain Lanchon, Musa Sesay, Lisa Le Gall, Bruno Pereira, Emmanuel Futier, Karine Nouette-Gaulain. 1. From the Department of Anesthesiology and Critical Care III, Bordeaux University Hospital, Bordeaux, France (M.B., R.L., M.S., L.L., K.N.-G.); INSERM, U1034, Biology of Cardiovascular Diseases, Pessac, France (M.B.); INSERM, U12-11, Laboratoire de Maladies Rares: Génétique et Métabolisme (MRGM) (K.N.-G), University of Bordeaux (M.B., K.N.-G), Bordeaux, France (K.N.-G); Biostatistics Unit (DRCI), Délégation Recherche Clinique and Innovation, CHU de Clermont-Ferrand - Villa annexe IFSI, Clermont-Ferrand cedex, France (B.P.); and Department of Perioperative Medicine, Anesthesiology and Critical Care, Estaing University Hospital, Clermont-Ferrand cedex 1, France (E.F.).
Abstract
BACKGROUND: Lung recruitment maneuver induces a decrease in stroke volume, which is more pronounced in hypovolemic patients. The authors hypothesized that the magnitude of stroke volume reduction through lung recruitment maneuver could predict preload responsiveness. METHODS: Twenty-eight mechanically ventilated patients with low tidal volume during general anesthesia were included. Heart rate, mean arterial pressure, stroke volume, and pulse pressure variations were recorded before lung recruitment maneuver (application of continuous positive airway pressure of 30 cm H2O for 30 s), during lung recruitment maneuver when stroke volume reached its minimal value, and before and after volume expansion (250 ml saline, 0.9%, infused during 10 min). Patients were considered as responders to fluid administration if stroke volume increased greater than or equal to 10%. RESULTS: Sixteen patients were responders. Lung recruitment maneuver induced a significant decrease in mean arterial pressure and stroke volume in both responders and nonresponders. Changes in stroke volume induced by lung recruitment maneuver were correlated with those induced by volume expansion (r = 0.56; P < 0.0001). A 30% decrease in stroke volume during lung recruitment maneuver predicted fluid responsiveness with a sensitivity of 88% (95% CI, 62 to 98) and a specificity of 92% (95% CI, 62 to 99). Pulse pressure variations more than 6% before lung recruitment maneuver discriminated responders with a sensitivity of 69% (95% CI, 41 to 89) and a specificity of 75% (95% CI, 42 to 95). The area under receiver operating curves generated for changes in stroke volume induced by lung recruitment maneuver (0.96; 95% CI, 0.81 to 0.99) was significantly higher than that for pulse pressure variations (0.72; 95% CI, 0.52 to 0.88; P < 0.05). CONCLUSIONS: The authors' study suggests that the magnitude of stroke volume decrease during lung recruitment maneuver could predict preload responsiveness in mechanically ventilated patients in the operating room.
BACKGROUND: Lung recruitment maneuver induces a decrease in stroke volume, which is more pronounced in hypovolemicpatients. The authors hypothesized that the magnitude of stroke volume reduction through lung recruitment maneuver could predict preload responsiveness. METHODS: Twenty-eight mechanically ventilated patients with low tidal volume during general anesthesia were included. Heart rate, mean arterial pressure, stroke volume, and pulse pressure variations were recorded before lung recruitment maneuver (application of continuous positive airway pressure of 30 cm H2O for 30 s), during lung recruitment maneuver when stroke volume reached its minimal value, and before and after volume expansion (250 ml saline, 0.9%, infused during 10 min). Patients were considered as responders to fluid administration if stroke volume increased greater than or equal to 10%. RESULTS: Sixteen patients were responders. Lung recruitment maneuver induced a significant decrease in mean arterial pressure and stroke volume in both responders and nonresponders. Changes in stroke volume induced by lung recruitment maneuver were correlated with those induced by volume expansion (r = 0.56; P < 0.0001). A 30% decrease in stroke volume during lung recruitment maneuver predicted fluid responsiveness with a sensitivity of 88% (95% CI, 62 to 98) and a specificity of 92% (95% CI, 62 to 99). Pulse pressure variations more than 6% before lung recruitment maneuver discriminated responders with a sensitivity of 69% (95% CI, 41 to 89) and a specificity of 75% (95% CI, 42 to 95). The area under receiver operating curves generated for changes in stroke volume induced by lung recruitment maneuver (0.96; 95% CI, 0.81 to 0.99) was significantly higher than that for pulse pressure variations (0.72; 95% CI, 0.52 to 0.88; P < 0.05). CONCLUSIONS: The authors' study suggests that the magnitude of stroke volume decrease during lung recruitment maneuver could predict preload responsiveness in mechanically ventilated patients in the operating room.
Authors: Hugues de Courson; Loic Ferrer; Grégoire Cane; Eric Verchère; Musa Sesay; Karine Nouette-Gaulain; Matthieu Biais Journal: Ann Intensive Care Date: 2019-10-11 Impact factor: 6.925
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