Pulse pressure variations to guide fluid therapy in donors: A multicentric echocardiographic observational study

• Published in: Journal of critical care 2014-08, Vol.29 (4), p.489-494
• Main Authors: Cinotti, Raphaël, MD, Roquilly, Antoine, MD, Mahé, Pierre-Joachim, MD, Feuillet, Fanny, Yehia, Ahiem, MD, Belliard, Guillaume, MD, Lejus, Corinne, MD, PhD, Blanloeil, Yvonnick, MD, PhD, Teboul, Jean-Louis, MD, PhD, Asehnoune, Karim, MD, PhD
• Format: Article
• Language: English
• Subjects: Adult; Blood Flow Velocity - physiology; Blood Pressure - physiology; Brain death; Brain Death - physiopathology; Brain injuries; Coma; Critical Care; Demography; Diabetes; Donors; Echocardiography; Female; Flow velocity; Fluid Therapy - methods; Fluids; Heart Rate - physiology; Humans; Male; Middle Aged; Prospective Studies; Respiration, Artificial; Sensitivity and Specificity; Shock, Septic - physiopathology; Shock, Septic - therapy; Stroke; Studies; Systole; Tissue and Organ Harvesting - statistics & numerical data; Ventilation; Ventricular Function, Right - physiology; ΔPP
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2014.03.027

Abstract Purpose Preload responsiveness parameters could be useful in the hemodynamic management of septic shock. Methods A multicentric prospective echocardiographic observational study was conducted from March 2009 to August 2011. Clinically brain-dead subjects were included. Pulse pressure variations (ΔPPs) were recorded. Cardiac index, variation of the maximum flow velocity of aortic systolic blood flow, and right ventricular function parameters were evaluated via transthoracic echocardiography. Fluid responsiveness was defined by at least 15% cardiac index increase, 30 minutes after a 500-mL colloid solution infusion. The number of organs harvested was recorded. Results Twenty-five subjects were included. Pulse pressure variation could not discriminate responders (n = 15) from nonresponders (n = 10). The best ΔPP threshold (20%) could discriminate responders with a sensitivity of 100% and a specificity of 40%. Variation of the maximum flow velocity of aortic systolic blood flow, tricuspid annular plane systolic excursion, and right ventricle dilation could not discriminate responders from nonresponders. Eighteen subjects underwent organ harvesting. The number of organs harvested was higher in responders (3.5 [3-5]) than in nonresponders (2.5 [2-3]; P = .03). Conclusions A ΔPP threshold of 13% is insufficient to guide volume expansion in donors. The best threshold is 20%. Fluid responsiveness monitoring could enhance organ harvesting.