Can dynamic indicators help the prediction of fluid responsiveness in spontaneously breathing critically ill patients?

To investigate whether the respiratory changes in arterial pulse (DeltaPP) and in systolic pressure (DeltaSP) could predict fluid responsiveness in spontaneously breathing (SB) patients. Because changes in intrathoracic pressure during spontaneous breathing (SB) might be insufficient to modify loadi...

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Bibliographic Details
Published in:Intensive care medicine 2007-07, Vol.33 (7), p.1117-1124
Main Authors: SOUBRIER, Stéphane, SAULNIER, Fabienne, HUBERT, Hervé, DELOUR, Pierre, LENCI, Hélène, ONIMUS, Thierry, NSEIR, Saad, DUROCHER, Alain
Format: Article
Language:English
Subjects:
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Biological and medical sciences
Blood Pressure
Catheters
Clinical death. Palliative care. Organ gift and preservation
Critical Illness
Echocardiography
Emergency and intensive care: metabolism and nutrition disorders. Enteral and parenteral nutrition
Female
Fluid Therapy
Heart rate
Hemodynamics
Hospitals
Humans
Intensive care
Intensive care medicine
Male
Medical sciences
Middle Aged
Prospective Studies
Pulmonary arteries
Respiratory Physiological Phenomena
Sensitivity and Specificity
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Summary:To investigate whether the respiratory changes in arterial pulse (DeltaPP) and in systolic pressure (DeltaSP) could predict fluid responsiveness in spontaneously breathing (SB) patients. Because changes in intrathoracic pressure during spontaneous breathing (SB) might be insufficient to modify loading conditions of the ventricles, performances of indicators were also assessed during a forced respiratory maneuver. Prospective interventional study. A 34-bed university hospital medico-surgical ICU. Thirty-two SB patients with clinical signs of hemodynamic instability. A 500-ml volume expansion (VE). Cardiac index, assessed using transthoracic echocardiography, increased by at least 15% after VE in 19 patients (responders). At baseline, only dynamic indicators were higher in responders than in nonresponders (13+/-5% vs. 7+/-3%, p=0.003 for DeltaPP and 10+/-4% vs. 6+/-2%, p=0.002 for DeltaSP). Moreover, they significantly decreased after VE (11+/-5% to 6+/-4%, p
ISSN:0342-4642
1432-1238
DOI:10.1007/s00134-007-0644-9