JOURNAL ARTICLE

Pulse pressure variations adjusted by alveolar driving pressure to assess fluid responsiveness

Fabrice Vallée, Jean Christophe M Richard, Arnaud Mari, Thomas Gallas, Eric Arsac, Pascale Sanchez Verlaan, Benjamin Chousterman, Kamran Samii, Michèle Genestal, Olivier Fourcade
Intensive Care Medicine 2009, 35 (6): 1004-10
19347330

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.

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