Academic Journal
Slope analysis for the prediction of fluid responsiveness by a stepwise PEEP elevation recruitment maneuver in mechanically ventilated patients
| العنوان: | Slope analysis for the prediction of fluid responsiveness by a stepwise PEEP elevation recruitment maneuver in mechanically ventilated patients |
|---|---|
| المؤلفون: | Sylvain Vallier, Jean-Baptiste Bouchet, Olivier Desebbe, Camille Francou, Darren Raphael, Bernard Tardy, Laurent Gergele, Jérôme Morel |
| المصدر: | BMC Anesthesiology, Vol 22, Iss 1, Pp 1-12 (2022) |
| بيانات النشر: | BMC |
| سنة النشر: | 2022 |
| المجموعة: | Directory of Open Access Journals: DOAJ Articles |
| مصطلحات موضوعية: | Lung recruitment maneuver, Fluid responsiveness, Central venous pressure, Pulse pressure, Hemodynamics, Mechanical ventilation, Anesthesiology, RD78.3-87.3 |
| الوصف: | Objective Assessment of fluid responsiveness is problematic in intensive care unit patients. Lung recruitment maneuvers (LRM) can be used as a functional test to predict fluid responsiveness. We propose a new test to predict fluid responsiveness in mechanically ventilated patients by analyzing the variations in central venous pressure (CVP) and systemic arterial parameters during a prolonged sigh breath LRM without the use of a cardiac output measuring device. Design Prospective observational cohort study. Setting Intensive Care Unit, Saint-Etienne University Central Hospital. Patients Patients under mechanical ventilation, equipped with invasive arterial blood pressure, CVP, pulse contour analysis (PICCO™), requiring volume expansion, with no right ventricular dysfunction. Interventions. None. Measurements and main results CVP, systemic arterial parameters and stroke volume (SV) were recorded during prolonged LRM followed by a 500 mL fluid expansion to asses fluid responsiveness. 25 patients were screened and 18 patients analyzed. 9 patients were responders to volume expansion and 9 were not. Evaluation of hemodynamic parameters suggested the use of a linear regression model. Slopes for systolic arterial pressure, pulse pressure (PP), CVP and SV were all significantly different between responders and non-responders during the pressure increase phase of LRM (STEP-UP) (p = 0.022, p = 0.014, p = 0.006 and p = 0.038, respectively). PP and CVP slopes during STEP-UP were strongly predictive of fluid responsiveness with an AUC of 0.926 (95% CI, 0.78 to 1.00), sensitivity = 100%, specificity = 89% and an AUC = 0.901 (95% CI, 0.76 to 1.00), sensibility = 78%, specificity = 100%, respectively. Combining sensitivity of PP and specificity of CVP, prediction of fluid responsiveness can be achieved with 100% sensitivity and 100% specificity (AUC = 0.96; 95% CI, 0.90 to 1.00). One patient showed inconclusive values using the grey zone approach (5.5%). Conclusions In patients under mechanical ventilation with no right ... |
| نوع الوثيقة: | article in journal/newspaper |
| اللغة: | English |
| تدمد: | 1471-2253 |
| Relation: | https://doi.org/10.1186/s12871-021-01544-x; https://doaj.org/toc/1471-2253; https://doaj.org/article/1b4258a435a04f12bf60667baf919ee6 |
| DOI: | 10.1186/s12871-021-01544-x |
| الاتاحة: | https://doi.org/10.1186/s12871-021-01544-x https://doaj.org/article/1b4258a435a04f12bf60667baf919ee6 |
| رقم الانضمام: | edsbas.F22D6F7C |
| قاعدة البيانات: | BASE |
Full Text Finder | تدمد: | 14712253 |
|---|---|
| DOI: | 10.1186/s12871-021-01544-x |