Pulse pressure variation : driving airway pressure ratio to predict fluid responsiveness in mechanically-ventilated patients
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Data di Pubblicazione:
2015
Citazione:
Pulse pressure variation : driving airway pressure ratio to predict fluid responsiveness in mechanically-ventilated patients / M..B.A. Marino, M. Ferrari, D. Chiumello, A. Protti, L. Gattinoni. ((Intervento presentato al 26. convegno SMART meeting tenutosi a Milano nel 2015.
Abstract:
Introduction: Accuracy of Pulse Pressure Variation (PPV) in predicting fluid responsiveness
during mechanical ventilation is higher when tidal volume is ≥8ml/kg [Michard, 2005] but lower
when tidal volume is <8 ml/kg [De Backer, 2005] of predicted body weight (PBW) possibly
because small tidal volumes induce only minimal changes in intra-thoracic pressure, cardiac preload
and afterload.
Objective: The aim of this study was to evaluate whether PPV divided by Driving (the difference
between end-inspiratory and end-expiratory) Airway Pressure (Paw) accurately predicts fluid
responsiveness during mechanical ventilation with tidal volume between 6 and 10 ml/kg PBW.
Methods: Nineteen critically ill patients ventilated with tidal volume between 6 and 10 ml/kg PBW
were enrolled. PPV and Paw were recorded before a fluid challenge. Patients with an increase in
stroke volume ≥15% across the fluid challenge were classified as “responders”.
Results: Six patients were “responders”. PPV/Paw was significantly higher in responders than in
non-responders (1,3 [0,9-1,8] vs. 0,7 [0,4-0,8]; p 0,003). PPV/Paw >0.9 predicted fluid
responsiveness with sensibility 83%, specificity 100%, positive predictive value 100% and negative
predictive value 93%.
Figure 1. Receiver-operating characteristic (ROC) curve of PPV/Paw. Area under ROC curve was
0,94 denoting very high diagnostic accuracy.
Conclusions: PPV/Paw accurately predicts fluid responsiveness during mechanical ventilation
with tidal volume between 6 and 10 ml/kg PBW.
Tipologia IRIS:
14 - Intervento a convegno non pubblicato
Elenco autori:
M..B.A. Marino, M. Ferrari, D. Chiumello, A. Protti, L. Gattinoni
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