Slope analysis for the prediction of fluid responsiveness by a stepwise PEEP elevation recruitment maneuver in mechanically ventilated patients
Abstract 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 analyz...
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| Format: | Article |
| Language: | English |
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BMC
2022-01-01
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| Series: | BMC Anesthesiology |
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| Online Access: | https://doi.org/10.1186/s12871-021-01544-x |
| _version_ | 1798033412378853376 |
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| author | Sylvain Vallier Jean-Baptiste Bouchet Olivier Desebbe Camille Francou Darren Raphael Bernard Tardy Laurent Gergele Jérôme Morel |
| author_facet | Sylvain Vallier Jean-Baptiste Bouchet Olivier Desebbe Camille Francou Darren Raphael Bernard Tardy Laurent Gergele Jérôme Morel |
| author_sort | Sylvain Vallier |
| collection | DOAJ |
| description | Abstract 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 heart dysfunction, the association of PP and CVP slope analysis during a prolonged sigh breath LRM seems to offer a very promising method for prediction of fluid responsiveness without the use and associated cost of a cardiac output measurement device. Trial registration NCT04304521 , IRBN902018/CHUSTE. Registered 11 March 2020, Fluid responsiveness predicted by a stepwise PEEP elevation recruitment maneuver in mechanically ventilated patients (STEP-PEEP) |
| first_indexed | 2024-04-11T20:30:04Z |
| format | Article |
| id | doaj.art-1b4258a435a04f12bf60667baf919ee6 |
| institution | Directory Open Access Journal |
| issn | 1471-2253 |
| language | English |
| last_indexed | 2024-04-11T20:30:04Z |
| publishDate | 2022-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Anesthesiology |
| spelling | doaj.art-1b4258a435a04f12bf60667baf919ee62022-12-22T04:04:31ZengBMCBMC Anesthesiology1471-22532022-01-0122111210.1186/s12871-021-01544-xSlope analysis for the prediction of fluid responsiveness by a stepwise PEEP elevation recruitment maneuver in mechanically ventilated patientsSylvain Vallier0Jean-Baptiste Bouchet1Olivier Desebbe2Camille Francou3Darren Raphael4Bernard Tardy5Laurent Gergele6Jérôme Morel7Department of Anesthesiology and Intensive Care, Elsan Alpes-Belledonne ClinicDepartment of Anesthesiology and Intensive Care, Etienne University Hospital, Jean-Monnet UniversityDepartment of Anesthesiology and Intensive Care, Ramsay Sante Sauvegarde ClinicDepartment of Anesthesiology and Intensive Care, Etienne University Hospital, Jean-Monnet UniversityDepartment of Anesthesiology & Perioperative Care, University of CaliforniaCentre d’Investigation Clinique - CIC 1408, Etienne University Hospital, Jean-Monnet UniversityDepartment of Anesthesiology and Intensive Care, Ramsay Sante HPL ClinicDepartment of Anesthesiology and Intensive Care, Etienne University Hospital, Jean-Monnet UniversityAbstract 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 heart dysfunction, the association of PP and CVP slope analysis during a prolonged sigh breath LRM seems to offer a very promising method for prediction of fluid responsiveness without the use and associated cost of a cardiac output measurement device. Trial registration NCT04304521 , IRBN902018/CHUSTE. Registered 11 March 2020, Fluid responsiveness predicted by a stepwise PEEP elevation recruitment maneuver in mechanically ventilated patients (STEP-PEEP)https://doi.org/10.1186/s12871-021-01544-xLung recruitment maneuverFluid responsivenessCentral venous pressurePulse pressureHemodynamicsMechanical ventilation |
| spellingShingle | Sylvain Vallier Jean-Baptiste Bouchet Olivier Desebbe Camille Francou Darren Raphael Bernard Tardy Laurent Gergele Jérôme Morel Slope analysis for the prediction of fluid responsiveness by a stepwise PEEP elevation recruitment maneuver in mechanically ventilated patients BMC Anesthesiology Lung recruitment maneuver Fluid responsiveness Central venous pressure Pulse pressure Hemodynamics Mechanical ventilation |
| title | Slope analysis for the prediction of fluid responsiveness by a stepwise PEEP elevation recruitment maneuver in mechanically ventilated patients |
| title_full | Slope analysis for the prediction of fluid responsiveness by a stepwise PEEP elevation recruitment maneuver in mechanically ventilated patients |
| title_fullStr | Slope analysis for the prediction of fluid responsiveness by a stepwise PEEP elevation recruitment maneuver in mechanically ventilated patients |
| title_full_unstemmed | Slope analysis for the prediction of fluid responsiveness by a stepwise PEEP elevation recruitment maneuver in mechanically ventilated patients |
| title_short | Slope analysis for the prediction of fluid responsiveness by a stepwise PEEP elevation recruitment maneuver in mechanically ventilated patients |
| title_sort | slope analysis for the prediction of fluid responsiveness by a stepwise peep elevation recruitment maneuver in mechanically ventilated patients |
| topic | Lung recruitment maneuver Fluid responsiveness Central venous pressure Pulse pressure Hemodynamics Mechanical ventilation |
| url | https://doi.org/10.1186/s12871-021-01544-x |
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