Arterial pressure changes during the Valsalva maneuver to predict fluid responsiveness in spontaneously breathing patients

García, Manuel Ignacio Monge; Cano, Anselmo Gil; Monrové, J.C. Díaz

doi:10.1007/s00134-008-1295-1

Cited by 61 publications

(32 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The search for predictive factors of fluid responsiveness in SB patients was justified, since fluid responsiveness occurred in only 43.5% of patients. Thus, as previously described in SB patients, VE does not consistently improve hemodynamics [4–8]. …”

Section: Discussionsupporting

confidence: 64%

“…Our results confirm that a transient increase in tidal volume due to a standardized DIM can increase ΔVF and ΔPP sensitivity for predicting responders to VE. The main strength of the specific DIM performed in this study is that it does not necessitate specific material such as a certain type of bed [9], spirometry transducers [8], or inspiratory threshold devices [23]. The main weakness of the maneuver is the lack of respiratory parameter measurements to control whether the inspiration strain is sufficient to increase venous return to the heart.…”

Section: Discussionmentioning

confidence: 99%

“…Dynamic indices, based on the analysis of SV preload dependence, have been validated to predict fluid responsiveness in mechanically ventilated patients [3]. However, only a few studies, yielding conflicting results, tested VE responsiveness indices in spontaneously breathing (SB) patients [4–8]. …”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Hemodynamic Changes during a Deep Inspiration Maneuver Predict Fluid Responsiveness in Spontaneously Breathing Patients

Preau

Dewavrin

Soland

et al. 2012

Cardiology Research and Practice

View full text Add to dashboard Cite

Objective. We hypothesized that the hemodynamic response to a deep inspiration maneuver (DIM) indicates fluid responsiveness in spontaneously breathing (SB) patients. Design. Prospective study. Setting. ICU of a general hospital. Patients. Consecutive nonintubated patients without mechanical ventilation, considered for volume expansion (VE). Intervention. We assessed hemodynamic status at baseline and after VE. Measurements and Main Results. We measured radial pulse pressure (PP) using an arterial catheter and peak velocity of femoral artery flow (VF) using continuous Doppler. Changes in PP and VF induced by a DIM (ΔPPdim and ΔVFdim) were calculated in 23 patients. ΔPPdim and ΔVFdim ≥12% predicted responders to VE with sensitivity of 90% and specificity of 100%. Conclusions. In a restricted population of SB patients with severe sepsis or acute pancreatitis, ΔPPdim and ΔVFdim are accurate indices for predicting fluid responsiveness. These results should be confirmed in a larger population before validating their use in current practice.

show abstract

Section: Discussionsupporting

confidence: 64%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Hemodynamic Changes during a Deep Inspiration Maneuver Predict Fluid Responsiveness in Spontaneously Breathing Patients

Preau

Dewavrin

Soland

et al. 2012

Cardiology Research and Practice

View full text Add to dashboard Cite

show abstract

“…Alternatively, one can require the patient to perform a deep inspiration [37] or Valsalva manoeuvre [38]. This is not to say that clinicians should ignore the presence of exaggerated cardiopulmonary interaction in this population.…”

Section: Arterial Side or Stroke Volume Based Methodsmentioning

confidence: 97%

Cardiopulmonary interactions and volume status assessment

Broccard

2012

J Clin Monit Comput

View full text Add to dashboard Cite

Assessment of the hemodynamics and volume status is an important daily task for physicians caring for critically ill patients. There is growing consensus in the critical care community that the "traditional" methods-e.g., central venous pressure or pulmonary artery occlusion pressure-used to assess volume status and fluid responsiveness are not well supported by evidence and can be misleading. Our purpose is to provide here an overview of the knowledge needed by ICU physicians to take advantage of mechanical cardiopulmonary interactions to assess volume responsiveness. Although not perfect, such dynamic assessment of fluid responsiveness can be helpful particularly in the passively ventilated patients. We discuss the impact of phasic changes in lung volume and intrathoracic pressure on the pulmonary and systemic circulation and on the heart function. We review how respirophasic changes on the venous side (great veins geometry) and arterial side (e.g., stroke volume/systolic blood pressure and surrogate signals) can be used to detect fluid responsiveness or hemodynamic alterations commonly encountered in the ICU. We review the physiological limitations of this approach.

show abstract

“…Unfortunately, these other indirect measures are less predictive than SVV and PPV. These other parameters derived from arterial pressure analysis include systolic pressure variation (SPV), aortic blood flow velocity recorded via esophageal Doppler ultrasound [59,60], pressure wave variation by pulse oximetry, aortic flow velocity time [61,62] and brachial flow variation time [63]. Interestingly, plethysmographic wave via pulse oximetry (Pplet) is a non-invasive dynamic parameter that mirrors arterial pulse pressure.…”

Section: Predicting Volume Responsivenessmentioning

confidence: 99%

Functional Hemodynamic Monitoring

Pinsky

2015

Critical Care Clinics

103

View full text Add to dashboard Cite

Functional hemodynamic monitoring is the assessment of the dynamic interactions of hemodynamic variables in response to a defined perturbation. Dynamic tissue O2 saturation (StO2) responses to complete stop flow conditions (vascular occlusion test), which can be created by measuring hand StO2 and occluding flow with a blood pressure cuff, assesses cardiovascular sufficiency and microcirculatory blood flow distribution. Recent interest in functional hemodynamic monitoring for the bedside assessment of cardiovascular insufficiency has heightened with the documentation of its accuracy in predicting volume responsiveness using a wide variety of monitoring devices both invasive and non-invasive and across multiple patient groups and clinical conditions. Accordingly, fluid responsiveness can be predicted in a quantities fashion by measuring as arterial pulse pressure variation, left ventricular stroke volume variation or their surrogates during positive pressure breathing or the change in cardiac output response to a passive leg raising maneuver. However, volume responsiveness, though important, reflects only part of the overall spectrum of functional physiological variables that can be measured to define physiologic state and monitor response to therapy.

show abstract

Arterial pressure changes during the Valsalva maneuver to predict fluid responsiveness in spontaneously breathing patients

Abstract: Arterial response during the Valsalva maneuver is a feasible tool for predicting fluid responsiveness in patients without mechanical ventilatory support.

Cited by 61 publications

References 37 publications

Hemodynamic Changes during a Deep Inspiration Maneuver Predict Fluid Responsiveness in Spontaneously Breathing Patients

Hemodynamic Changes during a Deep Inspiration Maneuver Predict Fluid Responsiveness in Spontaneously Breathing Patients

Cardiopulmonary interactions and volume status assessment

Functional Hemodynamic Monitoring

Contact Info

Product

Resources

About