End-Expiratory Occlusion Test Predicts Preload Responsiveness Independently of Positive End-Expiratory Pressure During Acute Respiratory Distress Syndrome

Silva, Serena; Jozwiak, Mathieu; Teboul, Jean‐Louis; Persichini, Romain; Richard, Christian; Monnet, Xavier

doi:10.1097/ccm.0b013e31828a2323

Cited by 59 publications

(50 citation statements)

References 32 publications

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“…2). In a study of patients with ARDS, the test remained valid at a PEEP level of 5 cmH 2 O as well as of 15 cmH 2 O [76]. The main limitation of the test is that it cannot be used in patients who are not intubated, and in patients who do not tolerate a 15-s respiratory hold (Table 2).…”

Section: End-expiratory Occlusion Test…mentioning

confidence: 99%

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Prediction of fluid responsiveness: an update

Monnet

Marik

Teboul

2016

Ann. Intensive Care

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427

336

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In patients with acute circulatory failure, the decision to give fluids or not should not be taken lightly. The risk of overzealous fluid administration has been clearly established. Moreover, volume expansion does not always increase cardiac output as one expects. Thus, after the very initial phase and/or if fluid losses are not obvious, predicting fluid responsiveness should be the first step of fluid strategy. For this purpose, the central venous pressure as well as other “static” markers of preload has been used for decades, but they are not reliable. Robust evidence suggests that this traditional use should be abandoned. Over the last 15 years, a number of dynamic tests have been developed. These tests are based on the principle of inducing short-term changes in cardiac preload, using heart–lung interactions, the passive leg raise or by the infusion of small volumes of fluid, and to observe the resulting effect on cardiac output. Pulse pressure and stroke volume variations were first developed, but they are reliable only under strict conditions. The variations in vena caval diameters share many limitations of pulse pressure variations. The passive leg-raising test is now supported by solid evidence and is more frequently used. More recently, the end-expiratory occlusion test has been described, which is easily performed in ventilated patients. Unlike the traditional fluid challenge, these dynamic tests do not lead to fluid overload. The dynamic tests are complementary, and clinicians should choose between them based on the status of the patient and the cardiac output monitoring technique. Several methods and tests are currently available to identify preload responsiveness. All have some limitations, but they are frequently complementary. Along with elements indicating the risk of fluid administration, they should help clinicians to take the decision to administer fluids or not in a reasoned way.

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Section: End-expiratory Occlusion Test…mentioning

confidence: 99%

“…In published studies, the EEO test’s effects on cardiac output were assessed by pulse contour analysis [36, 75, 76]. This technique has the advantage of being very precise.…”

Section: End-expiratory Occlusion Test…mentioning

confidence: 99%

Prediction of fluid responsiveness: an update

Monnet

Marik

Teboul

2016

Ann. Intensive Care

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427

336

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“…It is well known that fluid responsiveness is better predicted by the respiratory variation of SV and its pressure surrogates than by static measures of preload 12 . The EEO test has recently been proposed as a test for predicting preload dependence at the bedside that overcomes several limitations of SVV and PPV 6 , and it remains valid independently of the positive end-expiratory pressure in acute respiratory distress syndrome patients and even if the compliance of the lung is low 13,14 . In the present study, we add another advantage of the EEO test, since it holds the ability to predict fluid responsiveness in case of vasomotor tone increase during vasopressor drug infusion.…”

Section: Discussionmentioning

confidence: 99%

End-Expiratory Occlusion Test During Increase of Vasomotor Tone in a Rabbit Model of Hemorrhage

Bouchacourt

Grignola

2020

Sci Rep

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end-expiratory occlusion test (eeot) has been proposed as a preload responsiveness test that overcomes several limitations of pulse pressure (ppV) and stroke volume (SVV) variations. We compared the ability of EEOT versus SVV and PPV to predict fluid responsiveness during the increase of the vasomotor tone in a rabbit model of hemorrhage. ten rabbits were anesthetized, paralyzed, and mechanically ventilated during basal load (BL), after progressive blood withdrawal (BW), and after volume replacement. other two sets of data were obtained during vasomotor increase by phenylephrine (pHe) infusion in BL and BW. We estimated the change of stroke volume (∆SV eeot ) and aortic flow (∆Aof eeot ) during the eeot. ppV and SVV were obtained by the variation of beat-tobeat pp and SV, respectively. Baseline ppV, SVV, ∆SV eeot , and ∆Aof eeot increased significantly after BW, with a decrease of aortic flow (P < 0.05). PHE induced a significant decrease of PPV and SVV, but without affecting ∆SV eeot , and ∆Aof eeot . We conclude that ∆SV and ∆Aof during eeot kept the ability to predict fluid responsiveness during PHE infusion in a rabbit hemorrhage model. This result may suggest the advantage of EEOT with respect to SVV and PPV in predicting fluid responsiveness during vasomotor tone increase.The main goal of fluid therapy is to correct hypovolemia avoiding both under and over-resuscitation, as well as the excessive use of inotropic and vasopressor drugs. Moreover, the comorbidities and type of disease determine that not all patients are volume responsive. The preload responsiveness should be assessed to decide both to administer fluid in the early resuscitation phase of shock states and to stop fluid administration in the de-escalation phase of shock management 1 . Several indices are available at the bedside to predict fluid responsiveness. Dynamic parameters based on heart-lung interactions have been proposed to predict fluid responsiveness and to promote more rational fluid administration 2 . Nevertheless, respiratory variations of stroke volume (SVV), pulse pressure (PPV), and vena cava diameter have numerous limitations that reduce their accuracy and applicability in clinical scenarios 3 . By interrupting cyclic ventilation at end-expiration for a few seconds (end-expiratory occlusion, EEO), abolishing the inspiratory increase in intrathoracic pressure, and by passive leg raising tests, we can produce a self-volume challenge and increase cardiac output (CO) by a rapid and reversible increase of venous return (VR) in those patients preload-responsive 4,5 . Both tests have shown an excellent predictive value keeping their accuracy in patients with cardiac arrhythmias, with spontaneous breathing activity, with low compliance of the respiratory system and independently of positive end-expiratory pressure in acute respiratory distress syndrome patients 6,7 . However, passive leg raising presents some false negatives in patients with intra-abdominal pressure ≥16 mmHg, is contra-indicated to perform in patients with head trauma ...

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“…Monnet et al [30] performed a 15-s EEO test in 34 patients with shock, and fluid responsiveness was predicted by an increase in cardiac index more than 5% during the EEO with a sensitivity and a specificity of 91 and 100%, respectively. Good results were obtained also in patients affected by ARDS with low-respiratory compliance, a condition that precludes the use of PPV and SVV [31,32].…”

Section: End-expiratory Occlusion Testmentioning

confidence: 96%

Fluid bolus therapy

Carsetti

Cecconi

Rhodes

2015

Current Opinion in Critical Care

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Purpose of review When a condition of hypoperfusion has been identified, clinicians must decide whether fluids may increase blood flow or whether other therapeutic approaches are needed. For this purpose, several tests and parameters have been introduced in clinical practice to predict fluid responsiveness and guide therapy. Recent findingsFluid challenge is the gold standard test to assess the preload dependence of the patients. Moreover, several parameters and tests avoiding fluid administration are now available. Pulse pressure variation and stroke volume variation are based on heart-lung interaction and can be used to assess fluid responsiveness. These parameters have several limitations and can really be used in a limited number of critically ill patients. End-expiratory occlusion test and passive leg raising have been proposed to overcome these limitations. The aim of resuscitation is to increase blood flow and perfusion pressure. Dynamic arterial elastance has been recently proposed to predict the pressure response after fluid challenge in preloaddependent patients. Finally, the effects of volume expansion of hemodynamic parameters do not necessarily reach the microcirculation, which should also be assessed. SummaryNowadays, several parameters are available to assess fluid responsiveness. Clinicians need to know all of them, with their limitations, without forgetting that the final aim of all therapies is to improve the microcirculation.

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End-Expiratory Occlusion Test Predicts Preload Responsiveness Independently of Positive End-Expiratory Pressure During Acute Respiratory Distress Syndrome

Abstract: The end-expiratory occlusion test is reliable for detecting preload dependence whatever the positive end-expiratory pressure during acute respiratory distress syndrome.

Cited by 59 publications

References 32 publications

Prediction of fluid responsiveness: an update

Prediction of fluid responsiveness: an update

End-Expiratory Occlusion Test During Increase of Vasomotor Tone in a Rabbit Model of Hemorrhage

Fluid bolus therapy

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