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

Abstract

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.

Cardiopulmonary interactions and volume status assessment

“…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.…”

Impact of deep breathing on predictability of stroke volume variation in spontaneous breathing patients

“…Some respiratory interventions have been conducted to improve the predictability of dynamic indices for fluid responsiveness even under spontaneous breathing conditions . Hong et al evaluated whether forced inspiratory breathing could improve the reliability of PPV in predicting fluid responsiveness.…”

“…ROC analysis revealed that PPV during forced inspiratory breathing could predict fluid responsiveness even in the presence of spontaneous breathing, with a high AUC of 0.910. Preau et al found that, in spontaneously breathing patients, the changes in pulse pressure and peak systolic velocity of the femoral artery, induced by a deep inspiration manoeuvre, were significant predictors of fluid responsiveness, with a sensitivity of 90% and a specificity of 100%. Additionally, a previous study conducted by Bronzwaer et al has shown that paced breathing (6 breaths min −1 ) and expiratory resistance increased the power of SPV and PPV for predicting fluid responsiveness.…”

“…The respiratory variations in preload during normal spontaneous breathing may be too small to identify fluid responders. Recent studies have investigated some interventions, such as forced respiratory manoeuvres and expiratory resistance, to improve the predictive performance of dynamic indices even in spontaneously breathing patients, but have found conflicting results …”

“…Recent studies have investigated some interventions, such as forced respiratory manoeuvres and expiratory resistance, to improve the predictive performance of dynamic indices even in spontaneously breathing patients, but have found conflicting results. [10][11][12] We hypothesized that deep breathing would increase the respiratory variations of ventricular preload, and thus improve the reliability of dynamic indices in predicting fluid responsiveness, even under spontaneous breathing conditions. To test this hypothesis, we investigated the ability of SVV during deep breathing to discriminate fluid responders among spontaneously breathing surgical patients.…”