Use of ‘tidal volume challenge’ to improve the reliability of pulse pressure variation

Myatra, Sheila Nainan; Monnet, Xavier; Teboul, Jean‐Louis

doi:10.1186/s13054-017-1637-x

Cited by 46 publications

(32 citation statements)

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“…In fact, a similar approach has been already successfully used in patients undergoing forms of controlled ventilation to enhance the reliability of stroke volume variation and PP variation. Freitas et al increased the V T from 6 to mL to 8 mL/kg body weight for 5 min [37]; Reuter et al randomly applied 5, 10, and 15 mL/kg of V T [38] and, more recently, Myatra et al used a 1-min “V T -challenge”, increasing the V T from 6 up to 8 mL/kg [39]. Finally, the analysis of the slope for SAP nadir has previously been successfully applied in small cohorts of postsurgical patients [40–42].…”

Section: Discussionmentioning

confidence: 99%

Sigh maneuver to enhance assessment of fluid responsiveness during pressure support ventilation

et al. 2019

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BackgroundAssessment of fluid responsiveness is problematic in intensive care unit (ICU) patients, in particular for those undergoing modes of partial support, such as pressure support ventilation (PSV). We propose a new test, based on application of a ventilator-generated sigh, to predict fluid responsiveness in ICU patients undergoing PSV.MethodsThis was a prospective bi-centric interventional study conducted in two general ICUs. In 40 critically ill patients with a stable ventilatory PSV pattern and requiring volume expansion (VE), we assessed the variations in arterial systolic pressure (SAP), pulse pressure (PP) and stroke volume index (SVI) consequent to random application of 4-s sighs at three different inspiratory pressures. A radial arterial signal was directed to the MOSTCARE™ pulse contour hemodynamic monitoring system for hemodynamic measurements. Data obtained during sigh tests were recorded beat by beat, while all the hemodynamic parameters were averaged over 30 s for the remaining period of the study protocol. VE consisted of 500 mL of crystalloids over 10 min. A patient was considered a responder if a VE-induced increase in cardiac index (CI) ≥ 15% was observed.ResultsThe slopes for SAP, SVI and PP of were all significantly different between responders and non-responders (p < 0.0001, p = 0.0004 and p < 0.0001, respectively). The AUC of the slope of SAP (0.99; sensitivity 100.0% (79.4–100.0%) and specificity 95.8% (78.8–99.9%) was significantly greater than the AUC for PP (0.91) and SVI (0.83) (p = 0.04 and 0.009, respectively). The SAP slope best threshold value of the ROC curve was − 4.4° from baseline. The only parameter found to be independently associated with fluid responsiveness among those included in the logistic regression was the slope for SAP (p = 0.009; odds ratio 0.27 (95% confidence interval (CI95) 0.10–0.70)). The effects produced by the sigh at 35 cmH20 (Sigh35) are significantly different between responders and non-responders. For a 35% reduction in PP from baseline, the AUC was 0.91 (CI95 0.82–0.99), with sensitivity 75.0% and specificity 91.6%.ConclusionsIn a selected ICU population undergoing PSV, analysis of the slope for SAP after the application of three successive sighs and the nadir of PP after Sigh35 reliably predict fluid responsiveness.Trial registrationAustralian New Zealand Clinical Trials Registry, ACTRN12615001232527. Registered on 10 November 2015.Electronic supplementary materialThe online version of this article (10.1186/s13054-018-2294-4) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Sigh maneuver to enhance assessment of fluid responsiveness during pressure support ventilation

et al. 2019

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“…Prophylactic use of hydroxychloroquine has not prevented COVID-19 illness when administered within four days post-exposure [26]. Furthermore, its usefulness for the treatment of COVID- 19 has not yet shown prom- ising results: a multicentre trial in non-severe COVID-19 patients showed no clinical improvement after 15 days of hydroxychloroquine. The groups included either hydroxychloroquine alone or in combination with azithromycin versus standard of care [27].…”

Section: Pharmacological Therapymentioning

confidence: 99%

Evolution of COVID-19 management in critical care: review and perspective from a hospital in the United Kingdom

Jha¹,

Kulkarni²

2021

Acute Crit Care

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The unexpected emergence and spread of coronavirus disease 2019 (COVID-19) has been pandemic, with long-lasting effects, and unfortunately, it does not seem to have ended. Integrating advanced planning, strong teamwork, and clinical management have been both essential and rewarding during this time. Understanding the new concepts of this novel disease and accommodating them into clinical practice is an ongoing process, ultimately leading to advanced and highly specific treatment modalities. We conducted a literature review through PubMed, Europe PMC, Scopus, and Google Scholar to incorporate the most updated therapeutic principles. This article provides a concise and panoramic view of the cohort of critically ill patients admitted to the intensive care unit. We conclude that COVID-19 management includes low tidal volume ventilation, early proning, steroids, and a high suspicion for secondary bacterial/fungal infections. Lung ultrasound is emerging as a promising tool in assessing the clinical response. Managing non-clinical factors such as staff burnout, communication/ consent issues, and socio-emotional well-being is equally important.

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“…Thirty patients were nally included and analysed. The intra-observer variability of the measurement of IVCV at baseline was 9 [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]%.…”

Section: Patientsmentioning

confidence: 99%

“…Another means to predict preload responsiveness in case of low Vt is to perform a "Vt challenge" [9]. It consists in transiently increasing Vt from 6 to 8 mL/kg of predicted body weight and observing the induced changes in PPV.…”

Section: Introductionmentioning

confidence: 99%

Do Changes in Pulse Pressure Variation and Inferior Vena Cava Distensibility During Passive Leg Raising and Tidal Volume Challenge Detect Preload Responsiveness in Case of Low Tidal Volume Ventilation?

Taccheri

Gavelli

Teboul

et al. 2020

Preprint

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BackgroundIn patients ventilated with tidal volume (Vt) <8 mL/kg, pulse pressure variation (PPV) and, likely, the distensibility of the inferior vena cava diameter (IVCV) are unable to detect preload responsiveness. In this condition, passive leg raising (PLR) could be used but it requires a measurement of cardiac output. The tidal volume (Vt) challenge (PPV changes induced by a 1-min increase in Vt from 6 to 8 mL/kg) is another alternative, but it requires an arterial line. We tested whether, in case of Vt=6mL/kg, the effects of PLR could be assessed through changes in PPV or in IVCV rather than changes in cardiac output, and whether the effects of the Vt challenge could be assessed by changes in IVCV rather than changes in PPV.MethodsIn 30 critically ill patients without spontaneous breathing and cardiac arrhythmias, ventilated with Vt=6 mL/kg, we measured cardiac index (CI) (PiCCO2), IVCV and PPV before/during a PLR test and before/during a Vt challenge. A PLR-induced increase in CI ≥10% defined preload responsiveness.ResultsAt baseline, IVCV was not different between preload responders (n=15) and non-responders. Compared to non-responders, PPV and IVCV decreased more during PLR (by -38±16% and -26±28%, respectively) and increased more during the Vt challenge (by 64±42% and 91±72%, respectively) in responders. ∆PPVPLR, expressed either as absolute or percent relative changes, detected preload responsiveness (area under the receiver operating curve, AUROC: 0.98±0.02 for both). ∆IVCVPLR detected preload responsiveness only when expressed in absolute changes (AUROC: 0.76±0.10), not in relative changes. ∆PPVVt, expressed as absolute or percent relative changes, detected preload responsiveness (AUROC: 0.98±0.02 and 0.94±0.04, respectively). This was also the case for ∆IVCVVt but, the diagnostic threshold (1 point or 4%) was below the least significant change of IVCV (9[3-18]%).ConclusionsDuring mechanical ventilation with Vt=6 mL/kg, the effects of PLR can be assessed by changes in PPV. If IVCV is used, it should be expressed in percent and not in absolute changes. The effects of the Vt challenge can be assessed on PPV, but not on IVCV, since the diagnostic threshold is too small with regards to the reproducibility of this variable.Trial registrationIDRCB: 2016-A00893-48

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Use of ‘tidal volume challenge’ to improve the reliability of pulse pressure variation

Cited by 46 publications

References 47 publications

Sigh maneuver to enhance assessment of fluid responsiveness during pressure support ventilation

Sigh maneuver to enhance assessment of fluid responsiveness during pressure support ventilation

Evolution of COVID-19 management in critical care: review and perspective from a hospital in the United Kingdom

Do Changes in Pulse Pressure Variation and Inferior Vena Cava Distensibility During Passive Leg Raising and Tidal Volume Challenge Detect Preload Responsiveness in Case of Low Tidal Volume Ventilation?

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