Fluid responsiveness in patients under mechanical ventilation and low tidal volume ventilation through the pulse pressure variation after tidal volume challenge in the post-operative cardiac surgery

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
D F C Azevedo ◽  
R M Viera De Melo ◽  
A C Cunha ◽  
L G S Brito ◽  
T Viana ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Tidal Volume ◽  
Fluid Responsiveness ◽  
Postoperative Period ◽  
Pulse Pressure ◽  
Pressure Variation ◽  
Predict Fluid Responsiveness ◽  
Predicted Body Weight ◽  
Volume Challenge ◽  
Excellent Accuracy

Abstract Background It is known that in the immediate postoperative period of cardiac surgery, strict control of hemodynamic variables and blood volume is necessary, since there is an imbalance between oxygen supply and consumption. Thus, the present study seeks to validate methods previously used in different clinical situations to predict fluid responsiveness, in the current scenario of the immediate postoperative period of cardiac surgery. Purpose To evaluate the influence of “tidal volume challenge” from 6 ml / kg to 8 ml / kg of the predicted body weight (PBW) in conjunction with the end expiratory occlusion test (EEOT) in the variation of pulse pressure to predict fluid responsiveness in the immediate postoperative period of cardiac surgery. Methodology This prospective study included 30 patients after cardiac surgery. Hemodynamic and ventilatory parameters were initially recorded in mechanical ventilation at 6 ml/kg and after tidial volume challenge and with the EEOT at 8 ml/kg of predicted body weight (PBW). After recorded the intervention data, there was a return to ventilation at 6 ml/kg and a saline infusion of 500 ml was performed for 15 minutes. Fluid responsiveness was defined for patients who had an increase of 10% or more in velocity time integral (VTI) by echocardiogram after volume expansion compared to baseline value. Multivariate analysis was used to identify independent predictors of fluid response status. Sensitivity and specificity analyzes were performed to determine the predictive precision of each parameter. Results The main result of our study is that, when the tidal volume is increased from 6 to 8 ml/kg of PBW, the relative increase in pulse pressure variation (%ΔPPV6–8) predicts with excellent accuracy responsiveness to fluids with cut-off values of 18.3%, with sensitivity of 92.9% and specificity of 84% (P=0.019). Although changing PPV6, EEOT6 and EEOT8 are not reliable in predicting fluid responsiveness, they still require additional calculations. PPV8 also discriminates between responders and non-responders; however, with sensitivity (78.6%) and specificity (66.6%) when the value found in the PPV8 is up 8.5, but without statistical significance (figure). Conclusion The challenge of tidal volume and its influence on the ΔPP variation has excellent accuracy to predict fluid responsiveness in the immediate postoperative period of cardiac surgery. EEOT did not present good accuracy to predict fluid responsiveness in patients in the immediate postoperative period of cardiac surgery. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Ability of a New Smartphone Pulse Pressure Variation and Cardiac Output Application to Predict Fluid Responsiveness in Patients Undergoing Cardiac Surgery

2019 ◽  
Vol 128 (6) ◽  
pp. 1145-1151 ◽  
Author(s):  
Alexandre Joosten ◽  
Céline Boudart ◽  
Jean-Louis Vincent ◽  
Frederic Vanden Eynden ◽  
Luc Barvais ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Cardiac Surgery ◽  
Fluid Responsiveness ◽  
Pulse Pressure ◽  
Pulse Pressure Variation ◽  
Pressure Variation ◽  
Predict Fluid Responsiveness

scholarly journals Use of Pulse Pressure Variation as Predictor of Fluid Responsiveness in Patients Ventilated With Low Tidal Volume: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 14 ◽  
pp. 117954842090151
Author(s):  
Jorge Iván Alvarado Sánchez ◽  
Juan Daniel Caicedo Ruiz ◽  
Juan José Diaztagle Fernández ◽  
Gustavo Adolfo Ospina-Tascón ◽  
Luis Eduardo Cruz Martínez
Keyword(s):  
Mechanical Ventilation ◽  
Critical Care ◽  
Tidal Volume ◽  
Fluid Responsiveness ◽  
Pulse Pressure ◽  
Pulse Pressure Variation ◽  
Pressure Variation ◽  
Respiratory Effort ◽  
Predict Fluid Responsiveness ◽  
Operative Performance

Introduction: Pulse pressure variation (PPV) has been shown to be useful to predict fluid responsiveness in patients ventilated at tidal volume (Vt) >8 mL kg−1. Nevertheless, most conditions in critical care force to use lower Vt. Thus, we sought to evaluate the operative performance of PPV when a Vt ⩽8 mL kg−1 is used during mechanical ventilation support. Methods: We searched PubMed and Embase databases for articles evaluating the operative performance of PPV as a predictor of fluid responsiveness in critical care and perioperative adult patients ventilated with tidal volume ⩽8 mL kg−1 without respiratory effort and arrhythmias, between January 1990 and January 2019. We included cohort and cross-sectional studies. Two authors performed an Independently selection using predefined terms of search. The fitted data of sensitivity, specificity, and area under the curve (AUC) were assessed by bivariate and hierarchical analyses. Results: We retrieved 19 trials with a total of 777 patients and a total of 935 fluid challenges. The fitted sensitivity of PPV to predict fluid responsiveness during mechanical ventilation at Vt ⩽8 mL kg−1 was 0.65 (95% confidence interval [CI]: 0.57-0.73), the specificity was 0.79 (95% CI: 0.73-0.84), and the AUC was 0.75. The diagnostic odds ratio was 5.5 (95% CI: 3.08-10.01, P < .001) by the random-effects model. Conclusions: Pulse pressure variation shows a fair operative performance as a predictor of fluid responsiveness in critical care and perioperative patients ventilated with a tidal volume ⩽8 mL kg−1 without respiratory effort and arrhythmias.

scholarly journals Predicting Fluid Responsiveness Using Pulse Pressure Variation after Tidal Volume Challenge in Postoperative Patients Receiving Lung Protective Ventilation: A Clinical Trial

2019 ◽  
Author(s):  
Pimsai Kunakorn ◽  
Sunthiti Morakul ◽  
Tananchai Petnak ◽  
Pongsasit Singhatat ◽  
Chawika Pisitsak
Keyword(s):  
Stroke Volume ◽  
Tidal Volume ◽  
Fluid Responsiveness ◽  
Protective Ventilation ◽  
Pressure Variation ◽  
Lung Protective Ventilation ◽  
Predict Fluid Responsiveness ◽  
Low Tidal Volume ◽  
Volume Ventilation ◽  
Volume Challenge

Abstract Background: Lung protective ventilation with low tidal volume is beneficial in patients with intermediate to high risk of postoperative pulmonary complications. However, during low tidal volume ventilation, pulse pressure variation (PPV) and stroke volume variation (SVV) do not predict fluid responsiveness. We aimed to determine whether changes in PPV and SVV after transient increases in tidal volume can predict fluid responsiveness in these patients. Methods: We recorded 22 measurements from 15 patients who experienced postoperative acute circulatory failure. We performed a tidal volume challenge by transiently increasing tidal volume (VT) from 6 to 8 mL/kg (VT6–8), 8 to 10 mL/kg (VT8–10), and 6 to 10 mL/kg (VT6–10) of patients' predicted body weight. The change in PPV (∆PPV) at VT6–8 (∆PPV6–8), VT8–10 (∆PPV8–10), VT6–10 (∆PPV6–10) and the change in SVV (∆SVV) at VT6–8 (∆SVV6–8), VT8–10 (∆SVV8–10), and VT6–10 (∆SVV6–10) were recorded. Patients were classified as fluid responders if there was an increase in stroke volume of more than 10% after a fluid bolus. Results: Following the tidal volume challenge, ∆PPV and ∆SVV failed to predict fluid responsiveness, with areas under the receiver operating characteristic curves (with 95% confidence intervals) of 0.49 (0.23–0.74), 0.54 (0.29–0.79), 0.52 (0.28–0.77) for ∆PPV6–8, ∆PPV8–10, and ∆PPV6–10, and 0.55 (0.30–0.80), 0.55 (0.31–0.80), and 0.59 (0.34–0.84) for ∆SVV6–8, ∆SVV8–10, and ∆SVV6–10, respectively. Conclusions: Changes in PPV and SVV after the tidal volume challenge did not predict fluid responsiveness in postoperative patients with low tidal volume ventilation. Trial registration: This trial was registered with Clinicaltrials.in.th, TCTR20190808003.

Predicting Fluid Responsiveness Using Change in Pulse Pressure Variation and Stroke Volume Variation after Tidal Volume Challenge in Postoperative Patients Receiving Lung Protective Ventilation

2020 ◽  
Vol 103 (8) ◽  
pp. 729-735
Keyword(s):  
Stroke Volume ◽  
Tidal Volume ◽  
Fluid Responsiveness ◽  
Pulse Pressure ◽  
Pulse Pressure Variation ◽  
Stroke Volume Variation ◽  
Pressure Variation ◽  
Lung Protective Ventilation ◽  
Predict Fluid Responsiveness ◽  
Volume Variation

Background: Lung protective ventilation with low tidal volume (VT) is beneficial in patients with intermediate to high risk of post-operative pulmonary complications. However, during low VT ventilation, pulse pressure variation (PPV) and stroke volume variation (SVV) do not predict fluid responsiveness. Objective: To determine whether changes in PPV and SVV after transient increases in VT could predict fluid responsiveness. Materials and Methods: The authors recorded 20 measurements from 15 patients experiencing post-operative acute circulatory failure. The authors performed a VT challenge by transient increasing VT from 6 to 8 mL/kg (VT₆-₈), 8 to 10 mL/kg (VT₈-₁₀), and 6 to 10 mL/kg (VT₆-₁₀) of patients’ predicted body weight. The change in PPV (∆PPV) at VT₆-₈ (∆PPV₆-₈), VT₈-₁₀ (∆PPV₈-₁₀), VT₆-₁₀ (∆PPV₆-₁₀), and the change in SVV (∆SVV) at VT₆-₈ (∆SVV₆-₈), VT₈-₁₀ (∆SVV₈-₁₀), and VT₆-₁₀ (∆SVV₆-₁₀) were recorded. Patients were classified as fluid responders if there was an increase in stroke volume of more than 10% after a fluid bolus. Results: Following the VT challenge, ∆PPV and ∆SVV failed to predict fluid responsiveness, with areas under the receiver operating characteristic curves (with 95% confidence intervals) of 0.49 (0.23 to 0.74), 0.54 (0.29 to 0.79), 0.52 (0.28 to 0.77) for ∆PPV₆-₈, ∆PPV₈-₁₀, and ∆PPV₆-₁₀, and 0.55 (0.30 to 0.80), 0.55 (0.31 to 0.80), and 0.59 (0.34 to 0.84) for ∆SVV₆-₈, ∆SVV₈-₁₀, and ∆SVV₆-₁₀, respectively. Conclusion: Changes in PPV and SVV after the VT challenge did not predict fluid responsiveness in post-operative patients with low VT ventilation. Trial registration: Thai Clinical Trials Registry, TCTR 20190808003 Keywords: Pulse pressure variation, Stroke volume variation, Fluid responsiveness, Tidal volume challenge

scholarly journals Assessment of Fluid Responsiveness After Tidal Volume Challenge During Pressure-Controlled Ventilation Volume Guaranteed: An observational study

2020 ◽  
Author(s):  
Yu Jiang ◽  
Lingling Jiang ◽  
Jun Hu ◽  
Ye Zhang
Keyword(s):  
Body Weight ◽  
Tidal Volume ◽  
Fluid Responsiveness ◽  
Transient Increase ◽  
Anesthesia Induction ◽  
Predicted Body Weight ◽  
Controlled Ventilation ◽  
Pressure Controlled Ventilation ◽  
Pressure Controlled ◽  
Volume Challenge

Abstract Background: The reliability of pulse pressure variation (PPV) and stroke volume variation (SVV) to predict fluid responsiveness have not previously been established when using pressure-controlled ventilation-volume guaranteed (PCV-VG) mode. We hypothesized that with a transient increase in tidal volume from 6 to 8 mL/kg of predicted body weight (PBW), which we reference as the “tidal volume challenge (TVC)”, the changes to PPV and SVV will be an indicator of fluid responsiveness.Methods: The patients were first ventilated with a tidal volume of (Vt) 6 mL/kg of predicted body weight (PBW) using PCV-VG. Following intravenous anesthesia induction, PPV6 and SVV6 were recorded, then the TVC was performed, which increased Vt from 6 mL/kg to 8 mL/kg PBW for 1 minute and PPV8 and SVV8 were recorded again. The changes in value of PPV and SVV (ΔPPV6-8 and ΔSVV6-8) were calculated after TVC. Following the minute of TVC, the tidal volume was returned to 6 ml/kg PBW for the fluid challenge (FC), a colloid infusion of 6ml/kg PBW for 20 minutes. Patients were classified as responders if there was an increase in cardiac index (CI) of more than 15% after FC, otherwise the patients were identified as non-responders. Eligible patients were divided into groups of responders or non-responders.Results: 37 patients were classified as responders and 44 were non-responders. PPV6 and SVV6 could not predict the fluid responsiveness, while PPV8 and SVV8 could predict the fluid responsiveness when using PCV-VG mode. The changes in value of PPV and SVV after TVC (ΔPPV6-8 and ΔSVV6-8) identified true fluid responders with the highest sensitivity and specificity in the above variables, which predicted fluid responsiveness with the area under the receiver operating characteristic curves (AUCs) (95% CIs) being 0.96 (0.93-1.00) and 0.98 (0.96-1.00), respectively. No significant difference was found when comparing the AUCs of ΔPPV6-8 and ΔSVV6-8 (P > 0.05). Linear correlation was represented between the change value of CI after FC and the change value of SVV or PPV after TVC (r = 0.68; P < 0.0001 and r = 0.77; P < 0.0001, respectively).Conclusions: A transient increase in tidal volume, which we reference as the “tidal volume challenge (TVC)” could enhance the predictive value of PPV and SVV for the evaluation of fluid responsiveness in patients under ventilation with PCV-VG.Trial registration: Chinese Clinical Trial Registry (ChiCTR2000028995). Prospectively registered on 11 January 2020. http://www.medresman.org.

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