Prediction of fluid responsiveness using lung recruitment manoeuvre in paediatric patients receiving lung-protective ventilation

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Eun-Hee Kim ◽  
Ji-Hyun Lee ◽  
Young-Eun Jang ◽  
Sang-Hwan Ji ◽  
Hee-Soo Kim ◽  
...  
Keyword(s):  
Fluid Responsiveness ◽  
Protective Ventilation ◽  
Lung Recruitment ◽  
Recruitment Manoeuvre ◽  
Lung Protective Ventilation ◽  
Paediatric Patients

scholarly journals The tidal volume challenge improves the reliability of dynamic preload indices during robot-assisted laparoscopic surgery in the Trendelenburg position with lung-protective ventilation

2019 ◽  
Author(s):  
Joo-Hyun Jun ◽  
Rack Kyung Chung ◽  
Hee Jung Baik ◽  
Mi Hwa Chung ◽  
Joon-Sang Hyeon ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Stroke Volume ◽  
Tidal Volume ◽  
Fluid Responsiveness ◽  
Protective Ventilation ◽  
Volume Index ◽  
Lung Protective Ventilation ◽  
Predictive Capability ◽  
Robot Assisted ◽  
Trendelenburg Position

Abstract Background: The reliability of pulse pressure variation (PPV) and stroke volume variation (SVV) is controversial under pneumoperitoneum. In addition, the usefulness of these indices is being called into question with the increasing adoption of lung-protective ventilation using low tidal volume (VT) in surgical patients. A recent study indicated that changes in PPV or SVV obtained by transiently increasing VT (VT challenge) accurately predicted fluid responsiveness even in critically ill patients receiving low VT. We evaluated whether the changes in PPV and SVV induced by a VT challenge predicted fluid responsiveness during pneumoperitoneum. Methods: We performed an interventional prospective study in patients undergoing robot-assisted laparoscopic surgery in the Trendelenburg position under lung-protective ventilation. PPV, SVV, and the stroke volume index (SVI) were measured at a VT of 6 mL/kg and 3 minutes after increasing the VT to 8 mL/kg. The VT was reduced to 6 mL/kg, and measurements were performed before and 5 minutes after volume expansion (infusing 6% hydroxyethyl starch 6 ml/kg over 10 minutes). Fluid responsiveness was defined as ≥ 15% increase in the SVI. Results: Twenty-four of the 38 patients enrolled in the study were responders. In the receiver operating characteristic curve analysis, an increase in PPV > 1% after the VT challenge showed excellent predictive capability for fluid responsiveness, with an area under the curve (AUC) of 0.95 [95% confidence interval (CI), 0.83–0.99, P < 0.0001; sensitivity 92%, specificity 86%]. An increase in SVV > 2% after the VT challenge predicted fluid responsiveness, but showed only fair predictive capability, with an AUC of 0.76 (95% CI, 0.60–0.89, P < 0.0006; sensitivity 46%, specificity 100%). The augmented values of PPV and SVV following VT challenge also showed the improved predictability of fluid responsiveness compared to PPV and SVV values (as measured by VT) of 6 ml/kg. Conclusions: The change in PPV following the VT challenge has excellent reliability in predicting fluid responsiveness in our surgical population. The change in SVV and augmented values of PPV and SVV following this test are also reliable.

scholarly journals Effects of Stepwise Lung Recruitment Maneuvers in Patients with Early Acute Respiratory Distress Syndrome: A Prospective, Randomized, Controlled Trial

2019 ◽  
Vol 8 (2) ◽  
pp. 231 ◽  
Author(s):  
Shu-Chen Kung ◽  
Yi-Li Hung ◽  
Wan-Ling Chen ◽  
Ching-Min Wang ◽  
Hui-Chun Chang ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Protective Ventilation ◽  
Lung Recruitment ◽  
Occurrence Rate ◽  
Lung Protective Ventilation ◽  
Randomized Controlled ◽  
Recruitment Maneuvers

Since the clinical benefit of lung recruitment maneuvers (LRMs) is still conflicting, we performed this prospective, randomized, controlled study to investigate whether LRMs should be used in the routine management of acute respiratory distress syndrome (ARDS). This trial was conducted in four intensive care units (ICUs) to compare application of a modified stepwise LRMs with solely lung-protective ventilation in patients with moderate to severe ARDS within 72 h from the onset. The primary outcome was 28-day mortality, and the secondary outcomes were ventilator-free days and ICU-free days. We collected data on 120 ARDS patients from 2009 to 2012, and there was no difference in 28-day mortality between the two groups (28.3% vs. 30.0%, p = 0.84). However, among survivors, patients in the LRM group had a significant longer median duration of ventilator-free days (18 vs. 13 days; p = 0.04) and ICU-free days (16 vs. 11 days; p = 0.03) at 28 days than in the control group. The respiratory system compliance was significantly higher in the LRM group from day 1 to day 7. The occurrence rate of barotrauma was similar in both groups. We concluded that LRMs combined with lung-protective ventilation in early ARDS may improve patient outcomes.

scholarly journals Temporary increase in tidal volume to improve the reliability of dynamic preload indices during robot-assisted laparoscopic surgery in the Trendelenburg position with lung-protective ventilation

2019 ◽  
Author(s):  
Joo-Hyun Jun ◽  
Rack Kyung Chung ◽  
Hee Jung Baik ◽  
Mi Hwa Chung ◽  
Joon-Sang Hyeon ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Stroke Volume ◽  
Tidal Volume ◽  
Fluid Responsiveness ◽  
Protective Ventilation ◽  
Volume Index ◽  
Lung Protective Ventilation ◽  
Temporary Increase ◽  
Robot Assisted ◽  
Trendelenburg Position

Abstract Background: Pulse pressure variation (PPV) and stroke volume variation (SVV) induced by mechanical ventilation are widely used as predictors of fluid responsiveness. However, the reliability of these dynamic preload indices is controversial under pneumoperitoneum. In addition, the usefulness of these indices is being called into question with the increasing adoption of lung-protective ventilation using low tidal volume (VT) in surgical patients. We investigated whether increasing tidal volume (VT) from 6 to 8 ml/kg can improve the predictive power of PPV and SVV during pneurmoperitoneum. Methods: We performed a prospective observational study in patients undergoing robot-assisted laparoscopic surgery in the Trendelenburg position under lung-protective ventilation. PPV, SVV, and the stroke volume index (SVI) were measured at a VT of 6 mL/kg and 3 minutes after increasing the VT to 8 mL/kg. The VT was reduced to 6 mL/kg, and measurements were performed before and 5 minutes after volume expansion (infusing 6% hydroxyethyl starch 6 ml/kg over 10 minutes). Fluid responsiveness was defined as ≥ 15% increase in the SVI. Results: Twenty-four of the 38 patients enrolled in the study were responders. In the receiver operating characteristic curve analysis, the augmented PPV and SVV associated with a temporary increase in VT from 6 to 8 ml/kg improved the predictability of fluid responsiveness, with area under the curve (AUC) values of 0.85 (95% confidence interval (CI), 0.70–0.95, P < 0.0001) and 0.77 (95% CI 0.61–0.89, P = 0.0003), compared to PPV and SVV values (as measured by VT) of 6 ml/kg. The absolute change in PPV and SVV values obtained by transiently increasing VT also predicted fluid responsiveness, with AUC values of 0.95 (95% CI 0.83–0.99, P < 0.0001) and 0.76 (95% CI 0.60–0.89, P = 0.0006). Conclusions: Augmented PPV and SVV values, and absolute changes therein obtained by increasing VT from 6 to 8 ml/kg, predicted fluid responsiveness with high sensitivity and specificity in our surgical population.

scholarly journals Changes in stroke volume induced by lung recruitment maneuver can predict fluid responsiveness during intraoperative lung-protective ventilation in prone position

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ryota Watanabe ◽  
Koichi Suehiro ◽  
Akira Mukai ◽  
Katsuaki Tanaka ◽  
Tokuhiro Yamada ◽  
...  
Keyword(s):  
Stroke Volume ◽  
Prone Position ◽  
Recruitment Maneuver ◽  
Protective Ventilation ◽  
Lung Recruitment ◽  
Lung Protective Ventilation ◽  
Future Research ◽  
Gray Zone ◽  
Clinical Trial Registry ◽  
Lung Recruitment Maneuver

Abstract Background The present study aimed to evaluate the reliability of hemodynamic changes induced by lung recruitment maneuver (LRM) in predicting stroke volume (SV) increase after fluid loading (FL) in prone position. Methods Thirty patients undergoing spine surgery in prone position were enrolled. Lung-protective ventilation (tidal volume, 6–7 mL/kg; positive end-expiratory pressure, 5 cmH2O) was provided to all patients. LRM (30 cmH2O for 30 s) was performed. Hemodynamic variables including mean arterial pressure (MAP), heart rate, SV, SV variation (SVV), and pulse pressure variation (PPV) were simultaneously recorded before, during, and at 5 min after LRM and after FL (250 mL in 10 min). Receiver operating characteristic curves were generated to evaluate the predictability of SVV, PPV, and SV decrease by LRM (ΔSVLRM) for SV responders (SV increase after FL > 10%). The gray zone approach was applied for ΔSVLRM. Results Areas under the curve (AUCs) for ΔSVLRM, SVV, and PPV to predict SV responders were 0.778 (95% confidence interval: 0.590–0.909), 0.563 (0.371–0.743), and 0.502 (0.315–0.689), respectively. The optimal threshold for ΔSVLRM was 30% (sensitivity, 92.3%; specificity, 70.6%). With the gray zone approach, the inconclusive values ranged 25 to 75% for ΔSVLRM (including 50% of enrolled patients). Conclusion In prone position, LRM-induced SV decrease predicted SV increase after FL with higher reliability than traditional dynamic indices. On the other hand, considering the relatively large gray zone in this study, future research is needed to further improve the clinical significance. Trial registration UMIN Clinical Trial Registry UMIN000027966. Registered 28th June 2017.

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.

scholarly journals Performance of a capnodynamic method estimating cardiac output during respiratory failure - before and after lung recruitment

2019 ◽  
Vol 34 (6) ◽  
pp. 1199-1207
Author(s):  
Thorir Svavar Sigmundsson ◽  
Tomas Öhman ◽  
Magnus Hallbäck ◽  
Eider Redondo ◽  
Fernando Suarez Sipmann ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Respiratory Failure ◽  
Reference Method ◽  
Hemodynamic Instability ◽  
Lung Lavage ◽  
Lung Recruitment ◽  
Recruitment Manoeuvre ◽  
Percentage Error ◽  
Before And After ◽  
The Right

AbstractRespiratory failure may cause hemodynamic instability with strain on the right ventricle. The capnodynamic method continuously calculates cardiac output (CO) based on effective pulmonary blood flow (COEPBF) and could provide CO monitoring complementary to mechanical ventilation during surgery and intensive care. The aim of the current study was to evaluate the ability of a revised capnodynamic method, based on short expiratory holds (COEPBFexp), to estimate CO during acute respiratory failure (LI) with high shunt fractions before and after compliance-based lung recruitment. Ten pigs were submitted to lung lavage and subsequent ventilator-induced lung injury. COEPBFexp, without any shunt correction, was compared to a reference method for CO, an ultrasonic flow probe placed around the pulmonary artery trunk (COTS) at (1) baseline in healthy lungs with PEEP 5 cmH2O (HLP5), (2) LI with PEEP 5 cmH2O (LIP5) and (3) LI after lung recruitment and PEEP adjustment (LIPadj). CO changes were enforced during LIP5 and LIPadj to estimate trending. LI resulted in changes in shunt fraction from 0.1 (0.03) to 0.36 (0.1) and restored to 0.09 (0.04) after recruitment manoeuvre. Bias (levels of agreement) and percentage error between COEPBFexp and COTS changed from 0.5 (− 0.5 to 1.5) L/min and 30% at HLP5 to − 0.6 (− 2.3 to 1.1) L/min and 39% during LIP5 and finally 1.1 (− 0.3 to 2.5) L/min and 38% at LIPadj. Concordance during CO changes improved from 87 to 100% after lung recruitment and PEEP adjustment. COEPBFexp could possibly be used for continuous CO monitoring and trending in hemodynamically unstable patients with increased shunt and after recruitment manoeuvre.

Sign in / Sign up

Export Citation Format

Share Document