scholarly journals Changes of Operative Performance of Pulse Pressure Variation As A Predictor of Fluid Responsiveness in a Swine Model of Endotoxin Shock

2021 ◽  
Author(s):  
Jorge Iván Alvarado Sánchez ◽  
Juan Daniel Caicedo Ruiz ◽  
Juan Jose Diaztagle Fernández ◽  
Gustavo Adolfo Ospina Tascon ◽  
Manuel Ignacio Monge Garcia ◽  
...  
Keyword(s):  
Fluid Responsiveness ◽  
Pulse Pressure ◽  
Pulse Pressure Variation ◽  
Endotoxin Shock ◽  
Pressure Variation ◽  
Control Group ◽  
Inverse Association ◽  
Shock Model ◽  
Model Animal ◽  
Operative Performance

Abstract Background Several limitations regarding pulse pressure variation (PPV) use have been reported. Our aim was to describe changes in the PPV operative performance as a predictor of fluid responsiveness during the development of a swine endotoxin shock model and to assess hemodynamic variables associated with PPV changes. Methods A swine porcine endotoxin shock model was established (E. Coli 055:B5 endotoxin) in 7 pigs, and 3 pigs were included in the control group. The endotoxin was infused until the mean arterial pressure (MAP) dropped below 50 mmHg (TH0); then, the model animal was reanimated with fluids and vasopressors. We performed fluid challenges every hour for 6 hours. ROC curve analysis was conducted. Additionally, a linear mixed model was performed. Results The area under the curve (AUC) of PPV decreased from 0.95 (0.81–1.00) to 0.60 (0.17–1.00) at TH0. Its cutoff increased from 10.5–22.00% at TH0. PPV showed an inverse relationship with stroke volume, mean systemic filling pressure (MSFP), MAP, and systemic vascular resistance (SVR) (p < 0,001, AIC = 111.85). Conclusions The PPV operative performance as a predictor of fluid responsiveness decreased with the progression of endotoxic shock. This result could be due to the inverse association with MAP and SVR.

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 An Increase in Aortic Blood Flow after an Infusion of 100 ml Colloid over 1 Minute Can Predict Fluid Responsiveness

2011 ◽  
Vol 115 (3) ◽  
pp. 541-547 ◽  
Author(s):  
Laurent Muller ◽  
Medhi Toumi ◽  
Philippe-Jean Bousquet ◽  
Béatrice Riu-Poulenc ◽  
Guillaume Louart ◽  
...  
Keyword(s):  
Receiver Operating Characteristic ◽  
Fluid Responsiveness ◽  
Pulse Pressure ◽  
Pulse Pressure Variation ◽  
Operating Characteristic ◽  
Venous Pressure ◽  
Pressure Variation ◽  
Characteristic Curves ◽  
Receiver Operating Characteristic Curves ◽  
Receiver Operating

Background Predicting fluid responsiveness remains a difficult question in hemodynamically unstable patients. The author's objective was to test whether noninvasive assessment by transthoracic echocardiography of subaortic velocity time index (VTI) variation after a low volume of fluid infusion (100 ml hydroxyethyl starch) can predict fluid responsiveness. Methods Thirty-nine critically ill ventilated and sedated patients with acute circulatory failure were prospectively studied. Subaortic VTI was measured by transthoracic echocardiography before fluid infusion (baseline), after 100 ml hydroxyethyl starch infusion over 1 min, and after an additional infusion of 400 ml hydroxyethyl starch over 14 min. The authors measured the variation of VTI after 100 ml fluid (ΔVTI 100) for each patient. Receiver operating characteristic curves were generated for (ΔVTI 100). When available, receiver operating characteristic curves also were generated for pulse pressure variation and central venous pressure. Results After 500 ml volume expansion, VTI increased ≥ 15% in 21 patients (54%) defined as responders. ΔVTI 100 ≥ 10% predicted fluid responsiveness with a sensitivity and specificity of 95% and 78%, respectively. The area under the receiver operating characteristic curves of ΔVTI 100 was 0.92 (95% CI: 0.78-0.98). In 29 patients, pulse pressure variation and central venous pressure also were available. In this subgroup of patients, the area under the receiver operating characteristic curves for ΔVTI 100, pulse pressure variation, and central venous pressure were 0.90 (95% CI: 0.74-0.98, P &lt; 0.05), 0.55 (95% CI: 0.35-0.73, NS), and 0.61 (95% CI: 0.41-0.79, NS), respectively. Conclusion In patients with low volume mechanical ventilation and acute circulatory failure, ΔVTI 100 accurately predicts fluid responsiveness.

ARTERIAL PULSE PRESSURE VARIATION PREDICTING FLUID RESPONSIVENESS IN CRITICALLY ILL PATIENTS

Shock ◽  
2008 ◽  
Vol 30 (Suppl 1) ◽  
pp. 18-22 ◽  
Author(s):  
Jose Otavio C. Auler ◽  
Filomena R.B.G. Galas ◽  
Marcia R. Sundin ◽  
Ludhmila A. Hajjar
Keyword(s):  
Critically Ill ◽  
Fluid Responsiveness ◽  
Pulse Pressure ◽  
Critically Ill Patients ◽  
Pulse Pressure Variation ◽  
Pressure Variation ◽  
Arterial Pulse ◽  
Arterial Pulse Pressure
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