Ability of Capstesia™, a new smartphone Pulse Pressure Variation (PPV) and Cardiac Output (CO) application, to predict fluid responsiveness in mechanically ventilated patients

2017 ◽  
Author(s):  
Céline Boudart
Keyword(s):  
Cardiac Output ◽  
Fluid Responsiveness ◽  
Pulse Pressure ◽  
Pulse Pressure Variation ◽  
Pressure Variation ◽  
Predict Fluid Responsiveness ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Ventilated Patients

scholarly journals Influence of Respiratory Rate on Stroke Volume Variation in Mechanically Ventilated Patients

2009 ◽  
Vol 110 (5) ◽  
pp. 1092-1097 ◽  
Author(s):  
Daniel De Backer ◽  
Fabio Silvio Taccone ◽  
Roland Holsten ◽  
Fayssal Ibrahimi ◽  
Jean-Louis Vincent
Keyword(s):  
Stroke Volume ◽  
Fluid Responsiveness ◽  
Pulse Pressure ◽  
Pulse Pressure Variation ◽  
Pressure Variation ◽  
Respiratory Variation ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Caval Index ◽  
Ventilated Patients

Background Heart-lung interactions are used to evaluate fluid responsiveness in mechanically ventilated patients, but these indices may be influenced by ventilatory conditions. The authors evaluated the impact of respiratory rate (RR) on indices of fluid responsiveness in mechanically ventilated patients, hypothesizing that pulse pressure variation and respiratory variation in aortic flow would decrease at high RRs. Methods In 17 hypovolemic patients, thermodilution cardiac output and indices of fluid responsiveness were measured at a low RR (14-16 breaths/min) and at the highest RR (30 or 40 breaths/min) achievable without altering tidal volume or inspiratory/expiratory ratio. Results An increase in RR was accompanied by a decrease in pulse pressure variation from 21% (18-31%) to 4% (0-6%) (P < 0.01) and in respiratory variation in aortic flow from 23% (18-28%) to 6% (5-8%) (P < 0.01), whereas respiratory variations in superior vena cava diameter (caval index) were unaltered, i.e., from 38% (27-43%) to 32% (22-39%), P = not significant. Cardiac index was not affected by the changes in RR but did increase after fluids. Pulse pressure variation became negligible when the ratio between heart rate and RR decreased below 3.6. Conclusions Respiratory variations in stroke volume and its derivates are affected by RR, but caval index was unaffected. This suggests that right and left indices of ventricular preload variation are dissociated. At high RRs, the ability to predict the response to fluids of stroke volume variations and its derivate may be limited, whereas caval index can still be used.

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 Slope Analysis for the Prediction of Fluid Responsiveness by a Stepwise PEEP Elevation Recruitment Maneuver in Mechanically Ventilated Patients

2020 ◽  
Author(s):  
Sylvain VALLIER ◽  
Jean-Baptiste BOUCHET ◽  
Olivier DESEBBE ◽  
Camille FRANCOU ◽  
Darren RAPHAEL ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Cardiac Output ◽  
Fluid Responsiveness ◽  
Volume Expansion ◽  
Recruitment Maneuver ◽  
Predict Fluid Responsiveness ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Slope Analysis ◽  
Ventilated Patients

Abstract Objective:Assessment of fluid responsiveness is problematic in intensive care unit patients. Lung recruitment maneuvers (LRM) can be used as a functional test to predict fluid responsiveness. We propose a new test to predict fluid responsiveness in mechanically ventilated patients, analyzing the variations of central venous pressure (CVP) and systemic arterial parameters during a prolonged sigh breath LRM without the use of a cardiac output measuring device. Design:Prospective observational cohort study.Setting:Intensive Care Unit, Saint-Etienne University Central Hospital.Patients:Patients under mechanical ventilation, equipped with invasive arterial blood pressure, CVP, pulse contour analysis (PICCOTM), requiring volume expansion, with no right ventricular dysfunction.Interventions:None.Measurements and Main Results:CVP, systemic arterial parameters and stroke volume (SV) were recorded during prolonged LRM followed by a 500mL fluid expansion to asses fluid responsiveness. 25 patients were screened, 18 patients were analyzed. 9 patients were responders to volume expansion and 9 were not. Evaluation of hemodynamics parameters suggested the use of a linear interpolation model. Slopes for systolic aortic pressure, pulse pressure (PP), CVP and SV were all significantly different between responders and non-responders during pressure increase phase of LRM (STEP-UP) (p = 0.022, p = 0.014, p= 0.006 and p = 0.038, respectively). PP and CVP slopes during STEP-UP were strongly predictive of fluid responsiveness with an AUC of 0.926 (95% CI, 0.78 to 1.00), sensitivity = 100%, specificity = 89% and an AUC = 0.901 (95% CI, 0.76 to 1.00), sensibility = 78%, specificity = 100%, respectively. Combining sensitivity of PP and specificity of CVP, fluid responsiveness prediction can be obtained with 100% sensibility and 100% specificity (AUC=0.96; 95% CI, 0.90 to 1.00). 1 patient presented inconclusive values using the grey zone approach (5.5%).Conclusions:In patients under mechanical ventilation with no right cardiac dysfunction, the association of PP and CVP slope analysis during a prolonged sigh breath lung recruitment maneuver seems to offer a very promising method for fluid responsiveness prediction without the use and cost of a cardiac output measurement device.Trial registration: NCT04304521, IRBN902018/CHUSTERegistered 11 March 2020, Fluid responsiveness predicted by a stepwise PEEP elevation recruitment maneuver in mechanically ventilated patients (STEP-PEEP)https://www.clinicaltrials.gov/ct2/show/NCT04304521?term=NCT04304521&cntry=FR&draw=2&rank=1

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