Repositório Digital

A- A A+

Pulse pressure variation and prediction of fluid responsiveness in patients ventilated with low tidal volume

.

Pulse pressure variation and prediction of fluid responsiveness in patients ventilated with low tidal volume

Mostrar registro completo

Estatísticas

Título Pulse pressure variation and prediction of fluid responsiveness in patients ventilated with low tidal volume
Autor Costa, Clarisse Daniele Alves de Oliveira
Friedman, Gilberto
Vieira, Silvia Regina Rios
Fialkow, Léa
Abstract OBJECTIVE: To determine the utility of pulse pressure variation (DRESPPP) in predicting fluid responsiveness in patients ventilated with low tidal volumes (VT) and to investigate whether a lower DRESPPP cut-off value should be used when patients are ventilated with low tidal volumes. METHOD: This cross-sectional observational study included 37 critically ill patients with acute circulatory failure who required fluid challenge. The patients were sedated and mechanically ventilated with a VT of 6-7 ml/kg ideal body weight, which was monitored with a pulmonary artery catheter and an arterial line. The mechanical ventilation and hemodynamic parameters, including DRESPPP, were measured before and after fluid challenge with 1,000 ml crystalloids or 500 ml colloids. Fluid responsiveness was defined as an increase in the cardiac index of at least 15%. ClinicalTrial.gov: NCT01569308. RESULTS: A total of 17 patients were classified as responders. Analysis of the area under the ROC curve (AUC) showed that the optimal cut-off point for DRESPPP to predict fluid responsiveness was 10% (AUC = 0.74). Adjustment of the DRESPPP to account for driving pressure did not improve the accuracy (AUC = 0.76). A DRESPPP$10% was a better predictor of fluid responsiveness than central venous pressure (AUC = 0.57) or pulmonary wedge pressure (AUC = 051). Of the 37 patients, 25 were in septic shock. The AUC for DRESPPP$10% to predict responsiveness in patients with septic shock was 0.84 (sensitivity, 78%; specificity, 93%). CONCLUSION: The parameter DRESPPP has limited value in predicting fluid responsiveness in patients who are ventilated with low tidal volumes, but a DRESPPP.10% is a significant improvement over static parameters. A DRESPPP$10% may be particularly useful for identifying responders in patients with septic shock.
Contido em Clinics. São Paulo. Vol. 67, no. 7 (Jul. 2012), p. 773–778
Assunto Débito cardíaco
Pressão arterial
Respiração artificial
Volume de ventilação pulmonar
[en] Cardiac output
[en] Fluid responsiveness
[en] Low tidal volume
[en] Pulse pressure variation
Origem Nacional
Tipo Artigo de periódico
URI http://hdl.handle.net/10183/108658
Arquivos Descrição Formato
000874070.pdf (266.0Kb) Texto completo (inglês) Adobe PDF Visualizar/abrir

Este item está licenciado na Creative Commons License

Este item aparece na(s) seguinte(s) coleção(ões)


Mostrar registro completo

Percorrer



  • O autor é titular dos direitos autorais dos documentos disponíveis neste repositório e é vedada, nos termos da lei, a comercialização de qualquer espécie sem sua autorização prévia.
    Projeto gráfico elaborado pelo Caixola - Clube de Criação Fabico/UFRGS Powered by DSpace software, Version 1.8.1.