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Effect of tidal volume challenge on fluid responsiveness in septic patients with mechanical ventilation |
Dou Zhi-min, Lin Qing-ling, Cao Yong-qiang, Li Bin, Liu Jian |
Department of Critical Care Medicine, The First Hospital of Lanzhou University, Lanzhou 730000, China |
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Abstract Objective To explore the effect of tidal volume challenge(TVC) on fluid responsiveness in patients with sepsis during mechanical ventilation. Methods Seventy-two mechanical ventilation patients with sepsis were enrolled in the department of critical care medicine (ICU) of our hospital from January 2017 to December 2017. The basic characteristics of all patients were recorded. The patients were firstly ventilated with tidal volume (Vt) 6 mL/kg (ideal weight), and the pulse pressure variability (PPV6) and stroke volume variability (SVV6) were recorded. Then tidal volume challenge (TVC) was carried out, which increased Vt from 6 mL/kg to 8 mL/kg for 2 minutes, and PPV8 and SVV8 were recorded. After the completion of TVC, all the patients continued to ventilate with Vt 6 mL/kg and maintained for 10 minutes, followed by the passive leg raising test (PLRT). A PLRT induced increase in cardiac index(CI) of at least 10% was defined as fluid responder. The patients were divided into non-responders group and responders group. The change values of PPV and SVV (ΔPPV and ΔSVV) were calculated after TVC. Results Thirty-two patients were non-responders and the other 40 were responders. There were no significant differences in sex, age, APACHE Ⅱ score, SOFA score, respiratory function, hemodynamic index and CVP, CI, PPV and SVV before TVC between the two groups. After TVC, there was a significant increase in PPV8 and SVV8 compared with PPV6 and SVV6 in the responders group (P<0.05), but there was no significant change in the non-responders group. PPV8 and SVV8 of the two groups were also statistically different (PPV8: 13.3±4.5 vs. 7.3±3.2, P<0.01; SVV8: 14.6±5.6 vs. 7.8±3.5, P<0.01). The accuracy of PPV8 and SVV8 in the evaluation of capacity reactivity was higher than that of PPV6 and SVV6 (P<0.01). While the ΔPPV and ΔSVV were the best predictor of volume responsiveness (AUROC: 0.97 and 0.95. Conclusion With tidal volume challenge, ΔPPV and ΔSVV can accurately predict the fluid responsiveness of septic patients with mechanical ventilation.
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Corresponding Authors:
Li Bin, E-mail: lynd001@163.com
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[1]Rivers E, Nguyen B, Havstad S, et al. Early goal directed therapyin the treatment of severe sepsis and septic shock[J]. N Engl J Med, 2001, 345(19): 1368-1377.
[2]Acheampong A, Vincent JL. A positive fluid balance is an independent prognostic factor in patients with sepsis[J]. Crit Care, 2015, 19: 251.
[3]Sakr Y, Rubatto Birri PN, Kotfis K, et al. Higher Fluid Balance Increases the Risk of Death From Sepsis: Results From a Large International Audit[J]. Crit Care Med, 2017, 45(3): 386-394.
[4]Monnet X, Teboul JL. Assessment of fluid responsiveness: recent advances[J]. Curr Opin Crit Care, 2018, 24(3): 190-195.
[5]Perel A, Pizov R, Cotev S. Respiratory variations in the arterial pressure during mechanical ventilation reflect volume status and fluid responsiveness[J]. Intensive Care Med, 2014, 40(6): 798-807.
[6]Yang X, Du B. Does pulse pressure variation predict fluid responsiveness in critically ill patients A systematic review and meta-analysis[J]. Crit Care, 2014, 18(6): 650.
[7]Hong JQ, He HF, Chen ZY, et al. Comparison of stroke volume variation with pulse pressure variation as a diagnostic indicator of fluid responsiveness in mechanically ventilated critically ill patients[J]. Saudi Med J, 2014, 35(3): 261-268.
[8]De Backer D, Heenen S, Piagnerelli M, et al. Pulse pressure variations to predict fluid responsiveness: Influence of tidal volume[J]. Intensive Care Med, 2005, 31(4): 517-523.
[9]Rhodes A, Evans LE, Alhazzani W, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016[J]. Intensive Care Med, 2017, 43(3): 304-377.
[10]Levy MM, Evans LE, Rhodes A. The Surviving Sepsis Campaign Bundle: 2018 Update[J]. Crit Care Med, 2018, 46(6): 997-1000.
[11]Benes J, Kirov M, Kuzkov V, et al. Fluid Therapy: Double-Edged Sword during Critical Care[J]. Biomed Res Int, 2015, 2015: 729 075.
[12]Malbrain MLNG, Van Regenmortel N, Saugel B, et al. Principles of fluid management and stewardship in septic shock: it is time to consider the four D′s and the four phases of fluid therapy[J]. Ann Intensive Care, 2018, 8(1): 66.
[13]Casey JD, Brown RM, Semler MW. Resuscitation fluids[J]. Curr Opin Crit Care, 2018, 24(6): 512-518.
[14]Monnet X, Marik PE, Teboul JL. Prediction of fluid responsiveness: an update[J]. Ann Intensive Care, 2016, 6(1): 111.
[15]Monnet X, Marik P, Teboul JL. Passive leg raising for predicting fluid responsiveness: a systematic review and meta-analysis[J]. Intensive Care Med, 2016, 42(12): 1935-1947.
[16]Perel A. The value of dynamic preload variables during spontaneous ventilation[J]. Curr Opin Crit Care, 2017, 23(4): 310-317.
[17]Mesquida J, Gruartmoner G, Ferrer R. Passive leg raising for assessment of volume responsiveness: a review[J]. Curr Opin Crit Care, 2017, 23(3): 237-243.
[18]Michard F, Boussat S, Chemla D, et al. Relation between respiratory changes in arterial pulse pressure and fluid responsiveness in septic patients with acute circulatory failure[J]. Am J Respir Crit Care Med, 2000,162(1): 134-138.
[19]Cannesson M, Le Manach Y, Hofer CK, et al. Assessing the diagnostic accuracy of pulse pressure variations for the prediction of fluid responsiveness: a “Gray Zone” approach[J]. Anesthesiology, 2011, 115(2): 231-241.
[20]Min JJ, Gil NS, Lee JH, et al. Predictor of fluid responsiveness in the ′grey zone′: augmented pulse pressure variation through a temporary increase in tidal volume[J]. Br J Anaesth, 2017, 119(1): 50-56. |
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