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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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