Dynamic arterial elastance as a predictor of arterial pressure response to fluid administration: a validation study

IntroductionFunctional assessment of arterial load by dynamic arterial elastance (Eadyn), defined as the ratio between pulse-pressure variation (PPV) and stroke volume variation (SVV), has recently been shown to predict the arterial pressure response to volume expansion (VE) in hypotensive preload-dependent patients. However, since both SVV and PPV were obtained from pulse-pressure analysis, a mathematical coupling factor could not be excluded. We therefore designed this study to confirm whether Eadyn, obtained from two independent signals, allows the prediction of arterial pressure response to VE in fluid-responsive patients. Methods: We analyzed the response of arterial pressure to an intravenous infusion of 500?ml of normal saline in 53 mechanically ventilated patients with acute circulatory failure and preserved preload-dependence. Eadyn was calculated as the simultaneous ratio between PPV (obtained from an arterial line) and SVV (from an esophageal Doppler). A total of 80 fluid challenges were performed (median 1.5 per patient; IQR: 1 to 2). Patients were classified according to the increase in mean arterial pressure (MAP) after fluid administration in pressure-responders (?10%) and non-responders. Results: Thirty-three fluid challenges (41.2%) significantly increased MAP. At baseline, Eadyn was higher in pressure-responders (1.04???0.28 versus 0.60???0.14; P
Source: Critical Care - Category: Intensive Care Authors: Source Type: research