Ability of short-time low peep challenge to predict fluid responsiveness in mechanically ventilated patients in the intensive care

AbstractShort-time low PEEP challenge (SLPC, application of additional 5  cmH2O PEEP to patients for 30  s) is a novel functional hemodynamic test presented in the literature. We hypothesized that SLPC could predict fluid responsiveness better than stroke volume variation (SVV) in mechanically ventilated intensive care patients. Heart rate, mean arterial pressure, stroke volume index (SVI) and SVV we re recorded before SLPC, during SLPC and before and after 500 mL fluid loading. Patients whose SVI increased more than 15% after the fluid loading were defined as fluid responders. Reciever operating characteristics (ROC) curves were generated to evaluate the abilities of the methods to predict flu id responsiveness. Fifty-five patients completed the study. Twenty-five (46%) of them were responders. Decrease percentage in SVI during SLPC (SVIΔ%–SLPC) was 11.6 ± 5.2% and 4.3 ± 2.2% in responders and non-responders, respectively (p <  0.001). A good correlation was found between SVIΔ%–SLPC and percentage change in SVI after fluid loading (r = 0.728, P <  0.001). Areas under the ROC curves (ROC–AUC) of SVIΔ%–SLPC and SVV were 0.951 (95% CI 0.857–0.991) and 0.747 (95% CI 0.611–0.854), respectively. The ROC–AUC of SVIΔ%–SLPC was significantly higher than that of SVV (p = 0.0045). The best cut-off value of SVIΔ%–SLPC was 7.5% wit h 90% sensitivity and 96% specificity. The percentage change in SVI during SLPC predicts fluid respo...
Source: Journal of Clinical Monitoring and Computing - Category: Information Technology Source Type: research