Predicting volume responsiveness by using the end-expiratory occlusion in mechanically ventilated intensive care unit patients

• DOI: 10.1097/ccm.0b013e3181968fe1
• Publication Date: 2009-02-23T08:33:15Z
• Authors: Xavier Monnet; David Osman; Christophe Ridel; Bouchra Lamia; Christian Richard; Jean-Louis Teboul
• Keywords: Preload; Pulse pressure; Cardiac index; Positive End-Expiratory Pressure; Pulmonary wedge pressure; Mean arterial pressure

During mechanical ventilation, inspiration cyclically decreases the left cardiac preload. Thus, an end-expiratory occlusion may prevent cyclic impediment in preload and act like a fluid challenge. We tested whether this could serve as functional test for responsiveness patients with circulatory failure.Prospective study.Medical intensive care unit.Thirty-four mechanically ventilated shock whom volume expansion was planned.A 15-second followed by 500 mL saline infusion.Arterial pressure pulse contour-derived index (PiCCOplus) at baseline, during passive leg raising (PLR), 5-last seconds of occlusion, after expansion.Volume increased >15% (2.4 +/- 1.0 to 3.3 1.2 L/min/m, p < 0.05) 23 ("responders"). Before expansion, significantly arterial 15% 12% 11% responders whereas did not change nonresponders. Fluid predicted increase >or=5% sensitivity specificity 87% 100%, respectively, 91% respectively. The response accuracy that similar PLR better than (receiver operating characteristic curves area 0.957 [95% confidence interval [CI:] 0.825-0.994], 0.972 CI: 0.849-0.995], 0.937 0.797-0.990], 0.675 0.497-0.829], respectively).The hemodynamic can predict patients.