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Relation between respiratory changes in arterial pulse pressure and fluid responsiveness in septic patients with acute circulatory failure

Michard, F and Boussat, S and Chemla, D and Anguel, N and Mercat, A and Lecarpentier, Y and Richard, C and Pinsky, MR and Teboul, JL (2000) Relation between respiratory changes in arterial pulse pressure and fluid responsiveness in septic patients with acute circulatory failure. American Journal of Respiratory and Critical Care Medicine, 162 (1). 134 - 138. ISSN 1073-449X

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Abstract

In mechanically ventilated patients with acute circulatory failure related to sepsis, we investigated whether the respiratory changes in arterial pressure could be related to the effects of volume expansion (VE) on cardiac index (CI). Forty patients instrumented with indwelling systemic and pulmonary artery catheters were studied before and after VE. Maximal and minimal values of pulse pressure (Pp(max) and Pp(min)) and systolic pressure (Ps(max) and Ps(min)) were determined over one respiratory cycle. The respiratory changes in pulse pressure (ΔPp) were calculated as the difference between Pp(max) and Pp(min) divided by the mean of the two values and were expressed as a percentage. The respiratory changes in systolic pressure (ΔPs) were calculated using a similar formula. The VE-induced increase in CI was ≥ 15% in 16 patients (responders) and < 15% in 24 patients (nonresponders). Before VE, ΔPp (24 ± 9 versus 7 ± 3%, p < 0.001) and ΔPs (15 ± 5 versus 6 ± 3%, p < 0.001) were higher in responders than in nonresponders. Receiver operating characteristic (ROC) curves analysis showed that ΔPp was a more accurate indicator of fluid responsiveness than ΔPs. Before VE, a ΔPp value of 13% allowed discrimination between responders and nonresponders with a sensitivity of 94% and a specificity of 96%. VE-induced changes in CI closely correlated with ΔPp before volume expansion (r = 0.85, p < 0.001). VE decreased ΔPp from 14 ± 10 to 7 ± 5% (p < 0.001) and VE-induced changes in ΔPp correlated with VE-induced changes in CI (r = 0.72, p < 0.001). It was concluded that in mechanically ventilated patients with acute circulatory failure related to sepsis, analysis of ΔPp is a simple method for predicting and assessing the hemodynamic effects of VE, and that ΔPp is a more reliable indicator of fluid responsiveness than ΔPs. 2 2


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Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Michard, F
Boussat, S
Chemla, D
Anguel, N
Mercat, A
Lecarpentier, Y
Richard, C
Pinsky, MRpinsky@pitt.eduPINSKY0000-0001-6166-700X
Teboul, JL
Date: 1 January 2000
Date Type: Publication
Journal or Publication Title: American Journal of Respiratory and Critical Care Medicine
Volume: 162
Number: 1
Page Range: 134 - 138
DOI or Unique Handle: 10.1164/ajrccm.162.1.9903035
Schools and Programs: School of Medicine > Critical Care Medicine
Refereed: Yes
ISSN: 1073-449X
PubMed ID: 10903232
Date Deposited: 22 Mar 2012 20:56
Last Modified: 30 Mar 2021 14:56
URI: http://d-scholarship.pitt.edu/id/eprint/11425

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