Pulse pressure variations to guide fluid therapy in donors: A multicentric echocardiographic observational study

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• 作者：Raphaë ; l Cinotti ; MD^a ; ^{raphael.cinotti@chu-nantes.fr" class="auth_mail} ; Antoine Roquilly ; MD^a ; ^b ; ^{antoine.roquilly@chu-nantes.fr" class="auth_mail} ; Pierre-Joachim Mah&eacute ; MD^a ; ^{pierrejoachim.mahe@chu-nantes.fr" class="auth_mail} ; Fanny Feuillet^c ; ^d ; ^{fanny.feuillet@univ-nantes.fr" class="auth_mail} ; Ahiem Yehia ; MD^e ; ^{ahiem.yehia@chd-vendee.fr" class="auth_mail} ; Guillaume Belliard ; MD^f ; ^{g.belliard@ch-bretagne-sud.fr" class="auth_mail} ; Corinne Lejus ; MD ; PhD^a ; ^{corinne.lejus@chu-nantes.fr" class="auth_mail} ; Yvonnick Blanloeil ; MD ; PhD^g ; ^{yvonnick.blanloeil@chu-nantes.fr" class="auth_mail} ; Jean-Louis Teboul ; MD ; PhD^h ; ^{jlteboul.bicetre@invivo.edu" class="auth_mail} ; Karim Asehnoune ; MD ; PhD^a ; ^b ; ^{karim.asehnoune@chu-nantes.fr" class="auth_mail} ; The ATLANR&Eacute ; A Group
• 关键词：Brain death ; Brain injuries ; Donors ; 螖PP ; Echocardiography
• 刊名：Journal of Critical Care
• 出版年：August 2014
• 年：2014
• 卷：29
• 期：4
• 页码：489-494
• 全文大小：417 K

文摘

Preload responsiveness parameters could be useful in the hemodynamic management of septic shock.

Methods

A multicentric prospective echocardiographic observational study was conducted from March 2009 to August 2011. Clinically brain-dead subjects were included. Pulse pressure variations (螖PPs) were recorded. Cardiac index, variation of the maximum flow velocity of aortic systolic blood flow, and right ventricular function parameters were evaluated via transthoracic echocardiography. Fluid responsiveness was defined by at least 15% cardiac index increase, 30 minutes after a 500-mL colloid solution infusion. The number of organs harvested was recorded.

Results

Twenty-five subjects were included. Pulse pressure variation could not discriminate responders (n = 15) from nonresponders (n = 10). The best 螖PP threshold (20%) could discriminate responders with a sensitivity of 100% and a specificity of 40%. Variation of the maximum flow velocity of aortic systolic blood flow, tricuspid annular plane systolic excursion, and right ventricle dilation could not discriminate responders from nonresponders. Eighteen subjects underwent organ harvesting. The number of organs harvested was higher in responders (3.5 [3-5]) than in nonresponders (2.5 [2-3]; P = .03).

Conclusions

A 螖PP threshold of 13% is insufficient to guide volume expansion in donors. The best threshold is 20%. Fluid responsiveness monitoring could enhance organ harvesting.