Clinical relevance of pulse pressure variations for predicting fluid responsiveness in mechanically ventilated intensive care unit patients: the grey zone approach
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- 作者：Matthieu Biais (1)
Stephan Ehrmann (2)
Arnaud Mari (3)
Benjamin Conte (4)
Yazine Mahjoub (5)
Olivier Desebbe (6)
Julien Pottecher (7)
Karim Lakhal (8)
Dalila Benzekri-Lefevre (9)
Nicolas Molinari (10)
Thierry Boulain (9)
Jean-Yves Lefrant (4)
Laurent Muller (4)
with the collaboration of AzuRea Group - 刊名：Critical Care
- 出版年：2014
- 出版时间：December 2014
- 年：2014
- 卷：18
- 期：6
- 全文大小：1,087 KB
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Stephan Ehrmann (2)
Arnaud Mari (3)
Benjamin Conte (4)
Yazine Mahjoub (5)
Olivier Desebbe (6)
Julien Pottecher (7)
Karim Lakhal (8)
Dalila Benzekri-Lefevre (9)
Nicolas Molinari (10)
Thierry Boulain (9)
Jean-Yves Lefrant (4)
Laurent Muller (4)
with the collaboration of AzuRea Group
1. D茅partement des Urgences, H么pital Pellegrin, CHU de Bordeaux, F-33076 Bordeaux Cedex, France and University Bordeaux Segalen, Bordeaux, France
2. Service de R茅animation Polyvalente, CHRU de Tours, 2 boulevard Tonnell茅, F37044, Tours cedex 9, France
3. H么pitaux universitaires de Toulouse, D茅partement d鈥橝nesth茅sie-R茅animation, 31059 Toulouse, France et Universit茅 Paul Sabatier, Equipe d鈥橝ccueil 4564, Toulouse, France
4. Service des R茅animations, Division Anesth茅sie, R茅animation, Urgences, Douleur, CHU N卯mes, Place du Professeur Robert Debr茅, 30029, N卯mes Cedex 9, France
5. Unit茅 de r茅animation polyvalente, CHU Amiens, Amiens, France
6. Hospices Civils de Lyon, Groupement Hospitalier Est, Department of Anesthesiology and Intensive Care, Louis Pradel Hospital, Claude Bernard Lyon 1 University, Lyon, France
7. R茅animation Chirurgicale, Service dAnesth茅sie-R茅animation Chirurgicale, P么le Anesth茅sie-R茅animations Chirurgicales-SAMU-SMUR, H么pital de Hautepierre, H么pitaux Universitaires de Strasbourg, 1 Avenue Moli猫re, 67098, Strasbourg Cedex, France
8. R茅animation Chirurgicale Polyvalente, Service d鈥橝nesth茅sie-R茅animation, H么pital Nord Laennec, Centre Hospitalier Universitaire de Nantes, Boulevard Jacques Monod, Saint Herblain, 44093, Nantes cedex 1, France
9. Service de R茅animation M茅dicale, H么pital La Source, Centre Hospitalier R茅gional, avenue de l鈥橦么pital, 45067, Orl茅ans Cedex 1, France
10. Department of Statistics, University of Montpellier Lapeyronie Hospital, UMR 729 MISTEA, Montpellier, France - ISSN：1364-8535
文摘
Introduction Pulse pressure variation (PPV) has been shown to predict fluid responsiveness in ventilated intensive care unit (ICU) patients. The present study was aimed at assessing the diagnostic accuracy of PPV for prediction of fluid responsiveness by using the grey zone approach in a large population. Methods The study pooled data of 556 patients from nine French ICUs. Hemodynamic (PPV, central venous pressure (CVP) and cardiac output) and ventilator variables were recorded. Responders were defined as patients increasing their stroke volume more than or equal to 15% after fluid challenge. The receiver operating characteristic (ROC) curve and grey zone were defined for PPV. The grey zone was evaluated according to the risk of fluid infusion in hypoxemic patients. Results Fluid challenge led to increased stroke volume more than or equal to 15% in 267 patients (48%). The areas under the ROC curve of PPV and CVP were 0.73 (95% confidence interval (CI): 0.68 to 0.77) and 0.64 (95% CI 0.59 to 0.70), respectively (P 鈭? and a driving pressure (plateau pressure - PEEP) more than 20 cmH2O significantly improved the area under the ROC curve for PPV. When taking into account the risk of fluid infusion, the grey zone for PPV was 2 to 13%. Conclusions In ventilated ICU patients, PPV values between 4 and 17%, encountered in 62% patients exhibiting validity prerequisites, did not predict fluid responsiveness.