Key result
Pulse pressure variation during forced inspiration accurately predicts fluid responsiveness with ~0.91 AUC.
Why the study?
Does pulse pressure variation during forced inspiratory breathing predict fluid responsiveness in spontaneously breathing patients?
Observational (n=59)
Does pulse pressure variation during forced inspiratory breathing predict fluid responsiveness in spontaneously breathing patients?
Effect estimate: AUC 0.910
Absolute Event Rate: 18.2% vs 10.1%
p-value: p=<0.0001
Pulse pressure variation during forced inspiratory breathing accurately predicts fluid responsiveness in spontaneously breathing patients prior to general anesthesia.
May support pre-anesthesia fluid assessment in spontaneous breathers; leaves open need for randomized validation before practice change.
We evaluated whether pulse pressure variation can predict fluid responsiveness in spontaneously breathing patients. Fifty-nine elective thoracic surgical patients were studied before induction of general anaesthesia. After volume expansion with hydroxyethyl starch 6 ml.kg(-1) , patients were defined as responders by a ≥ 15% increase in the cardiac index. Haemodynamic variables were measured before and after volume expansion and pulse pressure variations were calculated during tidal breathing and during forced inspiratory breathing. Median (IQR [range]) pulse pressure variation during forced inspiratory breathing was significantly higher in responders (n = 29) than in non-responders (n = 30) before volume expansion (18.2 (IQR 14.7-18.2 [9.3-31.3])% vs. 10.1 (IQR 8.3-12.6 [4.8-21.1])%, respectively, p < 0.001). The receiver-operating characteristic curve revealed that pulse pressure variation during forced inspiratory breathing could predict fluid responsiveness (area under the curve 0.910, p < 0.0001). Pulse pressure variation measured during forced inspiratory breathing can be used to guide fluid management in spontaneously breathing patients.
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Hong et al. (2014) conducted an observational in Elective thoracic surgery (n=59). Pulse pressure variation during forced inspiratory breathing vs. Non-responders was evaluated on Fluid responsiveness (≥ 15% increase in cardiac index after volume expansion) (AUC 0.910, p=<0.0001). Pulse pressure variation during forced inspiratory breathing accurately predicted fluid responsiveness in spontaneously breathing patients (AUC 0.910, P<0.0001).
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