Hemodynamic Monitoring Clinical Trial
Official title:
Can Dynamic Changes of Pulse Pressure Variation During Passive Leg Raising or a Tidal Volume Challenge Help Predicting Preload Responsiveness in Mechanically Ventilated Patients With Spontaneous Breathing Activity
Background: Predicting preload responsiveness by using dynamic indicators before
administering fluids to critically ill patients is nowadays routinely performed at the
bedside. Unlike other dynamic indicators of preload responsiveness that require cardiac
output monitoring, pulse pressure variation (PPV) can be simply obtained via an arterial
catheter . However, PPV is not reliable in mechanically ventilated patients with spontaneous
breathing activity. We hypothesized that an increase in PPV after a tidal volume (TV)
challenge (TVC) or a decrease in PPV during passive leg raising (PLR) will predict preload
responsiveness in such cases.
Objective: to examine if the change in PPV during PLR and after a TVC can predict preload
responsiveness in patients with mechanical ventilation and persistent spontaneous breathing
Prospective non interventional study conducted in two intensive care units. Patients under
mechanical ventilation with spontaneous cycles, for whom the physician in charge decided to
test preload responsiveness were included. We collected demographic and clinical information,
the use of mechanical ventilation and its parameters, the use of vasopressors and their
dosage and blood lactate.
Firstly, transthoracic echocardiography (TTE) was performed to measure the velocity time
integral (VTI) of the left ventricular outflow tract .
A PLR maneuvre is performed with TTE probe in place and a new assessement of VTI is measured,
in addition to the PPV and other hemodynamic parmeters (Diastolic, mean and systolic arterial
pressure, heart rate, CVP). Delta VTI is the difference between VTI during PLR and VTI at
baseline divided by VTI at baseline.
Patients were considered as preload responsive when delta VTI was ≥10%. Secondly, a TVC was
performed by increasing the TV by 2mL/kg predicted body weight from its baseline value . PPV
was recorded before and after the TVC in addition to the other hemodynamic parmeters listed
above. Further more, respiratory parameters are collected: ventilator setting, plateau
pressure, upper airway pressure, before and during the TVC.
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