Izvorni znanstveni članak
https://doi.org/10.26800/LV-144-supl3-6
Ability of PEEP induced lung-heart interaction to assess volume responsiveness in perioperative setting
Andrej Šribar
; Clinical department of anesthesiology, resuscitation and intensive care medicine, University hospital Dubrava, Zagreb, Croatia, School of dental medicine, University of Zagreb, Zagreb, Croatia
Ivan Gospić
; Clinical department of anesthesiology, resuscitation and intensive care medicine, University hospital Dubrava, Zagreb, Croatia
Zrinka Šafarić Oremuš
; Clinical department of anesthesiology, resuscitation and intensive care medicine, University hospital Dubrava, Zagreb, Croatia
Verica Mikecin
; Clinical department of anesthesiology, resuscitation and intensive care medicine, University hospital Dubrava, Zagreb, Croatia
Ivana Presečki
; Clinical department of anesthesiology, resuscitation and intensive care medicine, University hospital Dubrava, Zagreb, Croatia
Sanja Sakan
; Clinical department of anesthesiology, resuscitation and intensive care medicine, University hospital Dubrava, Zagreb, Croatia
Jasminka Peršec
Prilozi: 00d_SADRZAJ.pdf
Sažetak
Goal: Various monitoring methods have been used throughout history to discriminate between volume responsive and volume non-responsive patients: static parameters, dynamic parameters, and maneuver provoked parameters (positive end expiratory pressure (PEEP) induced central venous pressure (CVP) change and passive leg raise (PLR) induced stroke volume index (SVI) change). Goal of this study is to assess whether PEEP
induced lung-heart interactions may be used to reliably assess volume responsiveness in mechanically ventilated patients after major abdominal surgery. Methods: 50 sedated and relaxed mechanically ventilated patients with 5 mbar of PEEP admitted to a mixed surgical ICU were measured mean arterial pressure (MAP), heart rate (HR), CVP, cardiac index (CI), stroke volume index (SVI) and pulse pressure variation (PPV) at 5 timepoints – baseline, 3 minutes at PEEP of 15 mbar, after return of PEEP to 5 mbar, while performing PLR maneuver of 3-minute duration and after return to supine position. Receiver operator characteristic (ROC) curves were used to assess predictive ability of measured parameters to assess volume responsiveness defined as PLR induced SVI increase ≥ 7%. Results: Volume responsive patients had lower baseline CVP and SVI, and higher PPV. Both responders and non- responders had a staistically significant PEEP induced drop in SVI and MAP, with an increase of PPV and CVP. During PLR, both groups demonstrated a significant increase in MAP and CVP and decrease in PPV, but only volume responders had a significant increase of CI and SVI and heart rate decrease. ROC curves were used to assess predictive ability of parameters to assess volume responsiveness, and only PPV at 5 mbar PEEP (AUC=0.88), PPV at 15 mbar PEEP (AUC=0.83) and PLR induced HR drop (AUC=0.83) may be considered reliable in clinical practice.
Conclusions: PEEP induced hemodynamic changes do not predict volume responsiveness reliably in comparison to PPV or PLR induced HR drop. Further studies are needed in hemodynamically unstable or patients with ARDS.
Ključne riječi
HEMODYNAMIC MONITORING; PPV; VOLUME RESPONSIVENESS; PEEP; PASSIVE LEG RAISING
Hrčak ID:
284185
URI
Datum izdavanja:
25.9.2022.
Posjeta: 1.036 *