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Dynamic arterial elastance as a predictor of arterial pressure response to fluid administration: a validation study.

García, MIM; Romero, MG; Cano, AG; Aya, HD; Rhodes, A; Grounds, RM; Cecconi, M (2014) Dynamic arterial elastance as a predictor of arterial pressure response to fluid administration: a validation study. Crit Care, 18 (6). p. 626. ISSN 1466-609X https://doi.org/10.1186/s13054-014-0626-6
SGUL Authors: Rhodes, Andrew

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Abstract

INTRODUCTION: Functional assessment of arterial load by dynamic arterial elastance (Eadyn), defined as the ratio between pulse pressure variation (PPV) and stroke volume variation (SVV), has recently been shown to predict the arterial pressure response to volume expansion (VE) in hypotensive, preload-dependent patients. However, because both SVV and PPV were obtained from pulse pressure analysis, a mathematical coupling factor could not be excluded. We therefore designed this study to confirm whether Eadyn, obtained from two independent signals, allows the prediction of arterial pressure response to VE in fluid-responsive patients. METHODS: We analyzed the response of arterial pressure to an intravenous infusion of 500 ml of normal saline in 53 mechanically ventilated patients with acute circulatory failure and preserved preload dependence. Eadyn was calculated as the simultaneous ratio between PPV (obtained from an arterial line) and SVV (obtained by esophageal Doppler imaging). A total of 80 fluid challenges were performed (median, 1.5 per patient; interquartile range, 1 to 2). Patients were classified according to the increase in mean arterial pressure (MAP) after fluid administration in pressure responders (≥ 10%) and non-responders. RESULTS: Thirty-three fluid challenges (41.2%) significantly increased MAP. At baseline, Eadyn was higher in pressure responders (1.04 ± 0.28 versus 0.60 ± 0.14; P < 0.0001). Preinfusion Eadyn was related to changes in MAP after fluid administration (R (2) = 0.60; P < 0.0001). At baseline, Eadyn predicted the arterial pressure increase to volume expansion (area under the receiver operating characteristic curve, 0.94; 95% confidence interval (CI): 0.86 to 0.98; P < 0.0001). A preinfusion Eadyn value ≥ 0.73 (gray zone: 0.72 to 0.88) discriminated pressure responder patients with a sensitivity of 90.9% (95% CI: 75.6 to 98.1%) and a specificity of 91.5% (95% CI: 79.6 to 97.6%). CONCLUSIONS: Functional assessment of arterial load by Eadyn, obtained from two independent signals, enabled the prediction of arterial pressure response to fluid administration in mechanically ventilated, preload-dependent patients with acute circulatory failure.

Item Type: Article
Additional Information: © García et al.; licensee BioMed Central Ltd. 2014 This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Keywords: Aged, Arterial Pressure, Blood Flow Velocity, Cardiac Output, Female, Fluid Therapy, Humans, Male, Middle Aged, Predictive Value of Tests, Prospective Studies, Respiration, Artificial, Stroke Volume, Humans, Blood Flow Velocity, Cardiac Output, Stroke Volume, Fluid Therapy, Respiration, Artificial, Prospective Studies, Predictive Value of Tests, Aged, Middle Aged, Female, Male, Arterial Pressure, 11 Medical And Health Sciences, Emergency & Critical Care Medicine
SGUL Research Institute / Research Centre: Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Academic Structure > Molecular and Clinical Sciences Research Institute (MCS) > Cell Sciences (INCCCS)
Journal or Publication Title: Crit Care
ISSN: 1466-609X
Language: eng
Dates:
DateEvent
19 November 2014Published
28 October 2014Accepted
Publisher License: Creative Commons: Attribution 4.0
PubMed ID: 25407570
Web of Science ID: WOS:000355092500040
Go to PubMed abstract
URI: http://sgultest.da.ulcc.ac.uk/id/eprint/110386
Publisher's version: https://doi.org/10.1186/s13054-014-0626-6

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