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CRITICAL CARE AND TRAUMA

The Influence of Tidal Volume on the Dynamic Variables of Fluid Responsiveness in Critically Ill Patients

Service d’Anesthésie-Réanimation et Unité Propre de Recherche de l’Enseignement Supérieur-Equipe d’Accueil (UPRES-EA 3540); Laboratoire de Biochimie Générale; Laboratoire d’Explorations Fonctionnelles Cardiorespiratoires; Université de Paris Sud, Hôpital de Bicêtre (APHP), Le Kremlin Bicêtre, France

Address correspondence and reprint requests to Alain R. Edouard, MD, PhD, Service d’Anesthésie-Réanimation, Hôpital de Bicêtre, 94275 Le Kremlin Bicêtre, France. Address e-mail to alain.edouard{at}bct.ap-hop-paris.fr.

Respiratory-related variabilities in stroke volume and arterial pulse pressure (%Pp) are proposed to predict fluid responsiveness. We investigated the influence of tidal volume (Vt) and adrenergic tone on these variables in mechanically ventilated patients. Cyclic changes in aortic velocity–time integrals (%VTI_Ao, echocardiography) and %Pp (catheter) were measured simultaneously before and after intravascular volume expansion, and Vt was randomly varied below and above its basal value. Intravascular volume expansion was performed by hydroxyethyl starch (100 mL, 60 s). Receiver operating characteristic curves were generated for %VTI_Ao, %Pp and left ventricle cross-sectional end-diastolic area (echocardiography), considering the change in stroke volume after intravascular volume expansion (15%) as the response criterion. Covariance analysis was used to test the influence of Vt on %VTI_Ao and %Pp. Twenty-one patients were prospectively included; 9 patients (43%) were responders to intravascular volume expansion. %VTI_Ao and %Pp were higher in responders compared with nonresponders. Predictive values of %VTI_Ao and %Pp were similar (threshold: 20.4% and 10.0%, respectively) and higher than that of left ventricle cross-sectional end-diastolic area at the appropriate level of Vt. %Pp was slightly correlated with norepinephrine dosage. %Pp increased with the increase in the level of Vt both before and after intravascular volume expansion, contrasting with an unexpected stability of %VTI_Ao. In conclusion, %VTI_Ao and %Pp are good predictors of intravascular fluid responsiveness but the divergent evolution of these two variables when Vt was increased needs further explanation.

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Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999