Effects of positive end-expiratory pressure on the predictability of fluid responsiveness in acute respiratory distress syndrome patients

Abstract The prediction accuracy of pulse pressure variation (PPV) for fluid responsiveness was suggested to be unreliable in low tidal volume (VT) ventilation. However, high PEEP can cause ARDS patients relatively hypovolemic and more fluid responsive. We hypothesized that high PEEP 15 cmH2O can of...

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Autores principales:	Yen-Huey Chen, Ying-Ju Lai, Ching-Ying Huang, Hui-Ling Lin, Chung-Chi Huang
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/6d290b849cdd41c2b257a2afa57af1eb
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spelling	oai:doaj.org-article:6d290b849cdd41c2b257a2afa57af1eb2021-12-02T16:50:17ZEffects of positive end-expiratory pressure on the predictability of fluid responsiveness in acute respiratory distress syndrome patients10.1038/s41598-021-89463-22045-2322https://doaj.org/article/6d290b849cdd41c2b257a2afa57af1eb2021-05-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-89463-2https://doaj.org/toc/2045-2322Abstract The prediction accuracy of pulse pressure variation (PPV) for fluid responsiveness was suggested to be unreliable in low tidal volume (VT) ventilation. However, high PEEP can cause ARDS patients relatively hypovolemic and more fluid responsive. We hypothesized that high PEEP 15 cmH2O can offset the disadvantage of low VT and improve the predictive performance of PPV. We prospectively enrolled 27 hypovolemic ARDS patients ventilated with low VT 6 ml/kg and three levels of PEEP (5, 10, 15 cmH2O) randomly. Each stage lasted for at least 5 min to allow for equilibration of hemodynamics and pulmonary mechanics. Then, fluid expansion was given with 500 ml hydroxyethyl starch (Voluven 130/70). The hemodynamics and PPV were automatically measured with a PiCCO2 monitor. The PPV values were significantly higher during PEEP15 than those during PEEP5 and PEEP10. PPV during PEEP15 precisely predicts fluid responsiveness with a cutoff value 8.8% and AUC (area under the ROC curve) of ROC (receiver operating characteristic curve) 0.847, higher than the AUC during PEEP5 (0.81) and PEEP10 (0.668). Normalizing PPV with driving pressure (PPV/Driving-P) increased the AUC of PPV to 0.875 during PEEP15. In conclusions, high PEEP 15 cmH2O can counteract the drawback of low VT and preserve the predicting accuracy of PPV in ARDS patients.Yen-Huey ChenYing-Ju LaiChing-Ying HuangHui-Ling LinChung-Chi HuangNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-9 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Yen-Huey Chen Ying-Ju Lai Ching-Ying Huang Hui-Ling Lin Chung-Chi Huang Effects of positive end-expiratory pressure on the predictability of fluid responsiveness in acute respiratory distress syndrome patients
description	Abstract The prediction accuracy of pulse pressure variation (PPV) for fluid responsiveness was suggested to be unreliable in low tidal volume (VT) ventilation. However, high PEEP can cause ARDS patients relatively hypovolemic and more fluid responsive. We hypothesized that high PEEP 15 cmH2O can offset the disadvantage of low VT and improve the predictive performance of PPV. We prospectively enrolled 27 hypovolemic ARDS patients ventilated with low VT 6 ml/kg and three levels of PEEP (5, 10, 15 cmH2O) randomly. Each stage lasted for at least 5 min to allow for equilibration of hemodynamics and pulmonary mechanics. Then, fluid expansion was given with 500 ml hydroxyethyl starch (Voluven 130/70). The hemodynamics and PPV were automatically measured with a PiCCO2 monitor. The PPV values were significantly higher during PEEP15 than those during PEEP5 and PEEP10. PPV during PEEP15 precisely predicts fluid responsiveness with a cutoff value 8.8% and AUC (area under the ROC curve) of ROC (receiver operating characteristic curve) 0.847, higher than the AUC during PEEP5 (0.81) and PEEP10 (0.668). Normalizing PPV with driving pressure (PPV/Driving-P) increased the AUC of PPV to 0.875 during PEEP15. In conclusions, high PEEP 15 cmH2O can counteract the drawback of low VT and preserve the predicting accuracy of PPV in ARDS patients.
format	article
author	Yen-Huey Chen Ying-Ju Lai Ching-Ying Huang Hui-Ling Lin Chung-Chi Huang
author_facet	Yen-Huey Chen Ying-Ju Lai Ching-Ying Huang Hui-Ling Lin Chung-Chi Huang
author_sort	Yen-Huey Chen
title	Effects of positive end-expiratory pressure on the predictability of fluid responsiveness in acute respiratory distress syndrome patients
title_short	Effects of positive end-expiratory pressure on the predictability of fluid responsiveness in acute respiratory distress syndrome patients
title_full	Effects of positive end-expiratory pressure on the predictability of fluid responsiveness in acute respiratory distress syndrome patients
title_fullStr	Effects of positive end-expiratory pressure on the predictability of fluid responsiveness in acute respiratory distress syndrome patients
title_full_unstemmed	Effects of positive end-expiratory pressure on the predictability of fluid responsiveness in acute respiratory distress syndrome patients
title_sort	effects of positive end-expiratory pressure on the predictability of fluid responsiveness in acute respiratory distress syndrome patients
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/6d290b849cdd41c2b257a2afa57af1eb
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Effects of positive end-expiratory pressure on the predictability of fluid responsiveness in acute respiratory distress syndrome patients

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