Institutional members access full text with Ovid®

Share this article on:

The Changes in Pulse Pressure Variation or Stroke Volume Variation After a “Tidal Volume Challenge” Reliably Predict Fluid Responsiveness During Low Tidal Volume Ventilation*

Myatra, Sheila Nainan MD, FCCM; Prabu, Natesh R MD, DM; Divatia, Jigeeshu Vasishtha MD, FCCM; Monnet, Xavier MD, PhD; Kulkarni, Atul Prabhakar MD, FICCM; Teboul, Jean-Louis MD, PhD

doi: 10.1097/CCM.0000000000002183
Clinical Investigations

Objectives: Stroke volume variation and pulse pressure variation do not reliably predict fluid responsiveness during low tidal volume ventilation. We hypothesized that with transient increase in tidal volume from 6 to 8 mL/kg predicted body weight, that is, “tidal volume challenge,” the changes in pulse pressure variation and stroke volume variation will predict fluid responsiveness.

Design: Prospective, single-arm study.

Setting: Medical-surgical ICU in a university hospital.

Patients: Adult patients with acute circulatory failure, having continuous cardiac output monitoring, and receiving controlled low tidal volume ventilation.

Interventions: The pulse pressure variation, stroke volume variation, and cardiac index were recorded at tidal volume 6 mL/kg predicted body weight and 1 minute after the “tidal volume challenge.” The tidal volume was reduced back to 6 mL/kg predicted body weight, and a fluid bolus was given to identify fluid responders (increase in cardiac index > 15%). The end-expiratory occlusion test was performed at tidal volumes 6 and 8 mL/kg predicted body weight and after reducing tidal volume back to 6 mL/kg predicted body weight.

Results: Thirty measurements were obtained in 20 patients. The absolute change in pulse pressure variation and stroke volume variation after increasing tidal volume from 6 to 8 mL/kg predicted body weight predicted fluid responsiveness with areas under the receiver operating characteristic curves (with 95% CIs) being 0.99 (0.98–1.00) and 0.97 (0.92–1.00), respectively. The best cutoff values of the absolute change in pulse pressure variation and stroke volume variation after increasing tidal volume from 6 to 8 mL/kg predicted body weight were 3.5% and 2.5%, respectively. The pulse pressure variation, stroke volume variation, central venous pressure, and end-expiratory occlusion test obtained during tidal volume 6 mL/kg predicted body weight did not predict fluid responsiveness.

Conclusions: The changes in pulse pressure variation or stroke volume variation obtained by transiently increasing tidal volume (tidal volume challenge) are superior to pulse pressure variation and stroke volume variation in predicting fluid responsiveness during low tidal volume ventilation.

Supplemental Digital Content is available in the text.

1Department of Anesthesiology, Critical Care and Pain, Tata Memorial Hospital, Mumbai, India.

2AP-HP, Hôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Service de réanimation médicale, Le Kremlin-Bicêtre, France.

*See also p. 558.

Existing hospital infrastructure for research was utilized.

This study was performed at Tata Memorial Hospital, Mumbai, India.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).

Drs. Monnet and Teboul are members of the Medical Advisory Board of Pulsion Medical Systems. The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: sheila150@hotmail.com

Copyright © by 2017 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.