Respiratory failure & ventilation
Fluid responsiveness in acute respiratory distress syndrome patients: a post hoc analysis of the HEMOPRED study
Authors' conclusion
Performance of dynamic indices to predict FR appears preserved in ARDS patients, albeit with distinct thresholds. Hypovolemia, indicated by a > 32% increase in aortic VTI during PLR, rather than FR, was associated with ICU mortality in this population.
Study context
- Population
- Mechanically ventilated patients with shock, with and without acute respiratory distress syndrome (ARDS)
- Participants
- 540 participants
- Comparison
- ARDS vs non-ARDS: performance of dynamic indices to predict fluid responsiveness (FR)
- ARDSn = 117
- Primary endpoint
- Performance of dynamic indices to predict FR (aortic VTI increase > 10% after PLR)
Methodological detailspost hoc analysis
- Post hoc analysis
Primary result
As reported in the abstract
Prediction of FR by ΔSVC (best index)
| Group | AUC |
|---|---|
| ARDS | 0.763 [0.659-0.868] |
| non-ARDS | 0.750 [0.698-0.802] |
AUC
ARDS0.763 [0.659-0.868]
non-ARDS0.750 [0.698-0.802]
- RV/LV end-diastolic area ratio > 0.8 or paradoxical septal motion strongly linked to absence of FR
- > 80% specificity
Further findings
FR prevalence
P = 0.384
Intensive care unit (ICU) mortality: hypovolemia (aortic velocity time integral (VTI) increase > 32% during passive leg raising (PLR)) and pulse pressure variation
| OR (CI) | P value | ||
|---|---|---|---|
| HypovolemiaIndependently associated | 1.355 (1.077–1.705) | P = 0.011 | |
| Pulse pressure variation | 1.014 (1.001–1.026) | P = 0.034 | |
| 0.512Odds ratio (log scale) |
ICU mortality by FR
- FR not associated with ICU mortality (47% vs. 46%)
- P = 1
Original publication
Fluid responsiveness in acute respiratory distress syndrome patients: a post hoc analysis of the HEMOPRED study. Intensive Care Med. Published 10 September 2024. doi:10.
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