Hemodynamics, fluids & transfusion
Inspiratory effort impacts the accuracy of pulse pressure variations for fluid responsiveness prediction in mechanically ventilated patients with spontaneous breathing activity: a prospective cohort study
Authors' conclusion
PPV is reliable in predicting FR in patients who received controlled ventilation with low spontaneous effort, defined as P0.1 < 1.5 cmH2O.
Study context
- Population
- Patients with acute circulatory failure on volume-controlled ventilation with spontaneous breathing activity, ICU of a university hospital53 (28.0%) responders
- Participants
- 189 patients
- Exposure
- PPV for fluid responsiveness prediction by inspiratory effort
- Outcome
- Accuracy of PPV to predict fluid responsiveness (cardiac output increase ≥ 10% after fluid challenge), by AUROC and gray zone
Methodological detailsdiagnostic accuracy, single-centre
- Diagnostic accuracy
- Single-centre
Main finding
As reported in the abstract
AUROC of PPV for fluid responsiveness by P0.1 stratum
| Group | Areas under receiver operating characteristic (AUROC) | PPV cut-off | Gray zone |
|---|---|---|---|
| P0.1 < 1.5 cmH2O | 0.90 (0.82-0.99) | 10.5% | 10.5-11.5% |
| P0.1 ≥ 1.5 cmH2O | 0.68 (0.57-0.79) | 9.5% | 8.5-16.5% |
Areas under receiver operating characteristic (AUROC)
P0.1 < 1.5 cmH2O0.90 (0.82-0.99)
P0.1 ≥ 1.5 cmH2O0.68 (0.57-0.79)
PPV cut-off
P0.1 < 1.5 cmH2O10.5%
P0.1 ≥ 1.5 cmH2O9.5%
Gray zone
P0.1 < 1.5 cmH2O10.5-11.5%
P0.1 ≥ 1.5 cmH2O8.5-16.5%
- P0.1 < 1.5 cmH2O vs P0.1 ≥ 1.5 cmH2O: P = 0.0016
Observational data: associations, not effects.
Further findings
AUROC of PPV, whole population
- PPV > 9.5% predicted fluid responsiveness, AUROC
- 0.79 (0.67-0.83)
PPV performance by ΔPocc median (< −9.8 vs ≥ −9.8 cmH2O)
- Predictive performance of PPV did not differ significantly between ΔPocc strata
Original publication
Inspiratory effort impacts the accuracy of pulse pressure variations for fluid responsiveness prediction in mechanically ventilated patients with spontaneous breathing activity: a prospective cohort study. Ann Intensive Care. Published 17 August 2023. doi:10.
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