Hemodynamics, fluids & transfusion
The increase in cardiac output induced by a decrease in positive end-expiratory pressure reliably detects volume responsiveness: the positive end-expiratory pressure (PEEP)-test study
Authors' conclusion
A CI increase > 8.6% during a PEEP-test, which consists in reducing PEEP to 5 cmH2O, reliably detects volume responsiveness in mechanically ventilated patients with a PEEP ≥ 10 cmH2O.
Study context
- Population
- Mechanically ventilated patients with PEEP ≥ 10 cmH2O and without spontaneous breathing
- Participants
- 64 participants
- Comparison
- PEEP-test vs passive leg raising (PLR)-test as reference for volume responsiveness
- Volume responsiven = 31
- Outcome
- Detection of volume responsiveness by CI increase during the PEEP-test
Methodological detailsprospective
- Prospective
Performance
As reported in the abstract
PEEP-test (CI increase > 8.6%) for detecting volume responsiveness
| Test or model | Sensitivity | Specificity | AUC |
|---|---|---|---|
| PEEP-test | 96.8% (95%CI: 83.3-99.9%) | 84.9% (95%CI 68.1-94.9%) | 0.94 (95%CI 0.85-0.98) (p < 0.0001 vs. 0.5) |
PEEP-test
Sensitivity96.8% (95%CI: 83.3-99.9%)
Specificity84.9% (95%CI 68.1-94.9%)
AUC0.94 (95%CI 0.85-0.98) (p < 0.0001 vs. 0.5)
Further findings
Median
| Outcome | Volume responsive | Volume unresponsive |
|---|---|---|
| CI change during PEEP-test | 16% (IQR 12–20%) | 6% (IQR 3–8%) |
| CI change during PLR | — not stated in the abstract | 2% (IQR 1–5%) |
— not stated in the abstract
- CI change during PEEP-test — CI in volume responsive from 2.4 ± 0.7 to 2.9 ± 0.9 L/min/m²
- p < 0.0001
- CI change during PLR — Median increase in CI during PLR (all patients)
- 14% (11-16%)
Correlation of CI changes by PLR and PEEP-test
- Spearman's correlation coefficient
- 0.76 (95%CI 0.63-0.85, p < 0.0001)
Original publication
The increase in cardiac output induced by a decrease in positive end-expiratory pressure reliably detects volume responsiveness: the PEEP-test study. Crit Care. Published 9 April 2023. doi:10.
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