Real-time changes in pulse pressure during a 10-second end-expiratory occlusion test reliably detect preload responsiveness

Gavelli, F; De Vita, N; Lai, C; Azzolina, D; Pavot, A; Jozwiak, M; Shi, R; Adda, I; Beurton, A; Teboul, JL; Monnet, X

doi:10.1186/s13054-025-05483-8

Hemodynamics, fluids & transfusion

Real-time changes in pulse pressure during a 10-second end-expiratory occlusion test reliably detect preload responsiveness

Crit CarePublished 13 Jun 2025Diagnostic accuracy study

An erratum to this article was published (Crit Care, 19 Aug 2025 ↗)

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Authors' conclusion

In ventilated patients with sinus rhythm, real-time changes in PP during a 10-second EEO reliably detect preload responsiveness.

Study context

Population: Mechanically ventilated patients with sinus rhythm; preload responsiveness = fluid bolus-induced ΔCI ≥ 15% or passive leg raising-induced ΔCI ≥ 10%61 (43%) preload responders
Participants: 143 participants

Comparison: End-expiratory occlusion (EEO)-induced ∆PP and ∆CI at 15-, 10- and 5-second durations, with or without end-inspiratory occlusion (EIO), for detecting preload responsiveness
Outcome: Diagnostic accuracy (area under the receiver operating characteristic (AUROC)) for detecting preload responsiveness

Performance

As reported in the abstract

AUROC for detecting preload responsiveness

Test or model	AUC
∆CIEEO-15''	0.935 [0.881-0.969]
∆CIEEO-10''	0.910 [0.851-0.951]
∆CIEEO-5''	0.541 [0.456-0.625]
∆PPEEO-15''	0.913 [0.857-0.952]
∆PPEEO-10''	0.912 [0.860-0.947]
∆PPEEO-5''	0.834 (0.763-0.891

AUC

∆CIEEO-15''0.935 [0.881-0.969]

∆CIEEO-10''0.910 [0.851-0.951]

∆CIEEO-5''0.541 [0.456-0.625]

∆PPEEO-15''0.913 [0.857-0.952]

∆PPEEO-10''0.912 [0.860-0.947]

∆PPEEO-5''0.834 (0.763-0.891

∆CIEEO-10'' vs ∆CIEEO-15'': P = 0.410 — similar
∆CIEEO-5'' vs ∆CIEEO-15'': P < 0.001 — smaller
∆PPEEO-15'' vs ∆CIEEO-15'': P = 0.346 — similar
∆PPEEO-10'' vs ∆CIEEO-15'': P = 0.336 — similar
∆PPEEO-5'' vs ∆CIEEO-15'': P = 0.005 — significantly smaller

Further findings

EEO-induced changes, responders vs non-responders

∆CIEEO-15'' responders vs non-responders (median [IQR]): 5.8 [4.5-7.3]% vs. 1.1 [0.1-3.4]%; p < 0.001
∆CIEEO-10'' responders vs non-responders: 3.0 [2.4-4.3]% vs. 0.6 [0.1-1.6]%; p < 0.001
∆PPEEO-5'' responders vs non-responders: 5.2 [2.8-8.7]% vs. 1.2 [0.3-2.8]%; p < 0.001
∆PPEEO-10'' responders vs non-responders: 7.7 [5.0-12.4]% vs. 1.8 [0.5-3.1]%; p < 0.001
∆PPEEO-15'' responders vs non-responders: 8.1 [5.1-11.8]% vs. 1.5 [0.5-3.0]%; p < 0.001
∆CIEEO-5'' did not differ between responders and non-responders

Adding EIO (∆CIEEO+EIO, ∆PPEEO+EIO)

Did not enhance reliability of the test at each test duration

Reference

Authors: Gavelli F, De Vita N, Lai C, Azzolina D, Pavot A, Jozwiak M, et al.
All 11 authors
Gavelli F, De Vita N, Lai C, Azzolina D, Pavot A, Jozwiak M, Shi R, Adda I, Beurton A, Teboul JL, Monnet X
Journal: Critical Care
Published: 13 Jun 2025
DOI: 10.1186/s13054-025-05483-8
PubMed: 40514683
Registration: IDRCB 2010A0095942

Topic: Hemodynamics, fluids & transfusion

Diagnostic definitions

∆CIEEO-15'': % change in CI vs baseline, averaged over the last five seconds of the 15-sec respiratory hold
∆CIEEO-10'': % change in CI vs baseline, between the 5th and the 10th seconds of the 15-sec respiratory hold
∆CIEEO-5'': % change in CI vs baseline, during the five first seconds of respiratory hold
∆PPEEO-15'': % change in PP vs baseline, averaged over the last five seconds of the 15-sec respiratory hold
∆PPEEO-10'': % change in PP vs baseline, between the 5th and the 10th seconds of the 15-sec respiratory hold
∆PPEEO-5'': % change in PP vs baseline, during the five first seconds of respiratory hold

Original publication

Real-time changes in pulse pressure during a 10-second end-expiratory occlusion test reliably detect preload responsiveness. Crit Care. Published 13 June 2025. doi:10.1186/s13054-025-05483-8

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