Background
Methods
Study aim
Study design
Patients
Protocol description
Measurements
Study endpoints
Statistical analysis
Results
Population
Characteristics | Overall population (n = 33) | Fluid non-responders (n = 18) | Fluid Responders (n = 15) |
p
|
---|---|---|---|---|
Age (years) | 69 (63–78) | 68 (60–71) | 74 (66–78) | 0.14 |
Male gender | 23 (70%) | 12 (67%) | 11 (73%) | 0.72 |
SAPS II | 58 (49–65) | 56 (45–65) | 58 (54–62) | 0.47 |
Time between ARDS onset and inclusion (day) | 1 (0–3) | 1 (0–1) | 2 (1–6) | 0.03 |
ARDS category | 0.28 | |||
• moderate ARDS | 10 (30%) | 7 (39%) | 3 (20%) | |
• severe ARDS | 23 (70%) | 11 (61%) | 12 (80%) | |
ARDS risk factorsa
| ||||
• pneumonia | 23 (72%) | 13 (72%) | 10 (67%) | 1 |
• non-pulmonary sepsis | 5 (15%) | 1 (6%) | 4 (27%) | 0.15 |
• aspiration of gastric content | 5 (15%) | 4 (22%) | 1 (7%) | 0.35 |
• other | 2 (6%) | 0 (0%) | 2 (13%) | 0.20 |
SOFA score | 11 (10–13) | 11 (9–13) | 12 (10–14) | 0.35 |
Midazolam dose (mg.kg-1.h-1) | 0.10 (0.06–0.13) | 0.09 (0.07–0.13) | 0.10 (0.06–0.12) | 0.90 |
Morphine dose (mg.kg-1.h-1) | 0.05 (0.04–0.07) | 0.04 (0.03–0.07) | 0.06 (0.04–0.08) | 0.36 |
ARDS adjunctive therapies | ||||
• NMBA administration | 30 (91%) | 16 (89%) | 14 (93%) | 1 |
• iNO administration | 4 (12%) | 2 (11%) | 2 (13%) | 1 |
• renal replacement therapy | 14 (42%) | 7 (39%) | 7 (47%) | 0.73 |
Clinician justification to administer intravascular fluidsb
| ||||
• arterial lactate >2 mmol.L-1
| 23 (70%) | 13 (72%) | 10 (67%) | 1 |
• MAP <65 mm Hg | 17 (52%) | 12 (67%) | 5 (33%) | 0.08 |
• cardiac output decrease | 12 (36%) | 5 (28%) | 7 (47%) | 0.30 |
• urine output <0.5 ml.kg.h-1
| 11 (33%) | 5 (28%) | 6 (40%) | 0.49 |
• heart rate >100 min-1
| 11 (33%) | 5 (28%) | 6 (40%) | 0.49 |
• skin mottling | 10 (30%) | 5 (28%) | 5 (33%) | 1 |
• 1 of the above criteria | 7 (21%) | 4 (22%) | 3 (20%) | |
• > 1 of the above criteria | 26 (79%) | 14 (78%) | 12 (80%) | 1 |
Cause of circulatory failure | ||||
• septic shock | 29 (88%) | 15 (83%) | 14 (93%) | 0.61 |
• cardiogenic shock | 2 (6%) | 1 (6%) | 1 (7%) | 1 |
• other | 2 (6%) | 2 (11%) | 0 (0%) | 0.49 |
Cardiac arrhythmia | 1 | |||
• atrial fibrillation | 7 (21%) | 4 (22%) | 3 (20%) | |
• other | 7 (21%) | 4 (22%) | 3 (20%) | |
• none | 19 (58%) | 10 (56%) | 9 (60%) |
Parameters | Overall population (n = 33) | Fluid non-responders (n = 18) | Fluid responders (n = 15) |
p
|
---|---|---|---|---|
Norepinephrine administration | 28 (85%) | 17 (94%) | 11 (73%) | 0.15 |
Norepinephrine dose (μg.kg-1.min-1) | 0.98 (0.41–1.50) | 0.68 (0.35–1.04) | 1.32 (0.71–1.97) | 0.12 |
Dobutamine administration | 7 (21%) | 4 (22%) | 3 (20%) | 1 |
Dobutamine dose (μg.kg-1.min-1) | 10.0 (7.5–14.8) | 11.4 (8.8–13.8) | 10.0 (5.2–14.9) | 0.86 |
Heart rate (min-1) | 100 (93–115) | 102 (92–117) | 100 (93–112) | 0.69 |
MAP (mm Hg) | 69 (64–72) | 67 (62–71) | 70 (68–72) | 0.14 |
PPV (%)a
| 7 (5–10) | 7 (5–8) | 7 (5–11) | 0.92 |
CVP (mm Hg) | 7 (5–11) | 7 (5–10) | 7 (4–11) | 0.93 |
CITPTD (L.min-1.m-2) | 2.75 (2.06–3.50) | 2.94 (2.26–3.50) | 2.70 (2.04–3.04) | 0.48 |
GEDVI (ml.m-2) | 701 (587–854) | 697 (586–866) | 701 (614–773) | 0.89 |
ELWI (ml.kg-1 PBW) | 14.6 (11.8–20.4) | 15.8 (12.6–20.9) | 13.7 (10.1–18.3) | 0.23 |
Global ejection fraction (%) | 16 (13–18) | 16 (14–20) | 16 (13–17) | 0.66 |
Respiratory rate (min-1) | 30 (28–35) | 30 (28–35) | 30 (28–35) | 0.84 |
Heart rate/respiratory rate ≤3.6 | 20 (61%) | 10 (56%) | 10 (67%) | 0.72 |
Tidal volume (ml.kg-1 PBW) | 6.0 (5.9–6.1) | 6.0 (6.0–6.1) | 6.0 (5.9–6.0) | 0.31 |
PEEP (cm H2O) | 8 (5–10) | 8 (6–10) | 8 (6–10) | 0.67 |
PEEPt,rs (cm H2O) | 9 (8–11) | 9 (8–11) | 10 (8–12) | 0.83 |
Pplat,rs (cm H2O) | 22 (20–27) | 22 (20–28) | 22 (18–26) | 0.54 |
Driving pressure (cm H2O) | 12 (10–15) | 13 (10–18) | 11 (9–14) | 0.23 |
Cst,rs (mL.cm H2O-1) | 30 (23–39) | 28 (21–38) | 31 (25–43) | 0.26 |
pH | 7.33 (7.27–7.38) | 7.31 (7.27–7.36) | 7.38 (7.28–7.42) | 0.20 |
PaO2/FiO2 (Torr) | 158 (120–208) | 155 (120–167) | 207 (109–241) | 0.17 |
PaCO2 (Torr) | 41 (38–51) | 46 (41–52) | 38 (36–44) | 0.06 |
Arterial lactate (mmol.L-1) | 2.5 (1.9–6.4) | 2.5 (1.9–6.3) | 2.5 (1.8–5.8) | 0.94 |
Hemodynamic measurements
Variables | Baseline-1 | Trendelenburg | Baseline-2 | VT 8 | Baseline-3 | EEO | Baseline-4 | VE |
---|---|---|---|---|---|---|---|---|
HR (min-1) | 101 (93-115) | 100 (93–113) | 100 (92–117) | 100 (92–114) | 101 (92–115) | 100 (93–113) | 99 (92–115) | 98 (90–110) |
MAP (mm Hg) | 69 (64–72) | - | 67 (62–72) | - | 66 (62–72) | - | 67 (62–73) | 78 (71–85)* |
PPV (%)a
| 7 (5–10) | - | 7 (6–8) | 11 (7–16)* | 8 (5–9) | - | 7 (5–8) | 5 (3–10) |
CVP (mm Hg) | 7 (5–11) | 11 (9–15)* | 7 (4–11) | 7 (4–11) | 7 (4–10) | 6 (4–10)** | 7 (5–11) | 9 (7–13)* |
CCI (L.min-1.m-2) | 2.8 (2.2–3.4) | 3.2 (2.5–3.5)* | 2.8 (2.1–3.4) | 2.7 (2.1–3.4) | 2.6 (2.0–3.4) | 2.8 (2.2–3.4) | 2.8 (2.0–3.4) | 3.1 (2.6–3.7)* |
CITPTD (L.min-1.m-2) | 2.75 (2.06-3.50) | - | - | - | - | - | - | 3.16 (2.51–3.84)* |
GEDVI (mL.m-2) | 696 (587–797) | - | - | - | - | - | - | 727 (606–894)* |
ELWI (mL.kg-1 PBW) | 14.6 (11.8–20.4) | - | - | - | - | - | - | 13.8 (11.7–20.1) |
GEF (%) | 16 (13–18) | - | - | - | - | - | - | 18 (15–22)* |
Trendelenburg maneuver
Tests | Number of patients analyzed | AUC (CI95%) | Optimal threshold | Gray zone of optimal threshold | Patients in gray zone, (number (%)) | Sensitivity (CI95%) | Specificity (CI95%) | PLR | NLR |
---|---|---|---|---|---|---|---|---|---|
ΔCCITREND
| 33 | 0.90* (0.80–1.00) | 8% | (5–12%) | 10 (30%) | 87% (67–100%) | 89% (72–100%) | 7.90 | 0.15 |
PPVBASELINE-1
| 19 | 0.49 (0.21–0.77) | 10% | (–Inf to Inf) | 19 (100%) | 33% (0–67%) | 80% (50–100%) | 1.65 | 0.84 |
PPVVT8
| 19 | 0.52 (0.24–0.80) | 9% | (–Inf to Inf) | 19 (100%) | 78% (44–100%) | 40% (10–70%) | 1.30 | 0.56 |
ΔPPV6-8
| 19 | 0.59 (0.31–0.88) | 29% | (17%–Inf) | 16 (84%) | 100% (100–100%) | 40% (10–70%) | 1.67 | 0 |
ΔCCIEEO
| 33 | 0.65 (0.46–0.84) | 10% | (−4% to 11%) | 26 (79%) | 33% (13–60%) | 100 (100–100%) | Inf | 0.67 |