Background
Methods
Patients
Measurements
Respiratory measurements
Hemodynamic measurements
Study protocol
Statistical analysis
Results
Patients' characteristics
Age (years)
| 64 ± 13 |
---|---|
Gender (M/F)
| 16/21 |
Weight (kg)
| 77 ± 17.2 |
Height (cm)
| 166.9 ± 7.6 |
Body surface area (m
2
)
| 1.88 ± 0.21 |
Body mass index (Kg m
-2
)
| 25.9 (23.4 to 31.2) |
APACHE II score at admission
| 18.8 ± 7.3 |
ICU survival rate (%)
| 24 (65%) |
Plasma lactate level, mmol/L
| 2.79 ± 1.82 |
Ventilator settings
| |
Tidal volume, mL/Kg predicted body weight
| 8.1 ± 1.2 |
Respiratory rate, b.p.m. | 20 (18 to 20) |
Total PEEP, cm H
2
O
| 6.4 (4 to 8) |
Mean airway pressure, cmH
2
O
| 12 (9.4 to 13) |
Peak airway pressure, cmH
2
O
| 31.1 ± 6.2 |
FiO
2
,%
| 0.73 ± 0.2 |
Vasoactive agents, n; dose (μg kg
-1
min
-1
)
| |
Norepinephrine
| 22; 0.23 (0.08 to 0.33) |
Dobutamine
| 6; 6.2 (3.3 to 9.5) |
Analgesia and sedative drugs
| |
Fentanyl, n; dose (μg kg
-1
h
-1
)
| 24; 1.58 ± 0.53 |
Remifentanyl, n; dose (μg kg
-1
min
-1
)
| 13; 0.14 ± 0.04 |
Midazolam, n; dose (mg kg
-1
h
-1
)
| 24; 0.09 ± 0.03 |
Propofol, n; dose (mg kg
-1
min
-1
)
| 2; 0.79 (0.7 to 0.89) |
ARDS, n
| 3 |
Days on mechanical ventilation
| 1 (1 to 1) |
ICU length of stay, days
| 8 (5 to 16) |
Reason for fluid administration, n (%)
| |
Hypotension
| 11 (30%) |
Oliguria
| 30 (81%) |
Decrease vasoactive dosage
| 19 (51%) |
Sepsis/Septic shock
| 26 (70%) |
Abdominal
| 11 (30%) |
Pulmonary
| 10 (27%) |
Urological
| 2 (7%) |
Neurological
| 2 (7%) |
Other
| 1 (3%) |
Effects of passive leg-raising maneuver
Effects of volume expansion
Baseline | PLR | Preinfusion | After VE | |
---|---|---|---|---|
CO, L/min
| ||||
Responders
| 5.40 ± 2.25 | 6.54 ± 2.53b
| 5.33 ± 2.43 | 6.81 ± 2.81c
|
Non-responders
| 6.51 ± 2.47 | 7.03 ± 2.73b
| 6.48 ± 2.52 | 6.85 ± 2.89c
|
SV, mL
| ||||
Responders
| 53.5 ± 26.3a
| 63.8 ± 26.5b
| 52.5 ± 26.9a
| 68.1 ± 27.5c
|
Non-responders
| 76.4 ± 31.3 | 82.7 ± 33.5b
| 76.3 ± 30.9 | 81.5 ± 33.1c
|
HR, b.p.m. | ||||
Responders
| 106 ± 25a
| 106 ± 24a
| 106 ± 26a
| 103 ± 24a
|
Non-responders
| 88 ± 20 | 87 ± 18 | 87 ± 20 | 86 ± 19 |
FTc, ms
| ||||
Responders
| 292 ± 51a
| 323 ± 50b
| 291 ± 52a
| 327 ± 54c
|
Non-responders
| 343 ± 61 | 360 ± 74b
| 342 ± 62 | 355 ± 83 |
Acc, m/s
2
| ||||
Responders
| 9.6 ± 4.5 | 9.7 ± 4.9 | 9.3 ± 4.6 | 10.4 ± 5.4c
|
Non-responders
| 10.3 ± 3.9 | 10.5 ± 4.1 | 10.3 ± 3.9 | 10.7 ± 4.7 |
SAP, mmHg
| ||||
Responders
| 107 ± 21 | 120 ± 21b
| 108 ± 21 | 122 ± 25c
|
Non-responders
| 107 ± 14 | 111 ± 16b
| 105 ± 15 | 111 ± 18c
|
DAP, mmHg
| ||||
Responders
| 61 ± 11 | 65 ± 12b
| 61 ± 12 | 64 ± 12c
|
Non-responders
| 63 ± 11 | 66 ± 10b
| 63 ± 10 | 65 ± 10c
|
MAP, mmHg
| ||||
Responders
| 76 ± 14 | 83 ± 13b
| 75 ± 14 | 83 ± 15c
|
Non-responders
| 78 ± 12 | 82 ± 12b
| 77 ± 12 | 81 ± 13c
|
PP, mmHg
| ||||
Responders
| 45.8 ± 15.7 | 55.3 ± 18.3b
| 46.9 ± 13.6 | 57.7 ± 19.7a, c
|
Non-responders
| 42.1 ± 10.1 | 45.2 ± 11.9b
| 42.1 ± 11.3 | 45.9 ± 12.9c
|
CPO, W
| ||||
Responders
| 0.92 ± 0.44 | 1.22 ± 0.49b
| 0.91 ± 0.47 | 1.25 ± 0.51c
|
Non-responders
| 1.10 ± 0.38 | 1.26 ± 0.46b
| 1.11 ± 0.43 | 1.23 ± 0.53c
|
TSVR, dyn·s·cm
-5
| ||||
Responders
| 1264 ± 442 | 1143 ± 368b
| 1299 ± 481 | 1130 ± 451c
|
Non-responders
| 1124 ± 535 | 1091 ± 510 | 1119 ± 504 | 1133 ± 538 |
PETCO
2
, mmHg
| ||||
Responders
| 35 (30 to 37) | 38 (33 to 40)b
| 35 (29 to 37) | 36 (30 to 38)c
|
Non-responders
| 34 (30 to 37) | 35 (30 to 38)b
| 34 (29 to 37) | 34 (28 to 37) |
Prediction of fluid responsiveness
Threshold | Sensitivity | Specificity | PV + | PV - | LR + | LR - | |
---|---|---|---|---|---|---|---|
ΔCO
PLR
|
12%
|
95.2%
|
93.7%
|
95.2%
|
93.7%
|
15.24
|
.05
|
[95% CI]
| [76.2-99.9%] | [69.8-99.8%] | [75.5-99.9%] | [69.8-99.8%] | [13-17.9] | [0.003-0.8] | |
ΔPETCO
2-PLR
|
5%
|
90.5%
|
93.7%
|
95%
|
88.2%
|
14.48
|
.1
|
[95% CI]
| [69.6-98.8%] | [69.8-99.8%] | [75.1-99.9%] | [62.6-98.7%] | [12-17.5] | [0.01-1] | |
FTc
|
300 ms
|
66.7%
|
81.2%
|
82.4%
|
65%
|
3.56
|
.41
|
[95% CI]
| [43-85.4%] | [54.4-96%] | [55.6-96.5%] | [40.8-84.6%] | [2.4-5.2] | [0.1-1.3] | |
ΔPP
PLR
|
11%
|
66.7%
|
81.2%
|
82.4%
|
65%
|
3.56
|
.41
|
[95% CI]
| [43-85.4%] | [54.4-96%] | [55.6-96.5%] | [40.8-84.6%] | [2.4-5.2] | [0.1-1.3] |