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Dynamic arterial elastance to predict arterial pressure response to volume loading in preload-dependent patients.doc

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Dynamic arterial elastance to predict arterial pressure response to volume loading in preload-dependent patients

MongeGarcíaetal.CriticalCare2011,15:R15 /content/15/1/R15 RESEARCH OpenAccess Dynamicarterialelastancetopredictarterial pressureresponsetovolumeloadingin preload-dependentpatients ManuelIgnacioMongeGarcía*,AnselmoGilCano,ManuelGraciaRomero Abstract Introduction:Hemodynamicresuscitationshouldbeaimedatachievingnotonlyadequatecardiacoutputbut alsosufficientmeanarterialpressure(MAP)toguaranteeadequatetissueperfusionpressure.Sincethearterial pressureresponsetovolumeexpansion(VE)dependsonarterialtone,knowingwhetherapatientispreload- dependentprovidesonlyapartialsolutiontotheproblem.Theobjectiveofthisstudywastoassesstheabilityofa functionalevaluationofarterialtonebydynamicarterialelastance(Eadyn),definedasthepulsepressurevariation (PPV)tostrokevolumevariation(SVV)ratio,topredictthehemodynamicresponseinMAPtofluidadministration inhypotensive,preload-dependentpatientswithacutecirculatoryfailure. Methods:Weperformedaprospectiveclinicalstudyinanadultmedical/surgicalintensivecareunitinatertiary careteachinghospital,including25patientswithcontrolledmechanicalventilationwhoweremonitoredwiththe Vigileo? monitor,forwhomthedecisiontogivefluidswasmadebecauseofthepresenceofacutecirculatory failure,includingarterialhypotension(MAP≤65mmHgorsystolicarterialpressure90mmHg)andpreserved preloadresponsivenesscondition,definedasaSVVvalue≥10%. Results:Beforefluidinfusion,Eadyn wassignificantlydifferentbetweenMAPresponders(MAPincrease≥15%after VE)andMAPnonresponders.VE-inducedincreasesinMAPwerestronglycorrelatedwithbaselineEadyn (r2=0.83; P0.0001).TheonlypredictorofMAPincreasewasEadyn (areaunderthecurve,0.986±0.02;95%confidence interval(CI),0.84-1).AbaselineEadyn value0.89predictedaMAPincreaseafterfluidadministrationwitha sensitivityof93.75%(95%CI,69.8%-99.8%)andaspecificityof100%(95%CI,66.4%-100%). Conclusions:FunctionalassessmentofarterialtonebyEadyn,measuredasthePVVtoSVVratio,predictedarterial pressureresponseaftervolumeloadinginhypotensive,preload-dependentpatientsundercont