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Critical Care
Published in: Critical Care 5/2009

Open Access 01-10-2009 | Research

Brachial artery peak velocity variation to predict fluid responsiveness in mechanically ventilated patients

Authors: Manuel Ignacio Monge García, Anselmo Gil Cano, Juan Carlos Díaz Monrové

Published in: Critical Care | Issue 5/2009

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Abstract

Introduction

Although several parameters have been proposed to predict the hemodynamic response to fluid expansion in critically ill patients, most of them are invasive or require the use of special monitoring devices. The aim of this study is to determine whether noninvasive evaluation of respiratory variation of brachial artery peak velocity flow measured using Doppler ultrasound could predict fluid responsiveness in mechanically ventilated patients.

Methods

We conducted a prospective clinical research in a 17-bed multidisciplinary ICU and included 38 mechanically ventilated patients for whom fluid administration was planned due to the presence of acute circulatory failure. Volume expansion (VE) was performed with 500 mL of a synthetic colloid. Patients were classified as responders if stroke volume index (SVi) increased ≥ 15% after VE. The respiratory variation in Vpeakbrach (ΔVpeakbrach) was calculated as the difference between maximum and minimum values of Vpeakbrach over a single respiratory cycle, divided by the mean of the two values and expressed as a percentage. Radial arterial pressure variation (ΔPPrad) and stroke volume variation measured using the FloTrac/Vigileo system (ΔSVVigileo), were also calculated.

Results

VE increased SVi by ≥ 15% in 19 patients (responders). At baseline, ΔVpeakbrach, ΔPPrad and ΔSVVigileo were significantly higher in responder than nonresponder patients [14 vs 8%; 18 vs. 5%; 13 vs 8%; P < 0.0001, respectively). A ΔVpeakbrach value >10% predicted fluid responsiveness with a sensitivity of 74% and a specificity of 95%. A ΔPPrad value >10% and a ΔSVVigileo >11% predicted volume responsiveness with a sensitivity of 95% and 79%, and a specificity of 95% and 89%, respectively.

Conclusions

Respiratory variations in brachial artery peak velocity could be a feasible tool for the noninvasive assessment of fluid responsiveness in patients with mechanical ventilatory support and acute circulatory failure.

Trial Registration

ClinicalTrials.gov ID: NCT00890071
Appendix
Available only for authorised users
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Metadata
Title
Brachial artery peak velocity variation to predict fluid responsiveness in mechanically ventilated patients
Authors
Manuel Ignacio Monge García
Anselmo Gil Cano
Juan Carlos Díaz Monrové
Publication date
01-10-2009
Publisher
BioMed Central
Published in
Critical Care / Issue 5/2009
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc8027

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