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Intensive Care Medicine

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01-05-2008 | Pediatric Original

Respiratory variations in aortic blood flow predict fluid responsiveness in ventilated children

Authors: Philippe Durand, Laurent Chevret, Sandrine Essouri, Vincent Haas, Denis Devictor

Published in: Intensive Care Medicine | Issue 5/2008

Abstract

Objective

To investigate whether respiratory variations in aortic blood flow velocity (ΔVpeak ao), systolic arterial pressure (ΔPS) and pulse pressure (ΔPP) could accurately predict fluid responsiveness in ventilated children.

Design and setting

Prospective study in a 18-bed pediatric intensive care unit.

Patients

Twenty-six children [median age 28.5 (16–44) months] with preserved left ventricular (LV) function.

Intervention

Standardized volume expansion (VE).

Measurements and main results

Analysis of aortic blood flow by transthoracic pulsed-Doppler allowed LV stroke volume measurement and on-line ΔVpeak ao calculation. The VE-induced increase in LV stroke volume was > 15% in 18 patients (responders) and < 15% in 8 (non-responders). Before VE, the ΔVpeak ao in responders was higher than that in non-responders [19% (12.1–26.3) vs. 9% (7.3–11.8), p = 0.001], whereas ΔPP and ΔPS did not significantly differ between groups. The prediction of fluid responsiveness was higher with ΔVpeak ao [ROC curve area 0.85 (95% IC 0.99–1.8), p = 0.001] than with ΔPS (0.64) or ΔPP (0.59). The best cut-off for ΔVpeak ao was 12%, with sensitivity, specificity, and positive and negative predictive values of 81.2%, 85.7%, 93% and 66.6%, respectively. A positive linear correlation was found between baseline ΔVpeak ao and VE-induced gain in stroke volume (rho = 0.68, p = 0.001).

Conclusions

While respiratory variations in aortic blood flow velocity measured by pulsed Doppler before VE accurately predict the effects of VE, ΔPS and ΔPP are of little value in ventilated children.

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Title: Respiratory variations in aortic blood flow predict fluid responsiveness in ventilated children
Authors: Philippe Durand
Laurent Chevret
Sandrine Essouri
Vincent Haas
Denis Devictor
Publication date: 01-05-2008
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 5/2008
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-008-1021-z

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Design and setting

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Measurements and main results

Conclusions

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