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01-04-2011 | Commentary

Why do pulse pressure variations fail to predict the response to fluids in acute respiratory distress syndrome patients ventilated with low tidal volume?

Authors: Daniel De Backer, Sabino Scolletta

Published in: Critical Care | Issue 2/2011

Abstract

Respiratory-associated variations in stroke volume and pulse pressure are frequently used to predict the response to fluid administration. However, it has been demonstrated that low tidal volume ventilation may limit their use in patients with acute respiratory distress syndrome (ARDS). In this issue, a trial investigates the value of pulse pressure variation to predict fluid responsiveness in a large series of patients with ARDS ventilated according to current guidelines.

Lakhal K, Ehrmann S, Benzekri-Lefevre D, Runge I, Legras A, Dequin PF, Mercier E, Wolff M, Regnier B, Boulain T: Respiratory pulse pressure variation fails to predict fluid responsiveness in acute respiratory distress syndrome. Crit Care 2011, 15: R85. 10.1186/cc10083PubMedCentralCrossRefPubMed

National Heart and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network, Wiedemann HP, Wheeler AP, Bernard GR, Thompson BT, Hayden D, deBoisblanc B, Connors AF Jr, Hite RD, Harabin AL: Comparison of two fluid-management strategies in acute lung injury. N Engl J Med 2006, 354: 2564-2575. 10.1056/NEJMoa062200CrossRef

Rivers EP, Kruse JA, Jacobsen G, Shah K, Loomba M, Otero R, Childs EW: The influence of early hemodynamic optimization strategies on biomarker patterns of severe sepsis and septic shock. Crit Care Med 2007, 35: 2016-2024. 10.1097/01.CCM.0000281637.08984.6ECrossRefPubMed

Eltzschig HK, Carmeliet P: Hypoxia and inflammation. N Engl J Med 2011, 364: 656-665. 10.1056/NEJMra0910283PubMedCentralCrossRefPubMed

The Acute Respiratory Distress Syndrome Network: Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 2000, 342: 1301-1308. 10.1056/NEJM200005043421801CrossRef

De Backer D, Heenen S, Piagnerelli M, Koch M, Vincent JL: Pulse pressure variations to predict fluid responsiveness: influence of tidal volume. Intensive Care Med 2005, 31: 517-523. 10.1007/s00134-005-2586-4CrossRefPubMed

Muller L, Louart G, Bousquet PJ, Candela D, Zoric L, de La Coussaye JE, Jaber S, Lefrant JY: The influence of the airway driving pressure on pulsed pressure variation as a predictor of fluid responsiveness. Intensive Care Med 2010, 36: 496-503. 10.1007/s00134-009-1686-yCrossRefPubMed

Vallée F, Richard JC, Mari A, Gallas T, Arsac E, Verlaan PS, Chousterman B, Samii K, Genestal M, Fourcade O: Pulse pressure variations adjusted by alveolar driving pressure to assess fluid responsiveness. Intensive Care Med 2009, 35: 1004-1010. 10.1007/s00134-009-1478-4CrossRefPubMed

Lefrant JY, De Backer D: Can we use pulse pressure variations to predict fluid responsiveness in patients with ARDS? Intensive Care Med 2009, 35: 966-968. 10.1007/s00134-009-1479-3CrossRefPubMed

10.

Talmor D, Sarge T, O'Donnell CR, Ritz R, Malhotra A, Lisbon A, Loring SH: Esophageal and transpulmonary pressures in acute respiratory failure. Crit Care Med 2006, 34: 1389-1394. 10.1097/01.CCM.0000215515.49001.A2PubMedCentralCrossRefPubMed

11.

De Backer D, Taccone FS, Holsten R, Ibrahimi F, Vincent JL: Influence of respiratory rate on stroke volume variation in mechanically ventilated patients. Anesthesiology 2009, 110: 1092-1097. 10.1097/ALN.0b013e31819db2a1CrossRefPubMed

12.

Magder S: Further cautions for the use of ventilatory-induced changes in arterial pressures to predict volume responsiveness. Crit Care 2010, 14: 197. 10.1186/cc9223PubMedCentralCrossRefPubMed

13.

Benes J, Chytra I, Altmann P, Hluchy M, Kasal E, Svitak R, Pradl R, Stepan M: Intraoperative fluid optimization using stroke volume variation in high risk surgical patients: results of prospective randomized study. Crit Care 2010, 14: R118. 10.1186/cc9070PubMedCentralCrossRefPubMed

Title: Why do pulse pressure variations fail to predict the response to fluids in acute respiratory distress syndrome patients ventilated with low tidal volume?
Authors: Daniel De Backer
Sabino Scolletta
Publication date: 01-04-2011
Publisher: BioMed Central
Published in: Critical Care / Issue 2/2011
Electronic ISSN: 1364-8535
DOI: https://doi.org/10.1186/cc10111

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Why do pulse pressure variations fail to predict the response to fluids in acute respiratory distress syndrome patients ventilated with low tidal volume?

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

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