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Critical Care
Published in: Critical Care 1/2019

Open Access 01-12-2019 | Research

Sigh maneuver to enhance assessment of fluid responsiveness during pressure support ventilation

Authors: Antonio Messina, Davide Colombo, Federico Lorenzo Barra, Gianmaria Cammarota, Giacomo De Mattei, Federico Longhini, Stefano Romagnoli, Francesco DellaCorte, Daniel De Backer, Maurizio Cecconi, Paolo Navalesi

Published in: Critical Care | Issue 1/2019

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Abstract

Background

Assessment of fluid responsiveness is problematic in intensive care unit (ICU) patients, in particular for those undergoing modes of partial support, such as pressure support ventilation (PSV). We propose a new test, based on application of a ventilator-generated sigh, to predict fluid responsiveness in ICU patients undergoing PSV.

Methods

This was a prospective bi-centric interventional study conducted in two general ICUs. In 40 critically ill patients with a stable ventilatory PSV pattern and requiring volume expansion (VE), we assessed the variations in arterial systolic pressure (SAP), pulse pressure (PP) and stroke volume index (SVI) consequent to random application of 4-s sighs at three different inspiratory pressures. A radial arterial signal was directed to the MOSTCARE™ pulse contour hemodynamic monitoring system for hemodynamic measurements. Data obtained during sigh tests were recorded beat by beat, while all the hemodynamic parameters were averaged over 30 s for the remaining period of the study protocol. VE consisted of 500 mL of crystalloids over 10 min. A patient was considered a responder if a VE-induced increase in cardiac index (CI) ≥ 15% was observed.

Results

The slopes for SAP, SVI and PP of were all significantly different between responders and non-responders (p < 0.0001, p = 0.0004 and p < 0.0001, respectively). The AUC of the slope of SAP (0.99; sensitivity 100.0% (79.4–100.0%) and specificity 95.8% (78.8–99.9%) was significantly greater than the AUC for PP (0.91) and SVI (0.83) (p = 0.04 and 0.009, respectively). The SAP slope best threshold value of the ROC curve was − 4.4° from baseline. The only parameter found to be independently associated with fluid responsiveness among those included in the logistic regression was the slope for SAP (p = 0.009; odds ratio 0.27 (95% confidence interval (CI95) 0.10–0.70)). The effects produced by the sigh at 35 cmH20 (Sigh35) are significantly different between responders and non-responders. For a 35% reduction in PP from baseline, the AUC was 0.91 (CI95 0.82–0.99), with sensitivity 75.0% and specificity 91.6%.

Conclusions

In a selected ICU population undergoing PSV, analysis of the slope for SAP after the application of three successive sighs and the nadir of PP after Sigh35 reliably predict fluid responsiveness.

Trial registration

Australian New Zealand Clinical Trials Registry, ACTRN12615001232​527. Registered on 10 November 2015.
Appendix
Available only for authorised users
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Metadata
Title
Sigh maneuver to enhance assessment of fluid responsiveness during pressure support ventilation
Authors
Antonio Messina
Davide Colombo
Federico Lorenzo Barra
Gianmaria Cammarota
Giacomo De Mattei
Federico Longhini
Stefano Romagnoli
Francesco DellaCorte
Daniel De Backer
Maurizio Cecconi
Paolo Navalesi
Publication date
01-12-2019
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2019
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-018-2294-4

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