Effects of positive end-expiratory pressure on the predictability of fluid responsiveness in acute respiratory distress syndrome patients

Abstract The prediction accuracy of pulse pressure variation (PPV) for fluid responsiveness was suggested to be unreliable in low tidal volume (VT) ventilation. However, high PEEP can cause ARDS patients relatively hypovolemic and more fluid responsive. We hypothesized that high PEEP 15 cmH2O can of...

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Main Authors: Yen-Huey Chen, Ying-Ju Lai, Ching-Ying Huang, Hui-Ling Lin, Chung-Chi Huang
Format: Article
Language:English
Published: Nature Publishing Group 2021-05-01
Series:Scientific Reports
Online Access:https://doi.org/10.1038/s41598-021-89463-2
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spelling doaj-6d290b849cdd41c2b257a2afa57af1eb2021-05-16T11:23:42ZengNature Publishing GroupScientific Reports2045-23222021-05-011111910.1038/s41598-021-89463-2Effects of positive end-expiratory pressure on the predictability of fluid responsiveness in acute respiratory distress syndrome patientsYen-Huey Chen0Ying-Ju Lai1Ching-Ying Huang2Hui-Ling Lin3Chung-Chi Huang4Department of Respiratory Therapy, College of Medicine, Chang Gung UniversityDepartment of Respiratory Therapy, College of Medicine, Chang Gung UniversityDepartment of Medical Imaging and Intervention, Chang Gung Memorial HospitalDepartment of Respiratory Therapy, College of Medicine, Chang Gung UniversityDepartment of Respiratory Therapy, College of Medicine, Chang Gung UniversityAbstract The prediction accuracy of pulse pressure variation (PPV) for fluid responsiveness was suggested to be unreliable in low tidal volume (VT) ventilation. However, high PEEP can cause ARDS patients relatively hypovolemic and more fluid responsive. We hypothesized that high PEEP 15 cmH2O can offset the disadvantage of low VT and improve the predictive performance of PPV. We prospectively enrolled 27 hypovolemic ARDS patients ventilated with low VT 6 ml/kg and three levels of PEEP (5, 10, 15 cmH2O) randomly. Each stage lasted for at least 5 min to allow for equilibration of hemodynamics and pulmonary mechanics. Then, fluid expansion was given with 500 ml hydroxyethyl starch (Voluven 130/70). The hemodynamics and PPV were automatically measured with a PiCCO2 monitor. The PPV values were significantly higher during PEEP15 than those during PEEP5 and PEEP10. PPV during PEEP15 precisely predicts fluid responsiveness with a cutoff value 8.8% and AUC (area under the ROC curve) of ROC (receiver operating characteristic curve) 0.847, higher than the AUC during PEEP5 (0.81) and PEEP10 (0.668). Normalizing PPV with driving pressure (PPV/Driving-P) increased the AUC of PPV to 0.875 during PEEP15. In conclusions, high PEEP 15 cmH2O can counteract the drawback of low VT and preserve the predicting accuracy of PPV in ARDS patients.https://doi.org/10.1038/s41598-021-89463-2
collection DOAJ
language English
format Article
sources DOAJ
author Yen-Huey Chen
Ying-Ju Lai
Ching-Ying Huang
Hui-Ling Lin
Chung-Chi Huang
spellingShingle Yen-Huey Chen
Ying-Ju Lai
Ching-Ying Huang
Hui-Ling Lin
Chung-Chi Huang
Effects of positive end-expiratory pressure on the predictability of fluid responsiveness in acute respiratory distress syndrome patients
Scientific Reports
author_facet Yen-Huey Chen
Ying-Ju Lai
Ching-Ying Huang
Hui-Ling Lin
Chung-Chi Huang
author_sort Yen-Huey Chen
title Effects of positive end-expiratory pressure on the predictability of fluid responsiveness in acute respiratory distress syndrome patients
title_short Effects of positive end-expiratory pressure on the predictability of fluid responsiveness in acute respiratory distress syndrome patients
title_full Effects of positive end-expiratory pressure on the predictability of fluid responsiveness in acute respiratory distress syndrome patients
title_fullStr Effects of positive end-expiratory pressure on the predictability of fluid responsiveness in acute respiratory distress syndrome patients
title_full_unstemmed Effects of positive end-expiratory pressure on the predictability of fluid responsiveness in acute respiratory distress syndrome patients
title_sort effects of positive end-expiratory pressure on the predictability of fluid responsiveness in acute respiratory distress syndrome patients
publisher Nature Publishing Group
series Scientific Reports
issn 2045-2322
publishDate 2021-05-01
description Abstract The prediction accuracy of pulse pressure variation (PPV) for fluid responsiveness was suggested to be unreliable in low tidal volume (VT) ventilation. However, high PEEP can cause ARDS patients relatively hypovolemic and more fluid responsive. We hypothesized that high PEEP 15 cmH2O can offset the disadvantage of low VT and improve the predictive performance of PPV. We prospectively enrolled 27 hypovolemic ARDS patients ventilated with low VT 6 ml/kg and three levels of PEEP (5, 10, 15 cmH2O) randomly. Each stage lasted for at least 5 min to allow for equilibration of hemodynamics and pulmonary mechanics. Then, fluid expansion was given with 500 ml hydroxyethyl starch (Voluven 130/70). The hemodynamics and PPV were automatically measured with a PiCCO2 monitor. The PPV values were significantly higher during PEEP15 than those during PEEP5 and PEEP10. PPV during PEEP15 precisely predicts fluid responsiveness with a cutoff value 8.8% and AUC (area under the ROC curve) of ROC (receiver operating characteristic curve) 0.847, higher than the AUC during PEEP5 (0.81) and PEEP10 (0.668). Normalizing PPV with driving pressure (PPV/Driving-P) increased the AUC of PPV to 0.875 during PEEP15. In conclusions, high PEEP 15 cmH2O can counteract the drawback of low VT and preserve the predicting accuracy of PPV in ARDS patients.
url https://doi.org/10.1038/s41598-021-89463-2
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