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Fluid responsiveness in pressure support ventilation: role of asynchrony
Critical Care volume 17, Article number: P202 (2013)
Pulse pressure variation (PPV) is a dynamic indicator of fluid responsiveness, which is known to have a low sensibility and specificity in patients ventilated in pressure support (PS) . We aim to investigate patient-ventilator asynchrony as a potential source of hemodynamic interference in PS.
We performed a prospective study including PS ventilated patients who met inclusion criteria for fluid depletion . Patients who showed an asynchrony index (AI) exceeding 10% were included in the asynchrony group (AG). The remaining patients were included in the synchrony group (SG) . Beat-to-beat hemodynamic variables were recorded through PRAM (Mostcare; Vytech Health srl, Padova, Italy). PPV cutoff of 13% was used to identify fluid responders/nonresponders. A fluid challenge of 500 ml normal saline was given in 5 minutes. An increase of 15% of cardiac index after 10 minutes indicated fluid responsiveness.
So far, eights patients showed an AI >10% while 16 did not. Overall sensitivity was 28.6% versus 50% in SG; overall specificity was 76.5% versus 91.7% in AG. Overall Cohen's k was 33.3% versus 61.2% in AG (see Figure 1). However, because none of the responders in the AG group was detected by PPV, statistical analysis was not feasible within this subgroup
The consistency of PPV in predicting fluid responsiveness during PS seems to be more reliable in the patients with better patient-ventilator synchrony.
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Messina, A., Colombo, D., Cammarota, G. et al. Fluid responsiveness in pressure support ventilation: role of asynchrony. Crit Care 17, P202 (2013). https://doi.org/10.1186/cc12140
- Emergency Medicine
- Normal Saline
- Cardiac Index
- Support Ventilation
- Pressure Support