HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Free Full Text (PDF) Free Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (22) Citing Articles via Google Scholar Google Scholar Articles by Bendjelid, K. Articles by Romand, J. A. Search for Related Content PubMed PubMed Citation Articles by Bendjelid, K. Articles by Romand, J. A.

INNOVATIVE METHODOLOGY

The respiratory change in preejection period: a new method to predict fluid responsiveness

Division of Surgical Intensive Care, Geneva University Hospitals, CH-1211 Geneva 14, Switzerland

Submitted 30 April 2003 ; accepted in final form 5 September 2003

The accuracy and clinical utility of preload indexes as bedside indicators of fluid responsiveness in patients after cardiac surgery is controversial. This study evaluates whether respiratory changes () in the preejection period (PEP; PEP) predict fluid responsiveness in mechanically ventilated patients. Sixteen postcoronary artery bypass surgery patients, deeply sedated under mechanical ventilation, were enrolled. PEP was defined as the time interval between the beginning of the Q wave on the electrocardiogram and the upstroke of the radial arterial pressure. PEP (%) was defined as the difference between expiratory and inspiratory PEP measured over one respiratory cycle. We also measured cardiac output, stroke volume index, right atrial pressure, pulmonary arterial occlusion pressure, respiratory change in pulse pressure, systolic pressure variation, and the down component of SPV. Data were measured without positive end-expiratory pressure (PEEP) and after application of a PEEP of 10 cmH₂O (PEEP₁₀). When PEEP₁₀ induced a decrease of >15% in mean arterial pressure value, then measurements were re-performed before and after volume expansion. Volume loading was done in eight patients. Right atrial pressure and pulmonary arterial occlusion pressure before volume expansion did not correlate with the change in stroke volume index after the fluid challenge. Systolic pressure variation, PEP, down, and change in pulse pressure before volume expansion correlated with stroke volume index change after fluid challenge (r² = 0.52, 0.57, 0.68, and 0.83, respectively). In deeply sedated, mechanically ventilated patients after cardiac surgery, PEP, a new method, can be used to predict fluid responsiveness and hemodynamic response to PEEP₁₀.

fluid resuscitation; heart-lung interactions; monitoring

This article has been cited by other articles:

				A. Miller, N. Coleman, A. Morelli, C. Ertmer, and M. Westphal Dobutamine and terlipressin in patients with septic shock Br. J. Anaesth., July 1, 2008; 101(1): 125 - 126. [Full Text] [PDF]

				J. O. Auler Jr., F. Galas, L. Hajjar, L. Santos, T. Carvalho, and F. Michard Online Monitoring of Pulse Pressure Variation to Guide Fluid Therapy After Cardiac Surgery Anesth. Analg., April 1, 2008; 106(4): 1201 - 1206. [Abstract] [Full Text] [PDF]

				C. Runcie, B. Tavernier, H. Solus-Biguenet, M. Fleyfel, and B. Vallet Predicting fluid responsiveness in theatre Br. J. Anaesth., April 1, 2007; 98(4): 545 - 547. [Full Text] [PDF]

				A. Ercole Assessing fluid responsiveness: the role of dynamic haemodynamic indices Trauma, January 1, 2007; 9(1): 13 - 19. [Abstract] [PDF]

				G. Natalini, A. Rosano, M. E. Franceschetti, P. Facchetti, and A. Bernardini Variations in Arterial Blood Pressure and Photoplethysmography During Mechanical Ventilation Anesth. Analg., November 1, 2006; 103(5): 1182 - 1188. [Abstract] [Full Text] [PDF]

				F. Michard Volume Management Using Dynamic Parameters Chest, October 1, 2005; 128(4): 1902 - 1903. [Full Text] [PDF]

				K. Uemura, T. Kawada, A. Kamiya, T. Aiba, I. Hidaka, K. Sunagawa, and M. Sugimachi Prediction of circulatory equilibrium in response to changes in stressed blood volume Am J Physiol Heart Circ Physiol, July 1, 2005; 289(1): H301 - H307. [Abstract] [Full Text] [PDF]

				F. Michard, U. Schmidt, K. Bendjelid, and J.-A. Romand Prediction of fluid responsiveness: searching for the Holy Grail J Appl Physiol, August 1, 2004; 97(2): 790 - 791. [Full Text] [PDF]

				F. Michard, D. Chemla, J.-L. Teboul, and S. Magder More Respect for Respiratory Variation in Arterial Pressure Am. J. Respir. Crit. Care Med., June 15, 2004; 169(12): 1333 - 1334. [Full Text] [PDF]