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Assessing fluid responsiveness in critically ill patients: False-positive pulse pressure variation is detected by Doppler echocardiographic evaluation of the right ventricle*
- Source :
- Critical Care Medicine. 37:2570-2575
- Publication Year :
- 2009
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2009.
-
Abstract
- To determine whether peak systolic velocity of tricuspid annular motion assessed by tissue Doppler echocardiography (Sta), a right ventricular function parameter, can discriminate patients with true- and false-positive pulse pressure variation. Pulse pressure variation is used to predict fluid responsiveness in mechanically ventilated patients. However, this parameter has been reported to be falsely positive, especially in patients with right ventricular dysfunction.A prospective study.Medical and surgical intensive care unit of a university hospital.Thirty- five mechanically ventilated patients hospitalized for24 hrs with a pulse pressure variation of12%.Doppler echocardiography (including measurement of Sta and stroke volume) was performed before and after infusion of 500 mL of colloid solution. Patients were classified into two groups according to their response to fluid infusion: responders (at least 15% increase in stroke volume) and nonresponders.Twenty-three patients (66%) were responders (true-positive group) and 12 (34%) were nonresponders (false-positive group). Before volume expansion, Sta was statistically lower in the nonresponder group (0.13 [0.04] vs. 0.20 [0.05], p = .0004). The area under the curve of the receiver operating characteristic curve was 0.87 (95% confidence interval, 0.74-1). In patients with pulse pressure variation of12%, a Sta cutoff value of 0.15 m/s discriminated between responders and nonresponders with a sensitivity of 91% (80-100) and a specificity of 83% (62-100).A Sta value of0.15 m/s seems to be an accurate parameter to detect false-positive pulse pressure variation. Echocardiography should therefore be performed before fluid infusion in patients with pulse pressure variation of12%.
- Subjects :
- Male
medicine.medical_specialty
Systole
Critical Illness
Positive pressure
Critical Care and Intensive Care Medicine
symbols.namesake
Tissue Doppler echocardiography
Intensive care
Internal medicine
medicine
Humans
False Positive Reactions
Prospective Studies
cardiovascular diseases
Pulse
Aged
Pulse (signal processing)
business.industry
Middle Aged
Echocardiography, Doppler
Pulse pressure
medicine.anatomical_structure
Ventricle
Anesthesia
Ventricular Function, Right
cardiovascular system
Cardiology
symbols
Fluid Therapy
Female
business
Doppler effect
Subjects
Details
- ISSN :
- 00903493
- Volume :
- 37
- Database :
- OpenAIRE
- Journal :
- Critical Care Medicine
- Accession number :
- edsair.doi.dedup.....c49d21db76df0f2acc59c6187c5b6123