Sánchez PNM, Garduño LJ, Amezcua GMA, Alva ANV, Zamora GSE, Gasca AJC

Language: Spanish
References: 9
Page: 547-551
PDF size: 273.60 Kb.

ABSTRACT

Introduction: determining the patient's ability to respond to volume expansion is essential during the management of hemodynamically unstable patients in the Intensive Care Unit (ICU), trying to avoid fluid overload that causes increased mortality. The increase in positive end-expiratory pressure (PEEP) decreases stroke volume (SV) and is explained by the decrease in venous return that could modify the response to fluids. Objectives: to evaluate whether the increase in the velocity integral over time (VTI) after a change in positive end-expiratory pressure (PEEP) predicts the volume response. Material and methods: prospective, longitudinal, comparative, analytical study. Patients admitted to the ICU with mechanical ventilation were included. The volume response was measured through the baseline VTI and subsequently with passive leg raising (PLR). The PEEP test consisted of a delta increase and then a 5 cmH2O decrease in PEEP, with its respective VTI measurement. Quantitative variables were analyzed using the Student t test. Results: a total of 54 patients were admitted, of which 53.7% were volume responders. A multivariate analysis was performed where the variables with significance were: VVTI OR 2.95 (95% CI 2.4-4.71, p = 0.029), VVTI 5 OR 1.28 (95% CI 1.12-5.10, p = 0.040), VTI 10 OR 3.07 (95% CI 2.37-7.19, p = 0.021), VVTI 10 OR 3.82 (95% CI 3.51-6.43, p = 0.016), the rest of the variables lost statistical significance. Conclusions: volume response can be detected using changes in mechanical ventilation; such as the PEEP test, using left ventricular outflow tract (LVOT) VTI as a surrogate for stroke volume. It is noteworthy that VTI variability was a variable that demonstrated statistical significance in all tests as a predictor of volume response.

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