| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
Guest Access | Sign In via User Name/Password
|
|
|
|||||||
Guest Access | Sign In via User Name/Password |
|||||||||
* From the Service de Réanimation et de Maladies Infectieuses (Drs. Feissel, Mangin, Ruyer, and Faller), Centre Hospitalier, Belfort, France; and the Service de Réanimation Médicale (Drs. Michard and Teboul), CHU de Bicêtre, AP-HP, Université Paris XI, Le Kremlin Bicêtre, France.
Correspondence to: Frédéric Michard, MD, Service de Réanimation Médicale, CHU de Bicêtre, 78 Rue du Général Leclerc, 94275 Le Kremlin-Bicêtre Cedex, France; e-mail: f.michard{at}wanadoo.fr
Study objective: To investigate whether the respiratory changes in peak velocity (Vpeak) of aortic blood flow could be related to the effects of volume expansion on cardiac index.
Design: Prospective clinical study.
Setting: Medical ICUs of a university hospital (20 beds) and of a nonuniversity hospital (15 beds).
Patients: Nineteen sedated septic shock patients who were receiving mechanical ventilation and who had preserved left ventricular (LV) systolic function.
Intervention: Volume expansion.
Measurements and results: Analysis of aortic blood flow by
transesophageal echocardiography allowed beat-to-beat measurement of
Vpeak before and after volume expansion. Maximum values of Vpeak
(Vpeakmax) and minimum values of Vpeak (Vpeakmin) were determined over
one respiratory cycle. The respiratory changes in Vpeak (
Vpeak) were
calculated as the difference between Vpeakmax and Vpeakmin divided by
the mean of the two values and were expressed as a percentage. The
indexed LV end-diastolic area (EDAI) and cardiac index were obtained at
the end of the expiratory period. The volume expansion-induced increase
in cardiac index was 
15% in 10 patients (responders) and < 15%
in 9 patients (nonresponders). Before volume expansion, Vpeak was
higher in responders than in nonresponders (20 ± 6% vs 10 ± 3%;
p < 0.01), while EDAI was not significantly different between the
two groups (9.7 ± 3.7 vs 9.7 ± 2.4
cm2/m2). Before volume expansion, a Vpeak
threshold value of 12% allowed discrimination between responders and
nonresponders with a sensitivity of 100% and a specificity of 89%.
Volume expansion-induced changes in cardiac index closely correlated
with the Vpeak before volume expansion
(r2 = 0.83; p < 0.001).
Conclusion: Analysis of respiratory changes in aortic blood velocity is an accurate method for predicting the hemodynamic effects of volume expansion in septic shock patients receiving mechanical ventilation who have preserved LV systolic function.
Key Words: aortic blood velocity • cardiac output • fluid responsiveness • left ventricular end-diastolic area • mechanical ventilation • septic shock • transesophageal echocardiography • volume expansion
This article has been cited by other articles:
|
|
 |
|
  L. Durairaj and G. A. Schmidt Fluid Therapy in Resuscitated Sepsis: Less Is More Chest, January 1, 2008; 133(1): 252 - 263. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. R. Pinsky Hemodynamic Evaluation and Monitoring in the ICU Chest, December 1, 2007; 132(6): 2020 - 2029. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Malhotra, M. Eikermann, and S. Magder Is Brachial Artery Peak Velocity Variation Ready for Prime Time? Chest, May 1, 2007; 131(5): 1279 - 1281. [Full Text] [PDF]
|
|
|
|
 |
|
 V. De Castro, J.-P. Goarin, L. Lhotel, N. Mabrouk, A. Perel, and P. Coriat Comparison of stroke volume (SV) and stroke volume respiratory variation (SVV) measured by the axillary artery pulse-contour method and by aortic Doppler echocardiography in patients undergoing aortic surgery Br. J. Anaesth., November 1, 2006; 97(5): 605 - 610. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. C. Kubitz, T. Annecke, G. I. Kemming, S. Forkl, N. Kronas, A. E. Goetz, and D. A. Reuter The influence of positive end-expiratory pressure on stroke volume variation and central blood volume during open and closed chest conditions. Eur. J. Cardiothorac. Surg., July 1, 2006; 30(1): 90 - 95. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Charron, C. Fessenmeyer, C. Cosson, J.-X. Mazoit, J.-L. Hebert, D. Benhamou, and A. R. Edouard The Influence of Tidal Volume on the Dynamic Variables of Fluid Responsiveness in Critically Ill Patients. Anesth. Analg., May 1, 2006; 102(5): 1511 - 1517. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Knobloch, A. Lichtenberg, M. Winterhalter, D. Rossner, M. Pichlmaier, and R. Phillips Non-Invasive Cardiac Output Determination by Two-Dimensional Independent Doppler During and After Cardiac Surgery Ann. Thorac. Surg., October 1, 2005; 80(4): 1479 - 1483. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Michard Volume Management Using Dynamic Parameters Chest, October 1, 2005; 128(4): 1902 - 1903. [Full Text] [PDF]
|
|
|
|
|
|
C. K. Hofer, S. M. Muller, L. Furrer, R. Klaghofer, M. Genoni, and A. Zollinger Stroke Volume and Pulse Pressure Variation for Prediction of Fluid Responsiveness in Patients Undergoing Off-Pump Coronary Artery Bypass Grafting Chest, August 1, 2005; 128(2): 848 - 854. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. Beaulieu and P. E. Marik Bedside Ultrasonography in the ICU: Part 1 Chest, August 1, 2005; 128(2): 881 - 895. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Berkenstadt, Z. Friedman, S. Preisman, I. Keidan, D. Livingstone, and A. Perel Pulse pressure and stroke volume variations during severe haemorrhage in ventilated dogs Br. J. Anaesth., June 1, 2005; 94(6): 721 - 726. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Rex, S. Brose, S. Metzelder, R. Huneke, G. Schalte, R. Autschbach, R. Rossaint, and W. Buhre Prediction of fluid responsiveness in patients during cardiac surgery Br. J. Anaesth., December 1, 2004; 93(6): 782 - 788. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Kramer, D. Zygun, H. Hawes, P. Easton, and A. Ferland Pulse Pressure Variation Predicts Fluid Responsiveness Following Coronary Artery Bypass Surgery Chest, November 1, 2004; 126(5): 1563 - 1568. [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]
|
|
|
|
 |
|
 S. Magder Clinical Usefulness of Respiratory Variations in Arterial Pressure Am. J. Respir. Crit. Care Med., January 15, 2004; 169(2): 151 - 155. [Full Text] [PDF]
|
|
|
|
|
|
A. Vieillard-Baron, K. Chergui, R. Augarde, S. Prin, B. Page, A. Beauchet, and F. Jardin Cyclic Changes in Arterial Pulse during Respiratory Support Revisited by Doppler Echocardiography Am. J. Respir. Crit. Care Med., September 15, 2003; 168(6): 671 - 676. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Michard, G. S. Martin, and E. W. Ely Underutilized Tools for the Assessment of Intravascular Volume Status Chest, July 1, 2003; 124(1): 414 - 416. [Full Text] [PDF]
|
|
|
|
|
|
M. R. Pinsky Probing the Limits of Arterial Pulse Contour Analysis to Predict Preload Responsiveness Anesth. Analg., May 1, 2003; 96(5): 1245 - 1247. [Full Text] [PDF]
|
|
|
|
|
|
C. Wiesenack, C. Prasser, G. Rodig, and C. Keyl Stroke Volume Variation as an Indicator of Fluid Responsiveness Using Pulse Contour Analysis in Mechanically Ventilated Patients Anesth. Analg., May 1, 2003; 96(5): 1254 - 1257. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S M Tibby and I A Murdoch Monitoring cardiac function in intensive care Arch. Dis. Child., January 1, 2003; 88(1): 46 - 52. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Slama, H. Masson, J.-L. Teboul, M.-L. Arnout, D. Susic, E. Frohlich, and M. Andrejak Respiratory variations of aortic VTI: a new index of hypovolemia and fluid responsiveness Am J Physiol Heart Circ Physiol, October 1, 2002; 283(4): H1729 - H1733. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Michard and J.-L. Teboul Predicting Fluid Responsiveness in ICU Patients* : A Critical Analysis of the Evidence Chest, June 1, 2002; 121(6): 2000 - 2008. [Abstract] [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
