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Simplified Method to Measure Respiratory-Related Changes in Arterial Pulse Pressure in Patients Receiving Mechanical Ventilation^*

^* From the Laboratoire de Physiopathologie Respiratoire et Unité de Réanimation (Ms. Morélot-Panzini and Dr. Lefort), Service de Pneumologie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris; and UPRES EA 2397 (Drs. Derenne and Similowski), Université Paris VI Pierre & Marie Curie, Paris, France.

Correspondence to: Thomas Similowski, MD, PhD, Service de Pneumologie et de Réanimation, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 47-83, Bd de l’Hôpital, 75651 Paris Cedex 13, France; e-mail: thomas. similowski{at}psl.ap-hop-paris.fr

Study objectives: Measuring respiratory-related changes in arterial pulse pressure is useful to guide fluid expansion in hemodynamically compromised patients. In the absence of automation, this can be uneasy in clinical practice. The objective of this study was to test an alternative approach (expiratory pause) that should be easier to apply.

Design: Prospective observational study comparing two measurement methods of a biological variable.

Patients: Seventeen patients receiving mechanical ventilation without spontaneous respiratory activity, with an arterial indwelling catheter, exhibiting respiratory-related fluctuations in arterial pressure.

Setting: Ten-bed respiratory ICU in a 2,000-bed university hospital.

Intervention: Analysis of clinically gathered data without specific experimental intervention.

Measurements: Determinations of the change in arterial pulse pressure observed during ventilatory cycling (Pp,dyn) ["dynamic"] and change in arterial pulse pressure observed during expiratory pauses (Pp,stat) ["static"] were performed to assess respiratory mechanics, and comparison of the two sets of data (correlation, Bland and Altman, Passing and Bablok regression).

Results: Pp,dyn and Pp,stat were strongly correlated (R = 0.964; 95% confidence interval, 0.917 to 0.987; p < 0.0001), with a good level of agreement (mean difference, 0.016; lower limit of agreement, - 0.087; upper limit, 0.120) and no systematic difference.

Conclusion: Measuring respiratory-related Pp,stat provides data that seem interchangeable with Pp,dyn, providing an easy means to routinely obtain this information.

Key Words: arterial pressure • critical care • fluid expansion • heart-lung interactions • hemodynamics • ICUs • mechanical ventilation • monitoring

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