RT Journal Article
T1 Dynamic arterial elastance to predict arterial pressure response to volume loading in preload-dependent patients
A1 Monge García, Manuel Ignacio
A1 Gil Cano, Anselmo
A1 Gracia Romero, Manuel
K1 Blood Pressure
K1 Hemodynamics
K1 Monitoring, Physiologic
K1 Respiration, Artificial
K1 Stroke Volume
K1 Presión arterial
K1 Hemodinámica
K1 Monitorización fisiológica
K1 Respiración artificial
K1 Volumen sistólico
AB INTRODUCTIONHemodynamic resuscitation should be aimed at achieving not only adequate cardiac output but also sufficient mean arterial pressure (MAP) to guarantee adequate tissue perfusion pressure. Since the arterial pressure response to volume expansion (VE) depends on arterial tone, knowing whether a patient is preload-dependent provides only a partial solution to the problem. The objective of this study was to assess the ability of a functional evaluation of arterial tone by dynamic arterial elastance (Ea(dyn)), defined as the pulse pressure variation (PPV) to stroke volume variation (SVV) ratio, to predict the hemodynamic response in MAP to fluid administration in hypotensive, preload-dependent patients with acute circulatory failure.METHODSWe performed a prospective clinical study in an adult medical/surgical intensive care unit in a tertiary care teaching hospital, including 25 patients with controlled mechanical ventilation who were monitored with the Vigileo(®) monitor, for whom the decision to give fluids was made because of the presence of acute circulatory failure, including arterial hypotension (MAP ≤65 mmHg or systolic arterial pressure <90 mmHg) and preserved preload responsiveness condition, defined as a SVV value ≥10%.RESULTSBefore fluid infusion, Ea(dyn) was significantly different between MAP responders (MAP increase ≥15% after VE) and MAP nonresponders. VE-induced increases in MAP were strongly correlated with baseline Ea(dyn) (r(2) = 0.83; P < 0.0001). The only predictor of MAP increase was Ea(dyn) (area under the curve, 0.986 ± 0.02; 95% confidence interval (CI), 0.84-1). A baseline Ea(dyn) value >0.89 predicted a MAP increase after fluid administration with a sensitivity of 93.75% (95% CI, 69.8%-99.8%) and a specificity of 100% (95% CI, 66.4%-100%).CONCLUSIONSFunctional assessment of arterial tone by Ea(dyn), measured as the PVV to SVV ratio, predicted arterial pressure response after volume loading in hypotensive, preload-dependent patients under controlled mechanical ventilation.
PB Biomed Central Ltd
YR 2011
FD 2011-01-15
LK http://hdl.handle.net/10668/720
UL http://hdl.handle.net/10668/720
LA en
NO Monge García MI, Gil Cano A, Gracia Romero M. Dynamic arterial elastance to predict arterial pressure response to volume loading in preload-dependent patients. Crit Care; 15(1):R15
NO Journal Article;
DS RISalud
RD Apr 7, 2025