Respiratory variations in aortic blood flow predict fluid responsiveness in ventilated children

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Invasive Hemodynamic Monitoring of Aortic and Pulmonary Artery Hemodynamics in a Large Animal Model of ARDS
08:12

Invasive Hemodynamic Monitoring of Aortic and Pulmonary Artery Hemodynamics in a Large Animal Model of ARDS

Published on: November 26, 2018

Philippe Durand1, Laurent Chevret, Sandrine Essouri

  • 1Pediatric Intensive Care Unit, Bicêtre Hospital, 78 rue du Gal Leclerc, 94275 Le Kremlin Bicêtre, France. philippe.durand@bct.ap-hop-paris.fr

Intensive Care Medicine
|February 9, 2008
PubMed

Insights

Respiratory variations in aortic blood flow velocity accurately predict fluid responsiveness in ventilated children. Systolic arterial pressure and pulse pressure variations showed little value for this prediction.

Area of Science:

  • Pediatric Critical Care Medicine
  • Hemodynamic Monitoring
  • Mechanical Ventilation

Background:

  • Fluid responsiveness assessment is crucial in mechanically ventilated children.
  • Predicting fluid responsiveness non-invasively can optimize fluid management.
  • Existing methods like pulse pressure variation have limitations.

Purpose of the Study:

  • To evaluate the accuracy of respiratory variations in aortic blood flow velocity (DeltaVpeak ao) in predicting fluid responsiveness.
  • To compare DeltaVpeak ao with systolic arterial pressure (DeltaPS) and pulse pressure (DeltaPP) variations.

Main Methods:

  • Prospective study in a pediatric intensive care unit.
  • Measured DeltaVpeak ao, DeltaPS, and DeltaPP before and after standardized volume expansion (VE).
  • Analyzed left ventricular stroke volume using transthoracic pulsed-Doppler.

Main Results:

  • DeltaVpeak ao accurately predicted fluid responsiveness (ROC area 0.85).
  • A DeltaVpeak ao cutoff of 12% demonstrated high sensitivity (81.2%) and specificity (85.7%).
  • DeltaPS and DeltaPP variations were poor predictors of fluid responsiveness.

Conclusions:

  • DeltaVpeak ao is a reliable non-invasive predictor of fluid responsiveness in ventilated children.
  • DeltaPS and DeltaPP variations have limited clinical utility for this purpose.
  • Pulsed-Doppler measurement of DeltaVpeak ao can guide fluid management in pediatric critical care.
Abstract

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