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Published on: June 27, 2025
Arterial pressure changes during the Valsalva maneuver to predict fluid responsiveness in spontaneously breathing
Manuel Ignacio Monge García1, Anselmo Gil Cano, Juan Carlos Díaz Monrové
1Servicio de Cuidados Críticos y Urgencias, Unidad de Investigación Experimental, Hospital del SAS Jerez, C/ Circunvalación s/n, 11407, Jerez de la Frontera, Spain. ignaciomonge@gmail.com
Objective:
To evaluate whether arterial pressure response during a Valsalva maneuver could predict fluid responsiveness in spontaneously breathing patients.
Design And Setting:
Prospective clinical study in a 17-bed multidisciplinary intensive care unit.
Patients:
Thirty patients without mechanical ventilation and equipped with a radial arterial catheter for whom the decision to give fluids was taken due to suspected hypovolemia.
Intervention:
A 10-s Valsalva maneuver was performed before and after volume expansion (VE). Patients were classified as responders if stroke volume index (SVi) increased >/=15% after VE.
Measurements And Results:
Pulse pressure changes during the Valsalva maneuver (VPP) were calculated as the difference between maximal pulse pressure during phase 1 and minimal pulse pressure during phase 2 of the Valsalva maneuver divided by the mean of the two values and expressed as a percentage. Valsalva changes in systolic pressure (VSP) were calculated in similar way. SVi changes induced by VE was correlated with baseline values of VPP and VSP (r (2) = 0.71 and r (2) = 0.60; P < 0.0001, respectively), and with VE-induced changes in VPP and VSP (r (2) = 0.56 and r (2) = 0.44; P < 0.0001 and P < 0.001, respectively). A VPP value of 52% and VSP of 30% predicted fluid responsiveness with a sensitivity of 91% and 73% and a specificity of 95 and 90%, respectively.
Conclusions:
Arterial response during the Valsalva maneuver is a feasible tool for predicting fluid responsiveness in patients without mechanical ventilatory support.
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