Objective To investigate whether pulse pressure variation( ΔPP) reflect the effects of PEEP and fluid resuscitation ( FR) on hemodynamic effects. Methods Twenty critical patients with acute lung injury was ventilated with volume control ( VT =8 mL/kg, Ti/Te = 1∶2) , and PaCO2 was kept at 35 to 45 mm Hg. PEEP was setted as 5 cm H2O and 15 cmH2O in randomized order. Hemodynamic parameters including cardiac index, pulse pressure, central venous pressure, etc. were monitered by PiCCO system.Measurements were performed after the application of 5 cmH2O PEEP ( PEEP5 group) and 15 cm H2OPEEP ( PEEP15 group) respectively. When the PEEP-induced decrease in cardiac index ( CI) was gt; 10% ,measurements were also performed after fluid resuscitation. Results Compared with PEEP5 group, CI was decreased significantly in PEEP15 group( P lt;0. 05) , and ΔPP was increased significantly( P lt; 0. 05) . In 14 patients whose PEEP-induced decrease in CI was gt; 10% , fluid resuscitation increased CI from ( 3. 01 ±0. 57) L·min - 1·m- 2 to ( 3. 62 ±0. 68) L·min- 1 ·m- 2 ( P lt;0. 01) , and decreased ΔPP from ( 17 ±3) % to ( 10 ±2) % ( P lt;0. 01) . PEEP15 -induced decrease in CI was correlated negatively with ΔPP on PEEP5 ( r= - 0.91, P lt;0. 01) and with the PEEP15 -induced increase in ΔPP ( r = - 0. 79, P lt;0. 01) . FR-induced changes in CI correlated with ΔPP before FR ( r =0. 96, P lt; 0. 01) and with the FR-induced decrease in ΔPP ( r= - 0. 95, P lt; 0. 01) . Conclusions In ventilated patients with ALI, ΔPP may be a simple anduseful parameter in predicting and assessing the hemodynamic effects of PEEP and FR.
Citation：
GU Qin,LIU Ning,YU Jianfeng.. The Clinical Value of Pulse Pressure Variation to Monitor the Fluid Responsiveness and Effects of PEEP in Ventilated Patients with Acute Lung Injury. Chinese Journal of Respiratory and Critical Care Medicine, 2009, 09(4): 388-391. doi:
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Michard F, Boussat S, Chemla D, et al. Relation between respiratory changes in arteral pulse pressure and fluid responsiveness in septic patients with acute circulatory failure. Am J respir Crit Care Med,2000, 162: 134-138.
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Berkenstadt H, Friedman Z, Preisman S, et al. Pulse pressure and stroke volume variations during severe haemorrhage in ventiated dogs. Br J Anaesth, 2005, 94: 721-726.
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樊勋, 程小曲, 郭奕萍, 等. 参附注射液对急性呼吸窘迫综合征机械通气患者心血管功能保护作用的研究. 中国中西医结合急救杂志, 2005, 12: 377-379.
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| 8. |
Kramer A, Zygun D, Hawes H, et al. Pulse pressure variation predicts fluid responsiveness following coronary artery bypass surgery. Chest, 2004, 126: 1563-1568.
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| 9. |
WiesenackC, PrasserC, R ding G, et al. Stroke volume variation as an indicator of fluid responsiveness using pulse contour analysis in mechanically ventilated patients. Anesth Analg, 2003, 96: 1245-1247.
|
| 10. |
De Backer D, Heenen S, Piagerelli M, et al. Pulse pressure variations to predict fluid responsiveness: influence of tidal volume.Intensive Care Med, 2005, 31: 517-523.
|
| 11. |
Lambert P, Sloth E, Smith B, et al. Does a positive end-expiratory pressure-induced reduction in stroke volume indicate preload responsiveness? An experimental study. Acta Anaesthesiol Scand,2007, 51: 415-425.
|
| 12. |
李敏, 秦英智, 马丽君. 不同呼气末正压设定对机械通气患者血流动力学及心功能的影响. 中国危重病急救医学, 2007, 19: 86-89.
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- 1. Michard F. Changes in arterial pressure during mechanical ventilation. Anesthesiology, 2005, 103: 419-428.
- 2. Pinsky MR. Recent advances in the clinical application of heart-lung interactions. Curr Opin Crit Care, 2002 , 8: 26 -31.
- 3. 中华医学会重症医学分会. 急性肺损伤/急性呼吸窘迫综合征诊断和治疗指南( 2006) . 中国危重病急救医学, 2006, 18: 706-710.
- 4. Tremblay LN, Slutsky AS. Ventilator-induced injury: from barotrauma to biotrauma. Proc Assoc Am Physicians, 1998, 110 :482-488.
- 5. Michard F, Boussat S, Chemla D, et al. Relation between respiratory changes in arteral pulse pressure and fluid responsiveness in septic patients with acute circulatory failure. Am J respir Crit Care Med,2000, 162: 134-138.
- 6. Berkenstadt H, Friedman Z, Preisman S, et al. Pulse pressure and stroke volume variations during severe haemorrhage in ventiated dogs. Br J Anaesth, 2005, 94: 721-726.
- 7. 樊勋, 程小曲, 郭奕萍, 等. 参附注射液对急性呼吸窘迫综合征机械通气患者心血管功能保护作用的研究. 中国中西医结合急救杂志, 2005, 12: 377-379.
- 8. Kramer A, Zygun D, Hawes H, et al. Pulse pressure variation predicts fluid responsiveness following coronary artery bypass surgery. Chest, 2004, 126: 1563-1568.
- 9. WiesenackC, PrasserC, R ding G, et al. Stroke volume variation as an indicator of fluid responsiveness using pulse contour analysis in mechanically ventilated patients. Anesth Analg, 2003, 96: 1245-1247.
- 10. De Backer D, Heenen S, Piagerelli M, et al. Pulse pressure variations to predict fluid responsiveness: influence of tidal volume.Intensive Care Med, 2005, 31: 517-523.
- 11. Lambert P, Sloth E, Smith B, et al. Does a positive end-expiratory pressure-induced reduction in stroke volume indicate preload responsiveness? An experimental study. Acta Anaesthesiol Scand,2007, 51: 415-425.
- 12. 李敏, 秦英智, 马丽君. 不同呼气末正压设定对机械通气患者血流动力学及心功能的影响. 中国危重病急救医学, 2007, 19: 86-89.
