Dynamické parametry preloadu při ventilaci tlakovou podporou

Title in English Dynamic parameters of preload in pressure support ventilation

SUK Pavel ZVONÍČEK Václav PAVLÍK Martin ŠTĚTKA Pavel ŠRÁMEK Vladimír

Year of publication 2009
Type Article in Periodical
Magazine / Source Anesteziologie a intenzivní medicína
MU Faculty or unit

Faculty of Medicine

Field Surgery incl. transplantology
Keywords heart-lung interactions; pressure support ventilation; pulse pressure variation; stroke volume variation; cardiac output; pulmonary artery occlusion pressure
Description Objective: To prove the reliability of pulse pressure variation (PPV) and stroke volume variation (SVV) in prediction of fluid responsiveness in patients on pressure support ventilation (PSV) and to assess the relationship between respiratory changes in filling pressures and pleural pressure. Design: Prospective clinical trial. Setting: University hospital multidisciplinary ICU. Methods: Patients with sinus rhythm on PSV in whom cardiac index (CI) was measured by thermodilution. Arterial, central venous (CVP) and pulmonary artery occlusion pressure (PAOP) were recorded and PPV, SVV, inspiratory drop in CVP (dCVP) and PAOP (dPAOP) calculated. Oesophageal pressure (Pes) was measured by balloon-tipped catheter. Fluid challenge: HES 500ml during 30 min. Data presented as median (interquartile range). Results: Total 17 patients, 2 excluded due to new atrial fibrillation. Fluid challenge tended to increase CI from 4.6 (3.4–5.6) to 4.9 (3.6–6.1) l . min-1 . m-2 (p = 0.098). Positive response (increase in CI > 10%) was recorded in 6 cases. PPV did not differ between responders 6.7 (2.7–13.8) % and non-responders 6.3 (4.3–9.0) % to fluid challenge (p = 0.851); for SVV 11.3 (6.1–17.4) % versus 9.1 (5.5–12.8) % (p = 0.64). dPes was 17 (7–19) cm H2O. Correlation dPAOP and dPes: r2 = 0.69; p < 0.001; dPes and dCVP: r2 = 0.53; p < 0.001. Conclusion: PPV and SVV failed in prediction of fluid responsiveness in patients on PSV. Changes of PAOP and less of CVP can be used for estimation of pleural pressure changes.

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