Fluid responsiveness in acute respiratory distress syndrome patients: a post hoc analysis of the HEMOPRED study

被引:2
作者
Joseph, Adrien [1 ,2 ]
Evrard, Bruno [3 ,4 ]
Petit, Matthieu [1 ,5 ]
Goudelin, Marine [3 ,4 ]
Prat, Gwenael [6 ]
Slama, Michel [7 ]
Charron, Cyril [1 ]
Vignon, Philippe [3 ,4 ]
Vieillard-Baron, Antoine [1 ,5 ]
机构
[1] GHU Paris Saclay, Univ Hosp Ambroise Pare, Assistance Publ Hop Paris, Med & Surg intens care unit, Boulogne Billancourt, France
[2] Univ Paris Saclay, Univ Versailles St Quentin, Lab Infect & Inflammat, Inserm U1173, Guyancourt, France
[3] Univ Limoges, Med Surg Intens Care Unit, INSERM C 1435, Limoges, France
[4] Univ Limoges, Fac Med, Limoges, France
[5] Univ Versailles St Quentin, Univ Paris Saclay, Inserm U1018, CESP, Guyancourt, France
[6] Brest Univ Hosp, Med Intens Care Unit, Brest, France
[7] Amiens Univ Hosp, Med Intens Care Unit, Amiens, France
关键词
Fluid therapy; Hemodynamic; Echocardiography; Acute respiratory distress syndrome; PULSE PRESSURE VARIATION; PROTECTIVE VENTILATION; TIDAL VOLUME; RIGHT HEART; LUNG; MANAGEMENT; EPIDEMIOLOGY; PREDICTORS; GUIDELINES; MORTALITY;
D O I
10.1007/s00134-024-07639-6
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Purpose: Optimal fluid management in patients with acute respiratory distress syndrome (ARDS) is challenging due to risks associated with both circulatory failure and fluid overload. The performance of dynamic indices to predict fluid responsiveness (FR) in ARDS patients is uncertain. Methods: This post hoc analysis of the HEMOPRED study compared the performance of dynamic indices in mechanically ventilated patients with shock, with and without ARDS, to predict FR, defined as an increase in aortic velocity time integral (VTI) > 10% after passive leg raising (PLR). Results: Among 540 patients, 117 (22%) had ARDS and were ventilated with a median tidal volume of 7.6 mL/kg [6.9-8.4] and a median positive end-expiratory pressure of 7 cmH(2)O [5-9]. FR was observed in 45 ARDS patients (39% vs 44% in non-ARDS patients, p = 0.384). Reliability of dynamic indices to predict FR remained consistent in ARDS patients, though with different thresholds. Collapsibility index of the superior vena cava (Delta SVC) showed the best predictive performance in both ARDS (area under the curve [AUC] = 0.763 [0.659-0.868]) and non-ARDS (AUC = 0.750 [0.698-0.802]) patients. A right to left ventricle end-diastolic area ratio > 0.8 or paradoxical septal motion were strongly linked to the absence of FR (> 80% specificity). FR was not associated with intensive care unit (ICU) mortality (47% vs. 46%, p = 1). However, hypovolemia, defined as an aortic VTI increase > 32% during PLR (median increase in patients with a partial SVC collapse) was independently associated with ICU mortality (odds ratio [OR] = 1.355 [1.077-1.705], p = 0.011), as well as pulse pressure variation (OR = 1.014 [1.001-1.026], p = 0.034). Conclusion: Performance of dynamic indices to predict FR appears preserved in ARDS patients, albeit with distinct thresholds. Hypovolemia, indicated by a > 32% increase in aortic VTI during PLR, rather than FR, was associated with ICU mortality in this population.
引用
收藏
页码:1850 / 1860
页数:11
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