Comparison of the Efficacy of Different Arterial Waveform-Derived Variables (Pulse Pressure Variation, Stroke Volume Variation, Systolic Pressure Variation) for Fluid Responsiveness in Hemodynamically Unstable Mechanically Ventilated Critically III Patients

Introduction:This study was conducted to assess fluid responsiveness in critically ill patients to avoid various complications of fluid overload. Material and methods: This study was done in an ICU of a tertiary care hospital after approval from the institute ethical committee over 18 months. A total of 54 consenting adult patients were included In the study. Patients were hemodynamically unstable requiring mechanical ventilation, had acute circulatory failure, or those with at least one clinical sign of inadequate tissue perfusion. All patients were ventilated using tidal volume of 6-8 ml/kg, RR-12-15/minutes, positive end expiratory pressure (PEEP)-5 cm of water, and plateau pressure was kept below 30 cm water. They were sedated throughout the study. The arterial line and the central venous catheter were placed and connected to Vigileo-FloTrac transducer (Edward Lifesciences). Patients were classified into responder and nonresponder groups on the basis of the cardiac Index (CI) after fluid challenge of 10 mL/kg of normal saline over 30 minutes. Pulse pressure variation (PPV), stroke volume variation (SW), and systolic pressure variation (SPV) were assessed and compared at baseline, 30 minutes, and 60 minutes. Results: in our study we found that PPV and SW were significantly lower among responders than nonresponders at 30 minutes and insignificant at 60 minutes. Stroke volume variation was 10.28 +/- 1.76 in the responder compared to 12.28 +/- 4.42 (p = 0.02) at 30 minutes and PPV was 15.28 +/- 6.94 in responders while It was 20.03 +/- 4.35 in nonresponders (p = 0.01). We found SPV was insignificant at all time periods among both groups. Conclusion: We can conclude that initial assessment for fluid responsiveness in critically ill mechanically ventilated patients should be based on PPV and SW to prevent complications of fluid overload and their consequences. Conclusion: We can conclude that initial assessment for fluid responsiveness in critically ill mechanically ventilated patients should be based on PPV and SW to prevent complications of fluid overload and their consequences.