Pulse pressure power spectrum predicts volume responsiveness in shock patients without sedation

Chih Hsin Lee, Jann Yuan Wang, Yao Kuang Wu, Hung Wen Chiu, Chou Chin Lan, Hung Chang, Chi Yuan Chen

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

The authors investigated whether the pulse pressure power spectrum (PPPS) could predict the effect of volume expansion (VE) in shock patients under mechanical ventilation without sedation. The PPPS within a frequency band of 0.15 to 0.75 Hz was developed with an animal model using nine domesticated piglets simulating acute hemorrhagic shock and then validated in 17 nonsedated mechanically ventilated shock patients. Hemodynamic parameters were recorded before and after VE. In the animal model under anesthesia and pressure-controlled ventilation, the absolute and proportional change of cardiac index after VE (ΔCI and ΔCI%) positively correlated with the square root of PPPS (SQRT-PPPS, r = 0.34 and r = 0.72, respectively). The correlations were weaker with PP variation averaged on 120-s sliding window (PPV120, r = 0.27 and r = 0.64, respectively) and PPV30 (r = 0.28 and r = 0.63, respectively) under pressure-controlled level 10 cmH2O. Defining the volume responder as ΔCI% greater than or equal to 15%, the area under the receiver operating characteristic curve (AROC) were equivalent for SQRT-PPPS (0.91), PPV120 (0.86), and PPV30 (0.85). For the 17 patients who had spontaneous breathing movements under assisted pressure-controlled ventilation, the ΔCI and ΔCI% positively correlated with SQRT-PPPS (r = 0.35 and r = 0.73, respectively). The correlations were weaker with PPV120 (r = 0.27 and r = 0.42) and PPV30 (r = 0.27 and r = 0.40). The AROC were 0.78 for SQRT-PPPS (P = 0.047), 0.71 for PPV120 (P = 0.131), and 0.69 for PPV30 (P = 0.185). In mechanically ventilated shock patients, SQRT-PPPS predicts volume responsiveness without the need for sedation to prevent spontaneous breathing movements.

Original languageEnglish
Pages (from-to)454-459
Number of pages6
JournalShock
Volume33
Issue number5
DOIs
Publication statusPublished - 2010
Externally publishedYes

Fingerprint

Shock
Blood Pressure
Pressure
ROC Curve
Ventilation
Respiration
Animal Models
Hemorrhagic Shock
Artificial Respiration
Anesthesia
Hemodynamics

Keywords

  • Animal model
  • Cardiac output
  • Heart-lung interaction
  • Mechanical ventilation
  • Pulse pressure variation

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Emergency Medicine
  • Medicine(all)

Cite this

Pulse pressure power spectrum predicts volume responsiveness in shock patients without sedation. / Lee, Chih Hsin; Wang, Jann Yuan; Wu, Yao Kuang; Chiu, Hung Wen; Lan, Chou Chin; Chang, Hung; Chen, Chi Yuan.

In: Shock, Vol. 33, No. 5, 2010, p. 454-459.

Research output: Contribution to journalArticle

Lee, Chih Hsin ; Wang, Jann Yuan ; Wu, Yao Kuang ; Chiu, Hung Wen ; Lan, Chou Chin ; Chang, Hung ; Chen, Chi Yuan. / Pulse pressure power spectrum predicts volume responsiveness in shock patients without sedation. In: Shock. 2010 ; Vol. 33, No. 5. pp. 454-459.
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abstract = "The authors investigated whether the pulse pressure power spectrum (PPPS) could predict the effect of volume expansion (VE) in shock patients under mechanical ventilation without sedation. The PPPS within a frequency band of 0.15 to 0.75 Hz was developed with an animal model using nine domesticated piglets simulating acute hemorrhagic shock and then validated in 17 nonsedated mechanically ventilated shock patients. Hemodynamic parameters were recorded before and after VE. In the animal model under anesthesia and pressure-controlled ventilation, the absolute and proportional change of cardiac index after VE (ΔCI and ΔCI{\%}) positively correlated with the square root of PPPS (SQRT-PPPS, r = 0.34 and r = 0.72, respectively). The correlations were weaker with PP variation averaged on 120-s sliding window (PPV120, r = 0.27 and r = 0.64, respectively) and PPV30 (r = 0.28 and r = 0.63, respectively) under pressure-controlled level 10 cmH2O. Defining the volume responder as ΔCI{\%} greater than or equal to 15{\%}, the area under the receiver operating characteristic curve (AROC) were equivalent for SQRT-PPPS (0.91), PPV120 (0.86), and PPV30 (0.85). For the 17 patients who had spontaneous breathing movements under assisted pressure-controlled ventilation, the ΔCI and ΔCI{\%} positively correlated with SQRT-PPPS (r = 0.35 and r = 0.73, respectively). The correlations were weaker with PPV120 (r = 0.27 and r = 0.42) and PPV30 (r = 0.27 and r = 0.40). The AROC were 0.78 for SQRT-PPPS (P = 0.047), 0.71 for PPV120 (P = 0.131), and 0.69 for PPV30 (P = 0.185). In mechanically ventilated shock patients, SQRT-PPPS predicts volume responsiveness without the need for sedation to prevent spontaneous breathing movements.",
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AB - The authors investigated whether the pulse pressure power spectrum (PPPS) could predict the effect of volume expansion (VE) in shock patients under mechanical ventilation without sedation. The PPPS within a frequency band of 0.15 to 0.75 Hz was developed with an animal model using nine domesticated piglets simulating acute hemorrhagic shock and then validated in 17 nonsedated mechanically ventilated shock patients. Hemodynamic parameters were recorded before and after VE. In the animal model under anesthesia and pressure-controlled ventilation, the absolute and proportional change of cardiac index after VE (ΔCI and ΔCI%) positively correlated with the square root of PPPS (SQRT-PPPS, r = 0.34 and r = 0.72, respectively). The correlations were weaker with PP variation averaged on 120-s sliding window (PPV120, r = 0.27 and r = 0.64, respectively) and PPV30 (r = 0.28 and r = 0.63, respectively) under pressure-controlled level 10 cmH2O. Defining the volume responder as ΔCI% greater than or equal to 15%, the area under the receiver operating characteristic curve (AROC) were equivalent for SQRT-PPPS (0.91), PPV120 (0.86), and PPV30 (0.85). For the 17 patients who had spontaneous breathing movements under assisted pressure-controlled ventilation, the ΔCI and ΔCI% positively correlated with SQRT-PPPS (r = 0.35 and r = 0.73, respectively). The correlations were weaker with PPV120 (r = 0.27 and r = 0.42) and PPV30 (r = 0.27 and r = 0.40). The AROC were 0.78 for SQRT-PPPS (P = 0.047), 0.71 for PPV120 (P = 0.131), and 0.69 for PPV30 (P = 0.185). In mechanically ventilated shock patients, SQRT-PPPS predicts volume responsiveness without the need for sedation to prevent spontaneous breathing movements.

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