TY - JOUR

T1 - Pulse pressure power spectrum predicts volume responsiveness in shock patients without sedation

AU - Lee, Chih Hsin

AU - Wang, Jann Yuan

AU - Wu, Yao Kuang

AU - Chiu, Hung Wen

AU - Lan, Chou Chin

AU - Chang, Hung

AU - Chen, Chi Yuan

PY - 2010

Y1 - 2010

N2 - 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.

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.

KW - Animal model

KW - Cardiac output

KW - Heart-lung interaction

KW - Mechanical ventilation

KW - Pulse pressure variation

UR - http://www.scopus.com/inward/record.url?scp=77951493467&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77951493467&partnerID=8YFLogxK

U2 - 10.1097/SHK.0b013e3181c8af66

DO - 10.1097/SHK.0b013e3181c8af66

M3 - Article

C2 - 19924032

AN - SCOPUS:77951493467

VL - 33

SP - 454

EP - 459

JO - Shock

JF - Shock

SN - 1073-2322

IS - 5

ER -