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Sigh maneuver to enhance assessment of fluid responsiveness during pressure support ventilation
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Sigh maneuver to enhance assessment of fluid responsiveness during pressure support ventilation
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Journal Article
Sigh maneuver to enhance assessment of fluid responsiveness during pressure support ventilation
2019
Overview
Background
Assessment of fluid responsiveness is problematic in intensive care unit (ICU) patients, in particular for those undergoing modes of partial support, such as pressure support ventilation (PSV). We propose a new test, based on application of a ventilator-generated sigh, to predict fluid responsiveness in ICU patients undergoing PSV.
Methods
This was a prospective bi-centric interventional study conducted in two general ICUs. In 40 critically ill patients with a stable ventilatory PSV pattern and requiring volume expansion (VE), we assessed the variations in arterial systolic pressure (SAP), pulse pressure (PP) and stroke volume index (SVI) consequent to random application of 4-s sighs at three different inspiratory pressures. A radial arterial signal was directed to the MOSTCARE™ pulse contour hemodynamic monitoring system for hemodynamic measurements. Data obtained during sigh tests were recorded beat by beat, while all the hemodynamic parameters were averaged over 30 s for the remaining period of the study protocol. VE consisted of 500 mL of crystalloids over 10 min. A patient was considered a responder if a VE-induced increase in cardiac index (CI) ≥ 15% was observed.
Results
The slopes for SAP, SVI and PP of were all significantly different between responders and non-responders (
p
< 0.0001,
p
= 0.0004 and
p
< 0.0001, respectively). The AUC of the slope of SAP (0.99; sensitivity 100.0% (79.4–100.0%) and specificity 95.8% (78.8–99.9%) was significantly greater than the AUC for PP (0.91) and SVI (0.83) (
p
= 0.04 and 0.009, respectively). The SAP slope best threshold value of the ROC curve was − 4.4° from baseline. The only parameter found to be independently associated with fluid responsiveness among those included in the logistic regression was the slope for SAP (
p
= 0.009; odds ratio 0.27 (95% confidence interval (CI
95
) 0.10–0.70)). The effects produced by the sigh at 35 cmH
2
0 (Sigh
35
) are significantly different between responders and non-responders. For a 35% reduction in PP from baseline, the AUC was 0.91 (CI
95
0.82–0.99), with sensitivity 75.0% and specificity 91.6%.
Conclusions
In a selected ICU population undergoing PSV, analysis of the slope for SAP after the application of three successive sighs and the nadir of PP after Sigh
35
reliably predict fluid responsiveness.
Trial registration
Australian New Zealand Clinical Trials Registry,
ACTRN12615001232527
. Registered on 10 November 2015.
Publisher
BioMed Central,BioMed Central Ltd,BMC
