Brachial cuff measurements for fluid responsiveness prediction in the critically ill

K Lakhal,I Runge,B Régnier,D Benzekri-Lefèvre,Pf Dequin,S Ehrmann,T Boulain,E Mercier,M Wolff,A Legras

doi:10.1186/cc9493

Abstract

The passive leg raising maneuver (PLR) with concomitant measurement of invasive arterial pressure (AP) or cardiac output (CO) changes are used to test volume responsiveness. The initial hemodynamic evaluation of shocked patients often relies on the sole non-invasive measurement of AP. We assessed the performance of PLR-induced changes in oscillometric measurements of systolic, mean and pulse AP (ΔplrSAP, ΔplrMAP and ΔplrPP).

Highlights

Static cardiac filling volumes have been suggested to better predict fluid responsiveness than filling pressures, but this may not apply to hearts with systolic dysfunction and dilatation
In patients with low global ejection fraction (GEF) indicating systolic cardiac dysfunction, pulmonary artery occlusion pressure (PAOP) has a greater predictive value than global end-diastolic volume index (GEDVI) for fluid responsiveness, whereas in patients with near-normal GEF, GEDVI is superior to PAOP
Our study suggests that, after coronary artery and major vascular surgery, prediction and monitoring of fluid responsiveness by pressures or transpulmonary thermodilution-derived volumes depends on systolic cardiac function and the degree of cardiac dilatation

Summary

Introduction

Static cardiac filling volumes have been suggested to better predict fluid responsiveness than filling pressures, but this may not apply to hearts with systolic dysfunction and dilatation. The clinical benefit of various hemodynamic monitoring techniques in the critically ill is still under debate [1,2,3,4,5] Static filling volumes, such as the transpulmonary dilution-derived global end-diastolic volume, have been suggested to better predict fluid responsiveness systolic dysfunction, measured by transesophageal echocardiography [20]. We suggested this in patients with presumed left ventricular systolic dysfunction based on transpulmonary thermodilutionderived global ejection fraction (GEF) following valvular surgery [21]. Volumes may better predict fluid responsiveness than pressures, while in hearts with systolic dysfunction and dilatation, pressures may better predict and monitor fluid responsiveness than volumes [5,22]

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Conclusion