The effects of respiratory rate and tidal volume on pulse pressure variation in healthy lungs-a generalized additive model approach may help overcome limitations

Johannes Enevoldsen*, Birgitte Brandsborg, Peter Juhl-Olsen, Stephen Edward Rees, Henriette Vind Thaysen, Thomas W L Scheeren, Simon Tilma Vistisen

*Corresponding author for this work

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaperJournal articleResearchpeer-review

Abstract

Pulse pressure variation (PPV) is a well-established method for predicting fluid responsiveness in mechanically ventilated patients. The predictive accuracy is, however, disputed for ventilation with low tidal volume (V T) or low heart-rate-to-respiratory-rate ratio (HR/RR). We investigated the effects of V T and RR on PPV and on PPV's ability to predict fluid responsiveness. We included patients scheduled for open abdominal surgery. Prior to a 250 ml fluid bolus, we ventilated patients with combinations of V T from 4 to 10 ml kg -1 and RR from 10 to 31 min -1. For each of 10 RR-V T combinations, PPV was derived using both a classic approach and a generalized additive model (GAM) approach. The stroke volume (SV) response to fluid was evaluated using uncalibrated pulse contour analysis. An SV increase > 10% defined fluid responsiveness. Fifty of 52 included patients received a fluid bolus. Ten were fluid responders. For all ventilator settings, fluid responsiveness prediction with PPV was inconclusive with point estimates for the area under the receiver operating characteristics curve between 0.62 and 0.82. Both PPV measures were nearly proportional to V T. Higher RR was associated with lower PPV. Classically derived PPV was affected more by RR than GAM-derived PPV. Correcting PPV for V T could improve PPV's predictive utility. Low HR/RR has limited effect on GAM-derived PPV, indicating that the low HR/RR limitation is related to how PPV is calculated. We did not demonstrate any benefit of GAM-derived PPV in predicting fluid responsiveness.Trial registration: ClinicalTrials.gov, reg. March 6, 2020, NCT04298931.

Original languageEnglish
JournalJournal of Clinical Monitoring and Computing
Volume38
Issue1
Pages (from-to)57-67
Number of pages11
ISSN1387-1307
DOIs
Publication statusPublished - Feb 2024

Keywords

  • Dynamic filling variable
  • Fluid responsiveness
  • Heart–lung interaction
  • Hemodynamic monitoring
  • Mechanical ventilation
  • Pulse pressure variation
  • Fluid Therapy/methods
  • Blood Pressure/physiology
  • Respiratory Rate
  • Humans
  • Lung
  • Stroke Volume/physiology
  • Tidal Volume
  • Hemodynamics/physiology
  • Respiration, Artificial/methods

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