Fluid Responsiveness Predicted by a Stepwise PEEP Elevation Recruitment Maneuver in Mechanically Ventilated Patients

Study Overview
=================
Brief Summary
-----------------
Hemodynamic and fluid optimization during perioperative period can reduce postoperative morbidity. The assessment of preload and determination of whether the patient is fluid responsive is still challenging. Static preload indices such as central venous pressure are not accurate to assess fluid responsiveness contrary to dynamic preload indices such as pulse pressure variation (PPV) and stroke volume (SV) variation. However, such indices suffer from several limitations and should be used under strict conditions. Alternative dynamic methods such as lung recruitment maneuvers (LRM) have been developed LRM can be used to reopen or prevent collapsed lung under mechanical ventilation so as to decrease respiratory complications. LRM induces a transient increase in intra-thoracic pressure and decreases in venous return, leading to a decrease in left ventricular end-diastolic area and stroke volume. Several studies have shown that the PEEP-induced decrease in stroke volume is related to pre-existing preload responsiveness. Few studies have also shown that LRM can represent a functional test to predict fluid responsiveness. However, monitoring stroke volume during LRM to assess fluid responsiveness is costly, and cardiac output devices may not be reliable. In this context, central venous pressure (CVP) or systemic arterial parameters monitoring are easily accessible and inexpensive during major surgery.

Detailed Description
-----------------
The aims of the current study were to assess the ability of a LRM with a stepwise increase of PEEP to predict fluid responsiveness in mechanically ventilated patients, to identify the best criteria for fluid responsiveness prediction between variations of systolic aortic pressure (SAP), mean arterial pressure (MAP), diastolic aortic pressure (DAP), pulse pressure (PP) and central venous pressure (CVP), to compare the ability of these criteria with pulse pressure variation (PPV) to predict fluid responsiveness

Official Title
-----------------
Fluid Responsiveness Predicted by a Stepwise PEEP Elevation Recruitment Maneuver in Mechanically Ventilated Patients, a Pilot Study

Conditions
-----------------
Mechanical Ventilation, Respiration, Artificial

Intervention / Treatment
-----------------
* Procedure: Lung recruitment maneuver


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: needing invasive arterial blood pressure and pulse contour analysis (PICCO system) for cardiac output measurement, central venous pressure monitoring, using of protective mechanical ventilation Indication for fluid expansion Admitted in the intensive care unit of CHU of St ETienne Exclusion Criteria: right ventricular dysfunction significant valvulopathy, ejection fraction less than 50%, arrhythmia contraindication to LRMs

Ages Eligible for Study
-----------------
Minimum Age: 18 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Intensive care<br>Patients admitted in the intensive care unit of the University Hospital of Saint-Etienne, France between December 2018 and July 2019 | Procedure: Lung recruitment maneuver<br>* Lung recruitment maneuver is used to reopen or prevent collapsed lung under mechanical ventilation so as to decrease respiratory complications. LRM induces a transient increase in intra-thoracic pressure and decreases in venous return, leading to a decrease in left ventricular end-diastolic area and stroke volume.<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| pulse pressure (mmHg) | Pulse pressure = systolic aortic pressure - diastolic aortic pressure | At the inclusion | 
| systolic aortic pressure (mmHg) |  | At the inclusion | 
| diastolic aortic pressure (mmHg) |  | At the inclusion | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| mean arterial pressure (mmHg) |  | At the inclusion | 
| Stroke volume (ml) |  | At the inclusion | 
| central venous pressure (mmHg) |  | At the inclusion | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
Mechanical Ventilation, Lung recruitment maneuver, central venous pressure, pulse pressure, stroke volume, fluid responsiveness