Arterial waveform-analysis is of limited value in daily clinical practice in the intensive care unit

TY - JOUR

T1 - Arterial waveform-analysis is of limited value in daily clinical practice in the intensive care unit

AU - Henningsen, Louise

AU - Haase, Nicolai

AU - Pedersen, Ulf Gøttrup

AU - Perner, Anders

PY - 2015/9/1

Y1 - 2015/9/1

N2 - Introduction: It is difficult to identify the patients who will respond to fluid therapy, but the arterial waveformderived variables have reasonably predictive values for fluid responsiveness. However, the patient must fulfil a number of prerequisites for these variables to be valid. We assessed the proportion of intensive care unit (ICU) patients with shock who at the time of resuscitation fulfilled the prerequisites for using the arterial waveform-derived variables. Methods: This was a prospective cohort study performed at six ICUs. The study included consecutive adult patients with shock (20 patients per ICU) who received fluid resuscitation on the first day of shock. The fulfilment or not of the prerequisites (sedation, sinus rhythm and controlled ventilation with tidal volumes > 7 ml/kg) was registered at the time of the first fluid resuscitation episode and at fluid resuscitation episodes during the following days. Results: A total of 119 patients with a median age of 68 years (interquartile range: 56-76 years) were included. At the time of the first fluid resuscitation, 82% (95% confidence interval (CI): 74-87) of the patients had sinus rhythm, 77% (95% CI: 69-84) were sedated, 55% (95% CI: 46-65) were on controlled ventilation and 50% (95% CI: 39-61) received tidal volumes of more than 7 ml/kg. Only 23% (95% CI: 14-33) of the patients fulfilled all four prerequisites. ConclusionS: Less than a quarter of the ICU patients with shock fulfilled all the prerequisites for the use of arterial waveform-derived variables to predict fluid responsiveness. Thus, these variables may be of limited use during resuscitation in the ICU. Funding: none. Trial registration: not relevant.

AB - Introduction: It is difficult to identify the patients who will respond to fluid therapy, but the arterial waveformderived variables have reasonably predictive values for fluid responsiveness. However, the patient must fulfil a number of prerequisites for these variables to be valid. We assessed the proportion of intensive care unit (ICU) patients with shock who at the time of resuscitation fulfilled the prerequisites for using the arterial waveform-derived variables. Methods: This was a prospective cohort study performed at six ICUs. The study included consecutive adult patients with shock (20 patients per ICU) who received fluid resuscitation on the first day of shock. The fulfilment or not of the prerequisites (sedation, sinus rhythm and controlled ventilation with tidal volumes > 7 ml/kg) was registered at the time of the first fluid resuscitation episode and at fluid resuscitation episodes during the following days. Results: A total of 119 patients with a median age of 68 years (interquartile range: 56-76 years) were included. At the time of the first fluid resuscitation, 82% (95% confidence interval (CI): 74-87) of the patients had sinus rhythm, 77% (95% CI: 69-84) were sedated, 55% (95% CI: 46-65) were on controlled ventilation and 50% (95% CI: 39-61) received tidal volumes of more than 7 ml/kg. Only 23% (95% CI: 14-33) of the patients fulfilled all four prerequisites. ConclusionS: Less than a quarter of the ICU patients with shock fulfilled all the prerequisites for the use of arterial waveform-derived variables to predict fluid responsiveness. Thus, these variables may be of limited use during resuscitation in the ICU. Funding: none. Trial registration: not relevant.

KW - Aged

KW - Arterial Pressure

KW - Critical Care

KW - Denmark

KW - Female

KW - Fluid Therapy

KW - Humans

KW - Intensive Care Units

KW - Male

KW - Middle Aged

KW - Monitoring, Ambulatory

KW - Patient Selection

KW - Prospective Studies

KW - Resuscitation

KW - Shock, Septic

M3 - Journal article

C2 - 26324086

SN - 2245-1919

VL - 62

SP - 1

EP - 4

JO - Danish Medical Journal

JF - Danish Medical Journal

IS - 9

M1 - A5136

ER -