Tsolaki Vasiliki, Zakynthinos George E, Karavidas Nikitas, Papadonta Maria Eirini, Dimeas Ilias, Parisi Kyriaki, Amanatidis Theofilos, Zakynthinos Epaminondas
Critical Care Department, University Hospital of Larissa, University of Thessaly, Faculty of Medicine, Larissa, Greece.
Third Cardiology Department, Sotiria Hospital, National and Kapodistrian University of Athens, Greece.
Crit Care Explor. 2025 May 28;7(6):e1273. doi: 10.1097/CCE.0000000000001273. eCollection 2025 Jun 1.
To evaluate the effects of positive end-expiratory pressure (PEEP) on pulse pressure variation (PPV) in patients with moderate/severe acute respiratory distress syndrome (ARDS).
Prospective interventional self-controlled study.
University Hospital of Larissa.
ARDS patients admitted intubated in the ICU (from August 2020 to March 2022).
None.
PPV and inferior vena cava (IVC) respiratory variability were evaluated at two PEEP levels (first value mainly based on PEEP/Fio2 and second value based on respiratory system compliance). Additionally, respiratory mechanics, hemodynamics, and echocardiographic indices assessing right ventricular (RV) size (RV end-diastolic area/left ventricular end-diastolic area [RVEDA/LVEDA]), RV systolic function, and RV afterload (pulmonary artery systolic pressure [PASP] and PASP/left ventricular outflow tract velocity time integral [PASP/VTILVOT]) were recorded. Ninety-five patients were evaluated. PPV decreased after PEEP reduction (11.7 ± 0.2 to 7.9% ± 0.2%), whereas IVC respiratory variability increased (9.1 ± 0.9 to 14.6% ± 0.1%) and central venous pressure decreased (all p < 0.0001). RV afterload indices decreased (p < 0.0001), simultaneously with RV size (< 0.0001) and systolic function indices' improvements (< 0.05); shock warranted less noradrenaline doses. The change in PPV correlated significantly to respiratory variability in IVC diameter distensibility (p < 0.0001) and moderately to changes in RV size and systolic function (change in RVEDA/change in LVEDA, change in tricuspid annular plane systolic excursion); RV afterload (change in PASP [ΔPASP], ΔPASP/VTILVOT); and change in Paco2 (all p < 0.05).
PPV alteration with PEEP decrease, associated with IVC distensibility increases, may indicate the presence of RV dysfunction and increased pulmonary vascular resistances. Whether the patients are in need for fluid loading, fluid responsiveness assessment may be further warranted.
评估呼气末正压（PEEP）对中重度急性呼吸窘迫综合征（ARDS）患者脉压变异（PPV）的影响。
前瞻性干预性自身对照研究。
拉里萨大学医院。
2020年8月至2022年3月期间入住重症监护病房（ICU）且已插管的ARDS患者。
无。
在两个PEEP水平评估PPV和下腔静脉（IVC）呼吸变异度（第一个值主要基于PEEP/FiO₂，第二个值基于呼吸系统顺应性）。此外，记录呼吸力学、血流动力学以及评估右心室（RV）大小（RV舒张末期面积/左心室舒张末期面积[RVEDA/LVEDA]）、RV收缩功能和RV后负荷（肺动脉收缩压[PASP]以及PASP/左心室流出道速度时间积分[PASP/VTILVOT]）的超声心动图指标。共评估了95例患者。PEEP降低后PPV下降（从11.7±0.2降至7.9%±0.2%），而IVC呼吸变异度增加（从9.1±0.9增至14.6%±0.1%）且中心静脉压降低（所有p<0.0001）。RV后负荷指标下降（p<0.0001），同时RV大小（<0.0001）及收缩功能指标改善（<0.05）；休克时去甲肾上腺素剂量减少。PPV的变化与IVC直径可扩张性的呼吸变异度显著相关（p<0.0001），与RV大小和收缩功能的变化中度相关（RVEDA变化/LVEDA变化、三尖瓣环平面收缩期位移变化）；RV后负荷（PASP变化[ΔPASP]、ΔPASP/VTILVOT）；以及动脉血二氧化碳分压变化（所有p<0.05）。
PEEP降低时PPV改变，伴IVC可扩张性增加，可能提示存在RV功能障碍及肺血管阻力增加。对于是否需要液体负荷治疗的患者，可能需要进一步进行液体反应性评估。
