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. 2025 Jun 13;29(1):241.
doi: 10.1186/s13054-025-05483-8.

Real-time changes in pulse pressure during a 10-second end-expiratory occlusion test reliably detect preload responsiveness

Francesco Gavelli  1   2 , Nello De Vita  3   4 , Christopher Lai  3 , Danila Azzolina  5 , Arthur Pavot  3 , Mathieu Jozwiak  3   6   7 , Rui Shi  3 , Imane Adda  3 , Alexandra Beurton  3 , Jean-Louis Teboul  3 , Xavier Monnet  3
Affiliations

Real-time changes in pulse pressure during a 10-second end-expiratory occlusion test reliably detect preload responsiveness

Francesco Gavelli et al. Crit Care. .

Erratum in

Abstract

Background: The end-expiratory occlusion (EEO) test detects preload responsiveness through changes in cardiac index (ΔCI) during a 15-second respiratory hold at end-expiration. We investigated the diagnostic accuracy of EEO-induced changes in arterial pulse pressure (∆PP), especially when the duration of EEO is reduced to 10'' and 5'', and whether adding an end-inspiratory occlusion (EIO) improves this diagnostic accuracy.

Methods: In 143 mechanically ventilated patients with sinus rhythm, EEO and EIO were performed while recording ΔCI and ∆PP values. Either a fluid bolus-induced ΔCI ≥ 15% or a passive leg raising-induced ΔCI ≥ 10% defined preload responsiveness. The effects of the EEO and EIO tests on PP and CI were evaluated as the percentage difference between values averaged either over the last five seconds of the 15-sec respiratory holds (ΔPPEEO-15'' and ΔPPEIO-15'', ΔCIEEO-15'' and ΔCIEIO-15''), or between the 5th and the 10th seconds of the 15-sec respiratory holds (ΔPPEEO-10'' and ΔPPEIO-10'', ΔCIEEO-10'' and ΔCIEIO-10''), or during the five first seconds of respiratory holds (ΔPPEEO-5'' and ΔPPEIO-5'', ΔCIEEO-5'' and ΔCIEIO-5'') and baseline.

Results: Sixty-one (43%) patients were preload responders. Both ∆CIEEO-15'' and ∆CIEEO-10'' were higher in responders than in non-responders' (5.8 [4.5-7.3]% vs. 1.1 [0.1-3.4]% and 3.0 [2.4-4.3]% vs. 0.6 [0.1-1.6]%, respectively; p < 0.001), whereas ∆CIEEO-5'' did not differ between responders and non-responders. ∆PPEEO-5'', ∆PPEEO-10'' and ∆PPEEO-15'' were significantly higher in responders than in non-responders (5.2 [2.8-8.7]% vs. 1.2 [0.3-2.8]%, 7.7 [5.0-12.4]% vs. 1.8 [0.5-3.1]% and 8.1 [5.1-11.8]% vs. 1.5 [0.5-3.0]%, respectively; p < 0.001). For detecting preload responsiveness, compared to the area under the receiver operating characteristic (AUROC) of ∆CIEEO-15'' (0.935 [0.881-0.969]), the AUROC of ∆CIEEO-10'' was similar (0.910 [0.851-0.951], p = 0.410), but the AUROC of ∆CIEEO-5'' was smaller (0.541 [0.456-0.625], p < 0.001); the AUROC of ∆PPEEO-15'' (0.913 [0.857-0.952], p = 0.346), and ∆PPEEO-10'' (0.912 [0.860-0.947], p = 0.336) were similar, but the AUROC of ∆PPEEO-5'' (0.834 (0.763-0.891, p = 0.005) was significantly smaller. Evaluation of ∆CIEEO+EIO and ∆PPEEO+EIO did not enhance reliability of the test at each test duration.

Conclusion: In ventilated patients with sinus rhythm, real-time changes in PP during a 10-second EEO reliably detect preload responsiveness.

Trial registration: No. IDRCB 2010A0095942. Registered 04 January 2010.

Keywords: Cardiac output; Fluid challenge; Fluid responsiveness; Haemodynamic monitoring; Passive leg Raising.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Data collection of each study was approved by an independent ethics committee (Comité pour la Protection des Personnes, Ile-de-France VII). Informed consent was obtained from each patient or from the patient’s legally authorized representative if the patient was unable to provide consent. The study was conducted in accordance with the Declaration of Helsinki. Consent for publication: All authors of the manuscript have read and agreed to its content and are accountable for all aspects of the accuracy and integrity of the manuscript. The data were used anonymously. Competing interests: FG has no conflicts of interest to disclose.NDV has no conflict of interest to discloseCL has received fees for lectures from Sedana MedicalDA has no conflict of interest to discloseAP has no conflict of interest to discloseMJ has no conflict of interest to discloseSR has no conflict of interest to discloseIA has no conflict of interest to discloseAB has no conflict of interest to discloseJLT has received fees for lectures from Masimo and Edwards Lifesciences. He has received fees for consulting from Pulsion Medical Systems (Getinge).XM has received fees for lectures from Baxter Healthcare, Philips, Masimo, AOP and Pulsion Medical Systems (Getinge). He has received fees for consulting from Pulsion Medical Systems (Getinge).

Figures

Fig. 1
Fig. 1
Description of the calculation of changes in arterial pulse pressure (∆PP) and of pulse contour-derived cardiac index (CIpulse) during end-expiratory (EEO) and end-inspiratory (EIO) occlusions using theoretical arterial pressure traces and cardiac index ∆PPEEO−5’’: changes in pulse pressure during the first 5 s of the end-expiratory occlusion, ∆PPEEO−10’’: changes in pulse pressure between the 5 th and 10 th seconds of the end-expiratory occlusion, ∆PPEEO−15’’: changes in pulse pressure during the last 5 s of the end-expiratory occlusion, ∆PPEIO−5’’: changes in pulse pressure during the first 5 s of the end-inspiratory occlusion, ∆PPEIO−10’’: changes in pulse pressure between the 5 th and 10 th seconds of the end-inspiratory occlusion, ∆PPEIO−15’’: changes in pulse pressure during the last 5 s of the end-inspiratory occlusion, ∆CIEEO−15’’: changes in cardiac index during the last 5 s of the end-expiratory occlusion, ∆CIEIO−15’’: changes in cardiac index during the last 5 s of the end-inspiratory occlusion
Fig. 2
Fig. 2
Percentage changes in arterial pulse pressure (∆PP) during end-expiratory (EEO) and end-inspiratory (EIO) occlusion in preload responders and preload non-responders depending on the time of measurements
Fig. 3
Fig. 3
Area under the receiver operating characteristic curves for changes in arterial pulse pressure (∆PP) during end-expiratory occlusions (EEO) to detect preload responsiveness. ∆PPEEO-5’’: changes in pulse pressure during the first 5 seconds of the end-expiratory occlusion, ∆PPEEO-10’’: changes in pulse pressure between the 5th and 10th seconds of the end-expiratory occlusion, ∆PPEEO-15’’: changes in pulse pressure during the last 5 seconds of the end-expiratory occlusion.
See this image and copyright information in PMC

References

    1. Gavelli F, Teboul J-L, Monnet X. The end-expiratory occlusion test: please, let me hold your breath! Crit Care. 2019;23:274. - PMC - PubMed
    1. Gavelli F, Shi R, Teboul J-L, Azzolina D, Monnet X. The end-expiratory occlusion test for detecting preload responsiveness: a systematic review and meta-analysis. Ann Intensive Care. 2020;10:65. - PMC - PubMed
    1. Georges D, de Courson H, Lanchon R, Sesay M, Nouette-Gaulain K, Biais M. End-expiratory occlusion maneuver to predict fluid responsiveness in the intensive care unit: an echocardiographic study. Crit Care. 2018;22:32. - PMC - PubMed
    1. Biais M, Larghi M, Henriot J, de Courson H, Sesay M, Nouette-Gaulain K. End-Expiratory occlusion test predicts fluid responsiveness in patients with protective ventilation in the operating room. Anesth Analg. 2017;125:1889–95. - PubMed
    1. Messina A, Montagnini C, Cammarota G, De Rosa S, Giuliani F, Muratore L, et al. Tidal volume challenge to predict fluid responsiveness in the operating room: an observational study. Eur J Anaesthesiol. 2019;36:583–91. - PubMed

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