RESUMO
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Assuntos
Encefalopatias/diagnóstico por imagem , Encefalopatias/virologia , Encéfalo/diagnóstico por imagem , Infecções por Coronavirus/diagnóstico por imagem , Pneumonia Viral/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus/isolamento & purificação , Encéfalo/patologia , Encefalopatias/epidemiologia , COVID-19 , Comorbidade , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/patologia , Feminino , Humanos , Unidades de Terapia Intensiva , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Pneumonia Viral/patologia , Estudos Retrospectivos , SARS-CoV-2RESUMO
BACKGROUND: Positive end-expiratory pressure (PEEP) increment induces a decrease in Stroke Volume Index (SVI). We hypothesized that the magnitude of SVI reduction due to a 5 cmH2O increase in PEEP could predict fluid responsiveness during low tidal volume ventilation. METHODS: Forty-eight patients completed the study. Heart rate, mean arterial pressure, SVI, pulse pressure variation (PPV) and stroke volume variation (SVV) were recorded before short-time low PEEP (SLPC) challenge (applied additional 5 cmH2O PEEP to patients for 30 seconds), during SLPC and before and after 500 mL fluid loading. Patients whose SVI increased more than 15% after the fluid loading were defined as volume responders. RESULTS: Twenty-one (44%) patients were volume responder. Decrease percentage in SVI during SLPC was 17.4±3.6% and 9.9±3.1% in responders and non-responders respectively (P<0.001). A strong correlation was found between decrease percentage in SVI during SLPC and increase percentage in SVI after fluid loading (R2=0.680, P<0.001). The area under receiver operating curves generated to predict fluid responsiveness for decrease percentage in SVI during SLPC (0.944, 95% CI: 0.836-0.990) was significantly higher than that for PPV (0.777, 95% CI: 0.634-0.884, P=0.025) and SVV (0.773, 95% CI: 0.630-0.882, P=0.022). Best cut-off values of decrease percentage in SVI during SLPC was -14.2 with 95% sensitivity and 89% specificity. CONCLUSIONS: SVI change percentage during SLPC can predict fluid responsiveness better than PPV and SVV in neurosurgery patients ventilated with low tidal volume.