Change in PPV with Tidal Volume Challenge to assess fluid responsiveness in patients suffering from Acute Respiratory Distress Syndrome undergoing low tidal volume mechanical ventilation in prone position

Patients admitted in ICU with septic shock (spread of infection in blood) caues low blood pressure. The first line of treatment for this is administration of intraveous fluids called as Fluid therapy. This fluid therapy, which involves the rapid administration of fluids in the patient’s veins, stands as one of the fundamental treatment modalities employed in patients afflicted by low blood pressure stemming from infection, otherwise known as septic shock. However, it is worth noting that only a minority of patients, specifically 50%, exhibit a positive response to fluid therapy, evidenced by an increase in blood pressure and an amelioration of blood supply to various organs, consequently averting the onset of organ failure.

In cases where patients display an unresponsiveness to fluid therapy, the administration of fluids may result in deleterious consequences, such as fluid accumulation within the lungs, which can precipitate lung congestion, thereby exacerbating the patient’s oxygen requirement. Consequently, the ability to accurately predict fluid responsiveness assumes paramount importance in the effective management of patients. In light of this, several tests have been devised with the aim of forecasting which patients will exhibit a favorable response to fluid therapy. However, the challenge lies in those patients who are placed in a prone position, that is, made to lie on their stomach for the purpose of ventilation, as part of their lung problems treatment. This specific group of patients presents a unique issue due to the lack of standardized tests available and the technical difficulties encountered when attempting to perform the existing tests.

To evaluate the effectiveness of the tidal volume challenge test, we are currently investigating one specific test. This test involves making adjustments to the ventilator settings in order to regulate the amount of breath administered to the patient. The breath volume is adjusted from 6ml/kg weight to 8ml/kg weight, and the test is conducted for a duration of 1 minute. The objective of this test is to observe the response in pulse pressure. Additionally, we will also assess the impact of administering fluids on the patient’s heart function. This will allow us to determine whether the reliability of pulse pressure variation (PPV) improves after measuring it following an increase in breath volume to 8ml/kg. By conducting this study, we aim to determine whether the change in PPV, while transiently increasing tidal volume to 8ml/kg Predicted Body Weight (PBW) in patients suffering from Acute Respiratory Distress Syndrome (ARDS) undergoing low tidal volume ventilation in the prone position, sufficiently predicts fluid responsiveness.

In order to examine the impact of lung compliance on the accuracy and reliability of the tidal volume challenge test, which aims to predict fluid responsiveness in patients who are experiencing acute respiratory distress syndrome (ARDS) and are undergoing low tidal volume ventilation in the prone position, it is crucial to thoroughly investigate the outcomes of this test. If the test produces favorable and encouraging results, it could potentially serve as a valuable and beneficial tool in the management and treatment of patients who are similar to yours, ultimately leading to improved patient care and outcomes.