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Meaning of Pulse Pressure Variation during ARDS

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Annual Update in Intensive Care and Emergency Medicine 2011

Part of the book series: Annual Update in Intensive Care and Emergency Medicine 2011 ((AUICEM,volume 1))

Abstract

Fluid management is a crucial issue during acute respiratory distress syndrome (ARDS). On the one hand, fluid administration is important to reverse adverse hemodynamic effects of mechanical ventilation with positive end-expiratory pressure (PEEP) or to restore adequate cardiovascular conditions in case of associated sepsis. On the other hand, since ARDS is characterized by the development of increased lung capillary permeability, fluid administration can result in lung fluid overload and hence in worsening of hypoxemia and further alteration of lung mechanics. Maintaining fluid balance is considered a major goal in the management of critically ill patients [1]–[3]. In comparison with a liberal strategy, a conservative strategy of fluid management in patients with acute lung injury (ALI) has been shown to shorten the duration of mechanical ventilation and intensive care without increasing non-pulmonary organ failure [3]. Accurate identification of patients who will not benefit from fluid administration in terms of hemodynamics (‘preload unresponsive’ patients) will enable unnecessary fluid loading to be avoided. In those identified as ‘preload responders’, the benefit/risk ratio of fluid administration should be assessed carefully before infusing fluid and must take into account not only indices of preload responsiveness but also markers of the severity of circulatory failure versus respiratory failure.

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Authors and Affiliations

  1. Medical Intensive Care Unit, Hôpital de Bicêtre, 78 rue du Général Leclerc, 94275 Le, Kremlin-Bicêtre, France

    J. -L. Teboul & X. Monnet

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  1. J. -L. Teboul
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  2. X. Monnet
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Editors and Affiliations

  1. Department of Intensive Care, Erasme Hospital, Université libre de Bruxelles, Route de Lennik 808, B-1070, Brussels, Belgium

    Jean-Louis Vincent (Head) (Head)

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Teboul, J.L., Monnet, X. (2011). Meaning of Pulse Pressure Variation during ARDS. In: Vincent, JL. (eds) Annual Update in Intensive Care and Emergency Medicine 2011. Annual Update in Intensive Care and Emergency Medicine 2011, vol 1. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-18081-1_29

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  • DOI: https://doi.org/10.1007/978-3-642-18081-1_29

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