Is dynamic arterial elastance a predictor of an increase in blood pressure after fluid administration in pediatric patients with hypotension? Reanalysis of prospective observational studies

Ji Hyun Lee, Yea La Kwon, Jung Hwan Na, Young Eun Jang, Eun Hee Kim, Hee Soo Kim, Jin Tae Kim

Research output: Contribution to journalArticle

Abstract

Background: Dynamic arterial elastance (Eadyn) has been proposed to predict an increase in mean arterial pressure (MAP) after volume expansion in hypotensive adults. We aimed to evaluate the clinical usefulness of Eadyn as a predictor of arterial pressure response after fluid loading in pediatric patients with hypotension. Methods: We re-analyzed data of 63 hypotensive children (age, ≤5 years), collected from three previous prospective observational studies about fluid responsiveness. Pulse pressure variation (PPV), stroke volume variation (SVV), and respiratory variation in aortic blood flow velocity (ΔVpeak) were used to calculate Eadyn (PPV/SVV) and modified Eadyn (PPV/ΔVpeak). Preload-dependent patients were defined as those with ΔVpeak ≥12% before fluid loading. Patients were classified as pressure responders, if their MAP increased ≥15% after fluid administration. Results: Mean Eadyn (SD) was 1.06 (0.47) in pressure responders (n=39) and 0.99 (0.48) in nonresponders (n = 24) (mean difference, 0.08; 95% confidence interval [CI], −0.19-0.34; P =.567). Additionally, mean modified Eadyn was 1.27 (0.64) in responders and 1.11 (0.43) in nonresponders (mean difference, 0.17; 95% CI, −0.13-0.46; P = 0.269). Both Eadyn (AUC 0.506; 95% confidence interval [CI], 0.337 to 0.675; P = 0.948) and modified Eadyn (AUC 0.498; 95% CI, 0.328-0.669; P = 0.983), as well as other dynamic variables, could not predict pressure responsiveness in children. Sub-group analysis revealed similar findings in both in 39 preload-dependent and hypotensive patients (26 pressure responders and 13 nonpressure responders). Conclusion: Both Eadyn and modified Eadyn cannot predict whether blood pressure increases with fluid administration in pediatric patients with hypotension.

Original languageEnglish
Pages (from-to)34-42
Number of pages9
JournalPaediatric Anaesthesia
Volume30
Issue number1
DOIs
StatePublished - 1 Jan 2020

Fingerprint

Hypotension
Observational Studies
Prospective Studies
Pediatrics
Blood Pressure
Confidence Intervals
Pressure
Arterial Pressure
Stroke Volume
Area Under Curve
Blood Flow Velocity

Keywords

  • Doppler
  • arterial pressure
  • echocardiography
  • hypotension
  • pediatrics
  • stroke volume

Cite this

@article{4e7efe3a408a46af91ed62e1796ac6c6,
title = "Is dynamic arterial elastance a predictor of an increase in blood pressure after fluid administration in pediatric patients with hypotension? Reanalysis of prospective observational studies",
abstract = "Background: Dynamic arterial elastance (Eadyn) has been proposed to predict an increase in mean arterial pressure (MAP) after volume expansion in hypotensive adults. We aimed to evaluate the clinical usefulness of Eadyn as a predictor of arterial pressure response after fluid loading in pediatric patients with hypotension. Methods: We re-analyzed data of 63 hypotensive children (age, ≤5 years), collected from three previous prospective observational studies about fluid responsiveness. Pulse pressure variation (PPV), stroke volume variation (SVV), and respiratory variation in aortic blood flow velocity (ΔVpeak) were used to calculate Eadyn (PPV/SVV) and modified Eadyn (PPV/ΔVpeak). Preload-dependent patients were defined as those with ΔVpeak ≥12{\%} before fluid loading. Patients were classified as pressure responders, if their MAP increased ≥15{\%} after fluid administration. Results: Mean Eadyn (SD) was 1.06 (0.47) in pressure responders (n=39) and 0.99 (0.48) in nonresponders (n = 24) (mean difference, 0.08; 95{\%} confidence interval [CI], −0.19-0.34; P =.567). Additionally, mean modified Eadyn was 1.27 (0.64) in responders and 1.11 (0.43) in nonresponders (mean difference, 0.17; 95{\%} CI, −0.13-0.46; P = 0.269). Both Eadyn (AUC 0.506; 95{\%} confidence interval [CI], 0.337 to 0.675; P = 0.948) and modified Eadyn (AUC 0.498; 95{\%} CI, 0.328-0.669; P = 0.983), as well as other dynamic variables, could not predict pressure responsiveness in children. Sub-group analysis revealed similar findings in both in 39 preload-dependent and hypotensive patients (26 pressure responders and 13 nonpressure responders). Conclusion: Both Eadyn and modified Eadyn cannot predict whether blood pressure increases with fluid administration in pediatric patients with hypotension.",
keywords = "Doppler, arterial pressure, echocardiography, hypotension, pediatrics, stroke volume",
author = "Lee, {Ji Hyun} and Kwon, {Yea La} and Na, {Jung Hwan} and Jang, {Young Eun} and Kim, {Eun Hee} and Kim, {Hee Soo} and Kim, {Jin Tae}",
year = "2020",
month = "1",
day = "1",
doi = "10.1111/pan.13769",
language = "English",
volume = "30",
pages = "34--42",
journal = "Paediatric Anaesthesia",
issn = "1155-5645",
publisher = "Wiley-Blackwell Publishing Ltd",
number = "1",

}

TY - JOUR

T1 - Is dynamic arterial elastance a predictor of an increase in blood pressure after fluid administration in pediatric patients with hypotension? Reanalysis of prospective observational studies

AU - Lee, Ji Hyun

AU - Kwon, Yea La

AU - Na, Jung Hwan

AU - Jang, Young Eun

AU - Kim, Eun Hee

AU - Kim, Hee Soo

AU - Kim, Jin Tae

PY - 2020/1/1

Y1 - 2020/1/1

N2 - Background: Dynamic arterial elastance (Eadyn) has been proposed to predict an increase in mean arterial pressure (MAP) after volume expansion in hypotensive adults. We aimed to evaluate the clinical usefulness of Eadyn as a predictor of arterial pressure response after fluid loading in pediatric patients with hypotension. Methods: We re-analyzed data of 63 hypotensive children (age, ≤5 years), collected from three previous prospective observational studies about fluid responsiveness. Pulse pressure variation (PPV), stroke volume variation (SVV), and respiratory variation in aortic blood flow velocity (ΔVpeak) were used to calculate Eadyn (PPV/SVV) and modified Eadyn (PPV/ΔVpeak). Preload-dependent patients were defined as those with ΔVpeak ≥12% before fluid loading. Patients were classified as pressure responders, if their MAP increased ≥15% after fluid administration. Results: Mean Eadyn (SD) was 1.06 (0.47) in pressure responders (n=39) and 0.99 (0.48) in nonresponders (n = 24) (mean difference, 0.08; 95% confidence interval [CI], −0.19-0.34; P =.567). Additionally, mean modified Eadyn was 1.27 (0.64) in responders and 1.11 (0.43) in nonresponders (mean difference, 0.17; 95% CI, −0.13-0.46; P = 0.269). Both Eadyn (AUC 0.506; 95% confidence interval [CI], 0.337 to 0.675; P = 0.948) and modified Eadyn (AUC 0.498; 95% CI, 0.328-0.669; P = 0.983), as well as other dynamic variables, could not predict pressure responsiveness in children. Sub-group analysis revealed similar findings in both in 39 preload-dependent and hypotensive patients (26 pressure responders and 13 nonpressure responders). Conclusion: Both Eadyn and modified Eadyn cannot predict whether blood pressure increases with fluid administration in pediatric patients with hypotension.

AB - Background: Dynamic arterial elastance (Eadyn) has been proposed to predict an increase in mean arterial pressure (MAP) after volume expansion in hypotensive adults. We aimed to evaluate the clinical usefulness of Eadyn as a predictor of arterial pressure response after fluid loading in pediatric patients with hypotension. Methods: We re-analyzed data of 63 hypotensive children (age, ≤5 years), collected from three previous prospective observational studies about fluid responsiveness. Pulse pressure variation (PPV), stroke volume variation (SVV), and respiratory variation in aortic blood flow velocity (ΔVpeak) were used to calculate Eadyn (PPV/SVV) and modified Eadyn (PPV/ΔVpeak). Preload-dependent patients were defined as those with ΔVpeak ≥12% before fluid loading. Patients were classified as pressure responders, if their MAP increased ≥15% after fluid administration. Results: Mean Eadyn (SD) was 1.06 (0.47) in pressure responders (n=39) and 0.99 (0.48) in nonresponders (n = 24) (mean difference, 0.08; 95% confidence interval [CI], −0.19-0.34; P =.567). Additionally, mean modified Eadyn was 1.27 (0.64) in responders and 1.11 (0.43) in nonresponders (mean difference, 0.17; 95% CI, −0.13-0.46; P = 0.269). Both Eadyn (AUC 0.506; 95% confidence interval [CI], 0.337 to 0.675; P = 0.948) and modified Eadyn (AUC 0.498; 95% CI, 0.328-0.669; P = 0.983), as well as other dynamic variables, could not predict pressure responsiveness in children. Sub-group analysis revealed similar findings in both in 39 preload-dependent and hypotensive patients (26 pressure responders and 13 nonpressure responders). Conclusion: Both Eadyn and modified Eadyn cannot predict whether blood pressure increases with fluid administration in pediatric patients with hypotension.

KW - Doppler

KW - arterial pressure

KW - echocardiography

KW - hypotension

KW - pediatrics

KW - stroke volume

UR - http://www.scopus.com/inward/record.url?scp=85076118062&partnerID=8YFLogxK

U2 - 10.1111/pan.13769

DO - 10.1111/pan.13769

M3 - Article

C2 - 31730254

AN - SCOPUS:85076118062

VL - 30

SP - 34

EP - 42

JO - Paediatric Anaesthesia

JF - Paediatric Anaesthesia

SN - 1155-5645

IS - 1

ER -