• Antonio Messina, Davide Colombo, Gianmaria Cammarota, Marta De Lucia, Maurizio Cecconi, Massimo Antonelli, Francesco Della Corte, and Paolo Navalesi.
• Anesthesia and Intensive Care Medicine, Maggiore della Carità University Hospital, Novara, Italy.
• J Crit Care. 2015 Oct 1; 30 (5): 1067-71.

PurposeDuring partial ventilatory support, pulse pressure variation (PPV) fails to adequately predict fluid responsiveness. This prospective study aims to investigate whether patient-ventilator asynchrony affects PPV prediction of fluid responsiveness during pressure support ventilation (PSV).Materials And MethodsThis is an observational physiological study evaluating the response to a 500-mL fluid challenge in 54 patients receiving PSV, 27 without (Synch) and 27 with asynchronies (Asynch), as assessed by visual inspection of ventilator waveforms by 2 skilled blinded physicians.ResultsThe area under the curve was 0.71 (confidence interval, 0.57-0.83) for the overall population, 0.86 (confidence interval, 0.68-0.96) in the Synch group, and 0.53 (confidence interval, 0.33-0.73) in the Asynch group (P = .018). Sensitivity and specificity of PPV were 78% and 89% in the Synch group and 36% and 46% in the Asynch group. Logistic regression showed that the PPV prediction was influenced by patient-ventilator asynchrony (odds ratio, 8.8 [2.0-38.0]; P < .003). Of the 27 patients without asynchronies, 12 had a tidal volume greater than or equal to 8 mL/kg; in this subgroup, the rate of correct classification was 100%.ConclusionsPatient-ventilator asynchrony affects PPV performance during partial ventilatory support influencing its efficacy in predicting fluid responsiveness.Copyright © 2015 Elsevier Inc. All rights reserved.

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