PEEP-Test for Fluid/Volume Responsiveness in Resuscitation

Fluid responsiveness is defined as “as the ability of the left ventricle to increase its stroke volume (SV) in response to fluid administration”. There are multiple strategies to define fluid responsiveness in patients who are on mechanical ventilation such as PPV, SVV, EEOP. Positive end-expiratory pressure (PEEP) can decrease cardiac output in mechanically ventilated patients. This is due to the increase of the pressure in the chest leading to a decrease in cardiac output. Increasing central blood volume by performing a passive leg raise can reverse this decrease in cardiac output. A PEEP-test, which is a transient decrease in PEEP, can be used to detect volume responsiveness.

A study by Lai et al. found that a CI increase of >8.6% during a PEEP-test reliably detects volume responsiveness. This obviously only applies to patients who are mechanically ventilated patients with a PEEP ≥10 cmH2O. Hat tip to the authors. Please read these data for yourself as there are numerous additional details. The PEEP-test is another strategy to assess for volume responsiveness in mechanically ventilated patients.

Citations Looking at the PEEP Test

Hasanin A. Fluid responsiveness in acute circulatory failure. J Intensive Care. 2015 Nov 19;3:50. doi: 10.1186/s40560-015-0117-0. PMID: 26594361; PMCID: PMC4653888.
Link to Article

Lai C, Shi R, Beurton A, Moretto F, Ayed S, Fage N, Gavelli F, Pavot A, Dres M, Teboul JL, Monnet X. The increase in cardiac output induced by a decrease in positive end-expiratory pressure reliably detects volume responsiveness: the PEEP-test study. Crit Care. 2023 Apr 9;27(1):136. doi: 10.1186/s13054-023-04424-7. PMID: 37031182; PMCID: PMC10082988.
Link to Article
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