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
Link to FULL FREE PDF

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
Link to FULL FREE PDF
Check out this Correspondence

How to Support My Work

I have started using Descript to edit my videos rather than just Final Cut Pro. I have found it to be extremely helpful at saving me time. CLICK HERE to give it a go.

My efforts are at no cost to you and I would like to keep it that way. You have to look at ads on this website, listen to them on my podcast and YouTube content. Thanks for bearing with me. You could also support my work by clicking on my Amazon Affiliate links prior to ordering things off of Amazon.

For example, if you want to learn more about Mechanical Ventilation, I recommend starting off with The Ventilator Book by Will Owens. If you click on that link, a window for Amazon will open up and I will earn between a 1-3% commission at no expense to you. The fun thing is that if you order anything else on Amazon, I will earn that amount off of your shopping cart even if you do not purchase the book. Pretty cool, right? In 2020, Amazon Affiliates helped me pay for the hosting of my website, LLC fees, and Netflix.

Disclaimer

Although great care has been taken to ensure that the information in this post is accurate, eddyjoe, LLC shall not be held responsible or in any way liable for the continued accuracy of the information, or for any errors, omissions or inaccuracies, or for any consequences arising therefrom.