End-expiratory Occlusion Test

• Volume expansion is a cornerstone of resuscitation for circulatory failure.
• As discussed in previous pearls, only 50% of unstable critically ill patients respond to fluid therapy.  For the 50% that don't respond, additional fluids may increase morbidity and mortality.
• In recent years, there has been tremendous focus on dynamic markers of fluid responsiveness, including respirophasic changes in IVC diameter, passive leg raising, and pulse pressure variation (PPV).
• An additional dynamic marker of fluid responsiveness is the end-expiratory occlusion test.
• Unlike PPV, this test can be performed on patients with spontaneous breathing activity and those with cardiac arrhythmias.
• Recent literature indicates that a 5% increase in cardiac output during a 15-second end-expiratory occlusion test predicts a positive response to a 500 ml saline infusion.

References

Monnet X, Teboul JL. Assessment of volume responsiveness during mechanical ventilation: recent advances. Critical Care 2013; 17:217.