Real-world evaluation of eadyn as a predictor of vasopressor weaning success in critically ill patients: a retrospective cohort study

Abstract

Dynamic arterial elastance (Eadyn), defined as the ratio of pulse pressure variation (PPV) to stroke volume variation (SVV) [1], has been reported in previous studies as a reliable index for assessing pressure responsiveness to volume expansion and vasopressor weaning. Its clinical utility has also been studied by randomized controlled trials [2, 3]. Among the available methods for measuring SVV, FloTrac® sensor (Edwards Lifesciences, Irvine, CA, USA) is particularly advantageous due to its ease and ability to provide continuous measurements. However, concerns have been raised regarding the issue of mathematical coupling, which can occur when both PPV and SVV are derived from the same arterial pressure waveform, potentially leading to biased estimates [4]. Additionally, some studies using FloTrac® for SVV measurement have reported low area under the receiver operating characteristic curve (AUROC) values for Eadyn. Given these concerns and the small sample sizes in previous studies, we conducted a larger analysis to validate the clinical utility of Eadyn using FloTrac®.

This is a single-center, retrospective cohort study using data from ACSYS® (Advanced Critical Care System, Philips Japan, Tokyo, Japan) from August 2017 to July 2024. Patients included in this study were those aged 18 years or older, who received vasopressors within 24 h of ICU admission, met the criteria for vasopressor reduction, and were monitored with FloTrac® (Supplementary document 1 and 2). Patient demographics and physiological parameters were collected as described in Supplementary document 3. SVV was measured using FloTrac® sensor, and PPV was measured using the same arterial pressure waveform as that used by FloTrac®. Positive responses were defined as a ≥ 15% decrease in mean arterial pressure (MAP) or the need for additional vasopressors (Supplementary document 2). ROC curves were generated to assess predictive performance, with AUROC, optimal cutoff, sensitivity, specificity, and diagnostic odds ratio reported. Subgroup analyses were conducted according to several variables including primary diagnosis at ICU admission, type of vasopressor administered, vasopressor dose prior to reduction, extent of dose reduction and modality of respiratory support. Several sensitivity analyses were also conducted by applying the following alternative assumptions: (1) the first vasopressor dose reduction event per patient, (2) a positive response as a ≥ 10% decrease in MAP; (3) baseline values obtained from 15 to 5 min before dose reduction; (4) post-reduction values obtained from either 15 to 25 min or 35 to 45 min after the intervention. (Supplementary document 4).

Among 10,710 patients admitted to the ICU, 542 patients were included in the analysis, with a total of 3,867 vasopressor de-escalation events (Supplementary Figure). Demographics and clinical information of the included patients are presented in Supplementary Table 1, and the characteristics of each vasopressor de-escalation event, stratified by negative and positive response, are summarized in Supplementary Table 2. Hemodynamic and respiratory parameters measured before and after vasopressor weaning are shown in Supplementary Table 3. In our cohort, 15.1% of vasopressor de-escalation events were classified as positive response. No significant difference was observed in the baseline norepinephrine equivalent (NEE) dose [5] between the two groups (5.50 vs. 5.00 mcg/min, p = 0.4); however, the magnitude of dose reduction as NEE was greater in the positive response group (1.00 vs. 1.50 mcg/min, p < 0.001) (Supplementary Table 3). No significant difference in baseline Eadyn values was observed between the negative and positive response groups (0.90 vs. 0.89, p = 0.996) (Supplementary Table 3). ROC analysis yielded an AUROC of 0.500 (Fig. 1a). Neither subgroup analyses nor sensitivity analyses demonstrated an AUC exceeding 0.6 except for adrenaline as a tapered vasopressor (Figure 1b, Supplementary Tables 4 and 5).

The present study—using a large sample size—examined vasopressor weaning and yielded AUROC values of consistently close to 0.5 across primary and subgroup analyses. These findings suggest that, despite its practicality and previous reports of utility, Eadyn calculated using FloTrac® may have limited value in guiding vasopressor weaning decisions. Until more robust and consistently validated methods become available, clinicians should be cautious in relying on FloTrac®-derived Eadyn for bedside hemodynamic decision-making (Fig. 1).

Fig. 1

(a) Receiver operating characteristic (ROC) curve for dynamic arterial elastance (Eadyn) in predicting hypotension following vasopressor weaning. Sensitivity is plotted on the y-axis against 1 - specificity on the x-axis (b) Forest plot of area under the receiver operating characteristic curve (AUROC) for Eadyn by Subgroup. The horizontal lines represent the 95% confidence intervals (CIs) for each subgroup, while the black circles indicate the point estimates of AUROC. The dashed vertical line at AUROC = 0.5 represents the threshold for no discriminatory power. SOFA: Sequential Organ Failure Assessment, NEE: Norepinephrine Equivalence, IABP: Intra-Aortic Balloon Pumping, CRRT: Continuous Renal Replacement Therapy, VV-ECMO: Veno-Venous Extracorporeal Membrane Oxygenation, MV CMV: Mechanical ventilation in continuous mandatory ventilation mode, MV other: Mechanical ventilation in modes other than CMV mode, NPPV: Noninvasive Positive Pressure Ventilation

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The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Eadyn:

Dynamic arterial elastance (Eadyn)

PPV:

Pulse pressure variation

SVV:

Stroke volume variation

AUROC:

Area under the receiver operating characteristic curve

MAP:

Mean arterial pressure

NEE:

Norepinephrine equivalent

SOFA:

Sequential organ failure assessment

NEE:

Norepinephrine equivalence

IABP:

Intra-Aortic balloon pumping

CRRT:

Continuous renal replacement therapy

VV-ECMO:

Veno-Venous extracorporeal membrane oxygenation

MV CMV:

Mechanical ventilation in continuous mandatory ventilation mode

MV other:

Mechanical ventilation in modes other than CMV mode

NPPV:

Noninvasive positive pressure ventilation

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Authors and Affiliations

1. Department of Anesthesiology and Critical Care Medicine, Jichi Medical University Saitama Medical Center, 1-847 Amanumacho, Omiya-Ku, Saitama, 330-8503, Japan

   Yoshihiro Nagai, Shohei Ono, Shigehiko Uchino, Shinshu Katayama & Yusuke Iizuka

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1. Yoshihiro NagaiView author publications

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2. Shohei OnoView author publications

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3. Shigehiko UchinoView author publications

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4. Shinshu KatayamaView author publications

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5. Yusuke IizukaView author publications

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Contributions

N.Y., O.S., U.S., K.S., and I.Y. contributed to the conception and design of the Correspondence. Data collection was conducted by U.S. Data analysis was performed by N.Y., O.S., and U.S. N.Y. drafted the initial version of the manuscript. All authors critically reviewed the manuscript and provided feedback on previous versions. All authors read and approved the final version of the manuscript.

Corresponding author

Correspondence to Yusuke Iizuka.

Ethics approval and consent to participate

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Jichi Medical University Saitama Medical Center in view of the retrospective nature of the study and all the procedures being performed were part of the routine care. (June 16, 2025/S25-025).

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Not applicable.

Competing interests

SK provided a consultation agreement with Hamilton Medical. The other authors declare that they do not have any potential conflicts of interest.

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Nagai, Y., Ono, S., Uchino, S. et al. Real-world evaluation of eadyn as a predictor of vasopressor weaning success in critically ill patients: a retrospective cohort study. Crit Care 29, 350 (2025). https://doi.org/10.1186/s13054-025-05592-4

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• Received: 08 July 2025

• Accepted: 29 July 2025

• Published: 07 August 2025

• DOI: https://doi.org/10.1186/s13054-025-05592-4

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