Feissel Marc, Michard Frédéric, Faller Jean-Pierre, Teboul Jean-Louis
Réanimation médicale et maladies infectieuses, Centre hospitalier de Belfort, Belfort, France.
Intensive Care Med. 2004 Sep;30(9):1834-7. doi: 10.1007/s00134-004-2233-5. Epub 2004 Mar 25.
To investigate whether the respiratory variation in inferior vena cava diameter (DeltaD(IVC)) could be related to fluid responsiveness in mechanically ventilated patients.
Prospective clinical study.
Medical ICU of a non-university hospital.
Mechanically ventilated patients with septic shock (n=39).
Volume loading with 8 mL/kg of 6% hydroxyethylstarch over 20 min.
Cardiac output and DeltaD(IVC) were assessed by echography before and immediately after the standardized volume load. Volume loading induced an increase in cardiac output from 5.7+/-2.0 to 6.4+/-1.9 L/min (P<0.001) and a decrease in DeltaD(IVC) from 13.8+/-13.6 vs 5.2+/-5.8% (P<0.001). Sixteen patients responded to volume loading by an increase in cardiac output > or =15% (responders). Before volume loading, the DeltaD(IVC) was greater in responders than in non-responders (25+/-15 vs 6+/-4%, P<0.001), closely correlated with the increase in cardiac output (r=0.82, P<0.001), and a 12% DeltaD(IVC) cut-off value allowed identification of responders with positive and negative predictive values of 93% and 92%, respectively.
Analysis of DeltaD(IVC) is a simple and non-invasive method to detect fluid responsiveness in mechanically ventilated patients with septic shock.
探讨机械通气患者下腔静脉直径呼吸变异度（DeltaD(IVC)）是否与液体反应性相关。
前瞻性临床研究。
一家非大学医院的医学重症监护病房。
机械通气的感染性休克患者（n = 39）。
在20分钟内给予8 mL/kg的6%羟乙基淀粉进行容量负荷试验。
在标准化容量负荷试验前后，通过超声心动图评估心输出量和DeltaD(IVC)。容量负荷试验使心输出量从5.7±2.0升/分钟增加至6.4±1.9升/分钟（P<0.001），DeltaD(IVC)从13.8±13.6%降至5.2±5.8%（P<0.001）。16例患者对容量负荷试验有反应，心输出量增加≥15%（反应者）。在容量负荷试验前，反应者的DeltaD(IVC)大于无反应者（25±15%对6±4%，P<0.001），与心输出量增加密切相关（r = 0.82，P<0.001），DeltaD(IVC)截断值为12%时可识别反应者，其阳性预测值和阴性预测值分别为93%和92%。
分析DeltaD(IVC)是一种检测机械通气感染性休克患者液体反应性的简单、非侵入性方法。
