Vieillard-Baron Antoine, Chergui Karim, Rabiller Anne, Peyrouset Olivier, Page Bernard, Beauchet Alain, Jardin François
Medical Intensive Care Unit, University Hospital Ambroise Paré, Assistance Publique Hôpitaux de Paris, 9 avenue Charles de Gaulle, 92104 Boulogne Cedex, France.
Intensive Care Med. 2004 Sep;30(9):1734-9. doi: 10.1007/s00134-004-2361-y. Epub 2004 Jun 26.
In mechanically ventilated patients inspiratory increase in pleural pressure during lung inflation may produce complete or partial collapse of the superior vena cava. Occurrence of this collapse suggests that at this time external pressure exerted by the thoracic cavity on the superior vena cava is greater than the venous pressure required to maintain the vessel fully open. We tested the hypothesis that measurement of superior vena caval collapsibility would reveal the need for volume expansion in a given septic patient.
Prospective data collection for 66 successive patients in septic shock admitted in a medical intensive care unit and mechanically ventilated for an associated acute lung injury.
We simultaneously measured superior vena caval collapsibility by echocardiography and cardiac index by the Doppler technique at baseline and after a 10 ml/kg volume expansion by 6% hydroxyethyl starch in 30 min. The threshold superior vena caval collapsibility of 36%, calculated as (maximum diameter on expiration-minimum diameter on inspiration)/maximum diameter on expiration, allowed discrimination between responders (defined by an increase in cardiac index of at least 11% induced by volume expansion) and nonresponders, with a sensitivity of 90% and a specificity of 100%.
Superior vena cava measurement should be systematically performed during routine echocardiography in septic shock as it gives an accurate index of fluid responsiveness.
在机械通气患者中，肺膨胀时胸膜腔内压的吸气性增加可能导致上腔静脉完全或部分塌陷。这种塌陷的发生表明此时胸腔对上腔静脉施加的外部压力大于维持血管完全开放所需的静脉压力。我们检验了这样一个假设，即测量上腔静脉的可塌陷性能够揭示特定脓毒症患者是否需要扩容。
对医学重症监护病房收治的66例连续的脓毒症休克患者进行前瞻性数据收集，这些患者因相关急性肺损伤接受机械通气。
我们在基线时以及在30分钟内通过静脉输注6%羟乙基淀粉按10 ml/kg进行扩容后，采用超声心动图同时测量上腔静脉的可塌陷性，并采用多普勒技术测量心指数。上腔静脉可塌陷性阈值为36%，计算方法为（呼气时最大直径 - 吸气时最小直径）/呼气时最大直径，以此可区分反应者（定义为扩容后心指数至少增加11%）和无反应者，敏感性为90%，特异性为100%。
在脓毒症休克患者进行常规超声心动图检查时，应系统地测量上腔静脉，因为它能提供液体反应性的准确指标。
