Heenen Sarah, De Backer Daniel, Vincent Jean-Louis
Department of Intensive Care, Erasme University Hospital, Free University of Brussels, Route de Lennik, 808, B-1070 Brussels, Belgium.
Crit Care. 2006;10(4):R102. doi: 10.1186/cc4970.
The aim of the study was to evaluate the ability of different static and dynamic measurements of preload to predict fluid responsiveness in patients with spontaneous respiratory movements.
The subjects were 21 critically ill patients with spontaneous breathing movements receiving mechanical ventilation with pressure support mode (n = 9) or breathing through a face mask (n = 12), and who required a fluid challenge. Complete hemodynamic measurements, including pulmonary artery occluded pressure (PAOP), right atrial pressure (RAP), pulse pressure variation (DeltaPP) and inspiratory variation in RAP were obtained before and after fluid challenge. Fluid challenge consisted of boluses of either crystalloid or colloid until cardiac output reached a plateau. Receiver operating characteristics (ROC) curve analysis was used to evaluate the predictive value of the indices to the response to fluids, as defined by an increase in cardiac index of 15% or more.
Cardiac index increased from 3.0 (2.3 to 3.5) to 3.5 (3.0 to 3.9) l minute-1 m-2 (medians and 25th and 75th centiles), p < 0.05. At baseline, DeltaPP varied between 0% and 49%. There were no significant differences in DeltaPP, PAOP, RAP and inspiratory variation in RAP between fluid responders and non-responders. Fluid responsiveness was predicted better with static indices (ROC curve area +/- SD: 0.73 +/- 0.13 for PAOP, p < 0.05 vs DeltaPP and 0.69 +/- 0.12 for RAP, p = 0.054 compared with DeltaPP) than with dynamic indices of preload (0.40 +/- 0.13 for DeltaPP and 0.53 +/- 0.13 for inspiratory changes in RAP, p not significant compared with DeltaPP).
In patients with spontaneous respiratory movements, DeltaPP and inspiratory changes in RAP failed to predict the response to volume expansion.
本研究的目的是评估不同的静态和动态前负荷测量方法预测自主呼吸患者液体反应性的能力。
研究对象为21例接受机械通气（压力支持模式，n = 9例）或通过面罩呼吸（n = 12例）的危重症自主呼吸患者，这些患者需要进行液体负荷试验。在液体负荷试验前后进行完整的血流动力学测量，包括肺动脉闭塞压（PAOP）、右心房压（RAP）、脉压变异度（DeltaPP）和RAP吸气变异度。液体负荷试验包括输注晶体液或胶体液推注，直至心输出量达到平台期。采用受试者工作特征（ROC）曲线分析评估各指标对液体反应性的预测价值，液体反应性定义为心脏指数增加15%或更多。
心脏指数从3.0（2.3至3.5）升/分钟·米²增加至3.5（3.0至3.9）升/分钟·米²（中位数及第25和第75百分位数），p < 0.05。基线时，DeltaPP在0%至49%之间变化。液体反应者和无反应者之间的DeltaPP、PAOP、RAP及RAP吸气变异度无显著差异。与前负荷动态指标（DeltaPP为0.40±0.13，RAP吸气变化为0.53±0.13，与DeltaPP相比p无显著性差异）相比，静态指标（PAOP的ROC曲线面积±标准差：0.73±0.13，与DeltaPP相比p < 0.05；RAP为0.69±0.12，与DeltaPP相比p = 0.054）对液体反应性的预测更好。
在自主呼吸患者中，DeltaPP和RAP吸气变化未能预测容量扩张反应。
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