Sakka Samir G, Hanusch Tino, Thuemer Oliver, Wegscheider Karl
Department of Anesthesiology and Intensive Care Medicine, University Witten/Herdecke Medical Center Cologne-Merheim, Germany.
Anesth Analg. 2007 Oct;105(4):1079-82, table of contents. doi: 10.1213/01.ane.0000280440.08530.fb.
Use of the transpulmonary thermodilution technique has been suggested for extended hemodynamic monitoring in critically ill patients. However, many of these patients also require renal replacement therapy (RRT). Therefore, we analyzed the influence of venovenous RRT on measurement of cardiac index (CI), intrathoracic blood volume index (ITBVI), and extravascular lung water index (EVLWI).
We studied 24 consecutive critically ill patients (15 males, 9 females; age 39-81, mean 62 yr) who had received a clinically indicated 5F femoral arterial catheter (PV2015L20, Pulsion Medical Systems, Germany), which was connected to a monitor (PiCCOplus, Pulsion Medical Systems, Germany). A 12F dialysis catheter (Trilyse Expert, Vygon) was either advanced from the vena femoralis into the vena cava inferior (n = 12) or placed into the superior vena cava (n = 12). Patients continuously received heparin for anticoagulation. Hemodynamic measurements were performed in triplicate by central venous injection of saline (15 mL, <8 degrees C) during RRT, during a brief interruption in RRT (by disconnection, without retransfusion), and immediately after reconnection. Ventilator settings, fluid status, and vasoactive drugs remained unchanged.
RRT was associated with significant changes in CI (mean change, -0.1 L/min/m(2), P = 0.003) and ITBVI (mean change, -18 mL/m(2), P = 0.02), whereas EVLWI was unaffected (mean change, +0.1 mL/kg, P = 0.42). The influence of RRT on CI, ITBVI, and EVLWI was not statistically different in both subgroups.
RRT had no clinically relevant effect on measurement of CI, ITBVI, and EVLWI in patients with sepsis and maintained cardiac output. Furthermore, the dialysis catheter tip position had no significantly different influence under these conditions.
经肺温度稀释技术已被建议用于危重症患者的长期血流动力学监测。然而，这些患者中的许多人也需要肾脏替代治疗（RRT）。因此，我们分析了静脉-静脉RRT对心脏指数（CI）、胸腔内血容量指数（ITBVI）和血管外肺水指数（EVLWI）测量的影响。
我们研究了24例连续的危重症患者（15例男性，9例女性；年龄39 - 81岁，平均62岁），这些患者接受了临床上需要的5F股动脉导管（PV2015L20，德国普升医疗系统公司），该导管连接到一台监测仪（PiCCOplus，德国普升医疗系统公司）。一根12F透析导管（Trilyse Expert，威高公司）要么从股静脉推进到下腔静脉（n = 12），要么置于上腔静脉（n = 12）。患者持续接受肝素抗凝。在RRT期间、RRT短暂中断期间（通过断开连接，不进行回血）以及重新连接后立即通过中心静脉注射生理盐水（15 mL，<8℃）进行三次血流动力学测量。呼吸机设置、液体状态和血管活性药物保持不变。
RRT与CI（平均变化，-0.1 L/min/m²，P = 0.003）和ITBVI（平均变化，-18 mL/m²，P = 0.02）的显著变化相关，而EVLWI未受影响（平均变化，+0.1 mL/kg，P = 0.42）。RRT对CI、ITBVI和EVLWI的影响在两个亚组中无统计学差异。
RRT对脓毒症且心输出量维持的患者的CI、ITBVI和EVLWI测量无临床相关影响。此外，在这些条件下，透析导管尖端位置的影响无显著差异。
