Renner Jochen, Meybohm Patrick, Gruenewald Mathias, Steinfath Markus, Scholz Jens, Boening Andreas, Bein Berthold
Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Kiel, Germany.
Anesth Analg. 2007 Nov;105(5):1243-9, table of contents. doi: 10.1213/01.ane.0000281152.72734.d0.
Estimating volume status in infants and neonates is challenging. Global end-diastolic volume (GEDV) and dynamic variables of preload, such as pulse pressure variation (PPV), may be alternative variables for estimating cardiac preload and fluid responsiveness. Therefore, we designed the present study to evaluate whether GEDV and PPV are suitable variables of preload and fluid responsiveness during rapidly changing loading conditions in a pediatric animal model.
Nineteen anesthetized and mechanically ventilated piglets (6.5 +/- 0.8 kg) were studied during different loading conditions. Hemodynamic measurements, including central venous pressure, pulmonary capillary wedge pressure, PPV, GEDV, and cardiac output derived by transpulmonary thermodilution, cardiac output, and stroke volume index obtained by pulmonary artery thermodilution were performed at normovolemia, and after fluid administration, with 25 mL/kg of hydroxylethyl starch 6%.
There was a significant percentage change of GEDV after volume loading (25% +/- 17%) that resulted in significant changes of all hemodynamic variables except of heart rate and systemic vascular resistance index. GEDV was the only preload variable that significantly correlated with volume-induced percentage change in stroke volume index (r = -0.61, P = 0.005). Area under the receiver operating characteristic curve was 0.8 for GEDV (P < 0.02) and 0.6 for PPV (P = ns).
In this pediatric animal model, GEDV derived from transpulmonary thermodilution was a reliable indicator of cardiac preload. Moreover, GEDV but not PPV, central venous pressure and pulmonary capillary wedge pressure accurately reflected fluid responsiveness.
评估婴儿和新生儿的容量状态具有挑战性。全心舒张末期容积（GEDV）和前负荷的动态变量，如脉压变异度（PPV），可能是评估心脏前负荷和液体反应性的替代变量。因此，我们设计了本研究，以评估在儿科动物模型中快速变化的负荷条件下，GEDV和PPV是否是合适的前负荷和液体反应性变量。
在不同负荷条件下对19只麻醉并机械通气的仔猪（6.5±0.8千克）进行研究。在血容量正常时以及给予25毫升/千克6%羟乙基淀粉进行液体输注后，进行血流动力学测量，包括中心静脉压、肺毛细血管楔压、PPV、GEDV，以及通过经肺热稀释法获得的心输出量、通过肺动脉热稀释法获得的心输出量和每搏量指数。
容量负荷后GEDV有显著的百分比变化（25%±17%），这导致除心率和全身血管阻力指数外的所有血流动力学变量都有显著变化。GEDV是唯一与容量诱导的每搏量指数百分比变化显著相关的前负荷变量（r = -0.61，P = 0.005）。GEDV的受试者工作特征曲线下面积为0.8（P < 0.02），PPV为0.6（P = 无统计学意义）。
在这个儿科动物模型中，经肺热稀释法得出的GEDV是心脏前负荷的可靠指标。此外，GEDV而非PPV、中心静脉压和肺毛细血管楔压能准确反映液体反应性。
