胸腔内血容量指数作为急性循环衰竭重症患者液体反应性的指标：与中心静脉压的比较

The intrathoracic blood volume index as an indicator of fluid responsiveness in critically ill patients with acute circulatory failure: a comparison with central venous pressure.

作者信息

Muller Laurent, Louart Guillaume, Bengler Christian, Fabbro-Peray Pascale, Carr Julie, Ripart Jacques, de La Coussaye Jean-Emmanuel, Lefrant Jean-Yves

机构信息

Division Anesthésie Réanimation Douleur Urgences, Groupe Hospitalo-Universitaire Caremeau, CHU Nîmes, Place du Professeur Robert Debré, 30029 Nîmes Cedex 9, France.

出版信息

Anesth Analg. 2008 Aug;107(2):607-13. doi: 10.1213/ane.0b013e31817e6618.

DOI:10.1213/ane.0b013e31817e6618

PMID:18633040

Abstract

BACKGROUND

The intrathoracic blood volume index (ITBVI) and central venous pressure (CVP) are routinely used to predict fluid responsiveness in critically ill patients with acute circulatory failure (systolic blood pressure < 90 mm Hg or vasopressor requirement). However, they have never been compared.

METHODS

In this prospective interventional study, we included 35 (21 men) mechanically ventilated and sedated patients with acute cardiovascular failure requiring cardiac output measurement (transpulmonary thermodilution technique). Fluid responsiveness was defined as an increase in stroke index (cardiac output/heart rate/body surface area) > or =15%. Receiver operating characteristic curves were generated for ITBVI and CVP.

RESULTS

Fluid challenge induced a stroke index increase > or =15% in 18 (51%) patients (responders). At baseline, no studied hemodynamic variables were different between responders and nonresponders. The areas under the receiver operating characteristic curves were 0.64 [95% CI: 0.46-0.80] for ITBVI and 0.68 [95% CI: 0.50-0.83] for CVP, without any statistical difference (P = 0.73). The best cut-off values for CVP and ITBVI were 9 mm Hg (sensitivity = 61%; specificity = 82%) and 928 mL . m(-2) (sensitivity = 78%; specificity = 53%).

CONCLUSION

ITBVI is similar to CVP in its ability to predict fluid responsiveness in critically ill patients with acute circulatory failure.

摘要

背景

胸腔内血容量指数（ITBVI）和中心静脉压（CVP）常用于预测急性循环衰竭（收缩压<90 mmHg或需要血管升压药）的危重症患者的液体反应性。然而，它们从未被比较过。

方法

在这项前瞻性干预研究中，我们纳入了35例（21例男性）需要测量心输出量（采用经肺热稀释技术）的机械通气和镇静的急性心血管衰竭患者。液体反应性定义为每搏输出量指数（心输出量/心率/体表面积）增加≥15%。绘制了ITBVI和CVP的受试者工作特征曲线。

结果

液体负荷试验使18例（51%）患者（反应者）的每搏输出量指数增加≥15%。基线时，反应者和无反应者之间所研究的血流动力学变量无差异。ITBVI的受试者工作特征曲线下面积为0.64[95%CI：0.46-0.80]，CVP的受试者工作特征曲线下面积为0.68[95%CI：0.50-0.83]，无统计学差异（P = 0.73）。CVP和ITBVI的最佳截断值分别为9 mmHg（敏感性=61%；特异性=82%）和928 mL·m-2（敏感性=78%；特异性=53%）。