Vistisen S T, Struijk J J, Larsson A
Cardiothoracic Intensive Care Unit, Department of Anaesthesia and Intensive Care, Aalborg Hospital-Aarhus University Hospitals, Nørrebrogade 44, bygning 1C, 1. sal, Aarhus C, Denmark.
Acta Anaesthesiol Scand. 2009 Apr;53(4):534-42. doi: 10.1111/j.1399-6576.2008.01893.x. Epub 2009 Feb 19.
Reliable continuous monitoring of fluid responsiveness is an unsolved issue in patients ventilated with low tidal volume. We hypothesised that variations in the pre-ejection period (PEP) defined as the time interval between electrocardiogram (ECG) R-wave and onset of systolic upstroke in arterial blood pressure could reliably predict fluid responsiveness in patients ventilated with moderately low tidal volume. Furthermore, we hypothesised that indexing dynamic parameters to tidal volume would improve their prediction. The aim was to refine and automate a previously suggested algorithm for PEP variation (DeltaPEP) and to test this new parameter indexed to tidal volume (PEPV), as a marker of fluid responsiveness along with central venous pressure (CVP), pulse pressure variation (PPV) and DeltaPEP. Additionally, the aim was to evaluate the concept of indexing dynamic parameters to tidal volume.
Arterial pressure, CVP, ECG and cardiac index (CI) were acquired from 23 mechanically ventilated post-cardiac surgery patients scheduled for volume expansion. PEPV, PPV and DeltaPEP were extracted.
Using responder/non-responder classification (response=change in CI>+15%), sensitivity and specificity were 100% and 83%, respectively, for PEPV, 94% and 83% for DeltaPEP, and 94% and 83% for PPV. CVP offered no relevant information. Tidal volume indexing improved sensitivity for DeltaPEP to 100%.
In this study in post-cardiac surgery patients, a refined parameter, PEPV, predicted fluid responsiveness better than PPV and DeltaPEP. Our results suggest that dynamic parameters using variations in PEP should be indexed to tidal volume.
对于接受低潮气量通气的患者，可靠地持续监测液体反应性是一个尚未解决的问题。我们假设，射血前期（PEP）的变化（定义为心电图（ECG）R波与动脉血压收缩期上升起始点之间的时间间隔）能够可靠地预测接受中度低潮气量通气患者的液体反应性。此外，我们假设将动态参数与潮气量进行指数化处理会改善其预测效果。目的是完善并自动化先前提出的PEP变化算法（DeltaPEP），并测试这个与潮气量指数化的新参数（PEPV），将其作为液体反应性的标志物，同时与中心静脉压（CVP）、脉压变异（PPV）和DeltaPEP进行比较。另外，目的是评估将动态参数与潮气量进行指数化处理的概念。
从23例计划进行容量扩充的心脏手术后机械通气患者获取动脉压、CVP、ECG和心脏指数（CI）。提取PEPV、PPV和DeltaPEP。
采用反应者/无反应者分类（反应=CI变化>+15%），PEPV的敏感性和特异性分别为100%和83%，DeltaPEP为94%和83%，PPV为94%和83%。CVP未提供相关信息。潮气量指数化使DeltaPEP的敏感性提高到100%。
在这项针对心脏手术后患者的研究中，一个经过完善的参数PEPV对液体反应性的预测优于PPV和DeltaPEP。我们的结果表明，利用PEP变化的动态参数应与潮气量进行指数化处理。
