Servicio de Cuidados Críticos y Urgencias, Unidad de Investigación Experimental, Hospital del SAS Jerez, Jerez de la Frontera, Spain.
Crit Care. 2009;13(5):R142. doi: 10.1186/cc8027. Epub 2009 Sep 3.
Although several parameters have been proposed to predict the hemodynamic response to fluid expansion in critically ill patients, most of them are invasive or require the use of special monitoring devices. The aim of this study is to determine whether noninvasive evaluation of respiratory variation of brachial artery peak velocity flow measured using Doppler ultrasound could predict fluid responsiveness in mechanically ventilated patients.
We conducted a prospective clinical research in a 17-bed multidisciplinary ICU and included 38 mechanically ventilated patients for whom fluid administration was planned due to the presence of acute circulatory failure. Volume expansion (VE) was performed with 500 mL of a synthetic colloid. Patients were classified as responders if stroke volume index (SVi) increased >or= 15% after VE. The respiratory variation in Vpeakbrach (DeltaVpeakbrach) was calculated as the difference between maximum and minimum values of Vpeakbrach over a single respiratory cycle, divided by the mean of the two values and expressed as a percentage. Radial arterial pressure variation (DeltaPPrad) and stroke volume variation measured using the FloTrac/Vigileo system (DeltaSVVigileo), were also calculated.
VE increased SVi by >or= 15% in 19 patients (responders). At baseline, DeltaVpeakbrach, DeltaPPrad and DeltaSVVigileo were significantly higher in responder than nonresponder patients [14 vs 8%; 18 vs. 5%; 13 vs 8%; P < 0.0001, respectively). A DeltaVpeakbrach value >10% predicted fluid responsiveness with a sensitivity of 74% and a specificity of 95%. A DeltaPPrad value >10% and a DeltaSVVigileo >11% predicted volume responsiveness with a sensitivity of 95% and 79%, and a specificity of 95% and 89%, respectively.
Respiratory variations in brachial artery peak velocity could be a feasible tool for the noninvasive assessment of fluid responsiveness in patients with mechanical ventilatory support and acute circulatory failure.
ClinicalTrials.gov ID: NCT00890071.
尽管已经提出了许多参数来预测危重病患者液体扩张的血流动力学反应，但其中大多数是有创的或需要使用特殊监测设备。本研究旨在确定使用多普勒超声测量肱动脉峰值流速流量的无创评估是否可以预测机械通气患者的液体反应性。
我们在一个 17 张病床的多学科 ICU 中进行了一项前瞻性临床研究，纳入了 38 名因急性循环衰竭而计划接受液体治疗的机械通气患者。通过输注 500 毫升合成胶体进行容量扩张（VE）。如果 VE 后每搏量指数（SVi）增加≥15%，则患者被归类为有反应者。Vpeakbrach 的呼吸变异（DeltaVpeakbrach）计算为 Vpeakbrach 在单个呼吸周期中的最大值和最小值之间的差异，除以两个值的平均值，并表示为百分比。还计算了桡动脉压力变化（DeltaPPrad）和使用 FloTrac/Vigileo 系统测量的每搏量变化（DeltaSVVigileo）。
VE 使 19 名患者（有反应者）的 SVi 增加≥15%。在基线时，有反应者的 DeltaVpeakbrach、DeltaPPrad 和 DeltaSVVigileo 明显高于无反应者[14%比 8%；18%比 5%；13%比 8%；P<0.0001]。DeltaVpeakbrach 值>10%预测液体反应性的敏感性为 74%，特异性为 95%。DeltaPPrad 值>10%和 DeltaSVVigileo 值>11%预测容量反应性的敏感性分别为 95%和 79%，特异性分别为 95%和 89%。
肱动脉峰值流速的呼吸变异可能是一种可行的工具，用于评估机械通气支持和急性循环衰竭患者的液体反应性。
ClinicalTrials.gov ID：NCT00890071。
