Department of Anesthesiology and Intensive Care Medicine, Centre Hospitalier Universitaire de Bordeaux, Place Amélie Raba Léon, Bordeaux, France.
Anesthesiology. 2009 Oct;111(4):855-62. doi: 10.1097/ALN.0b013e3181b27fb2.
Positive end-expiratory pressure (PEEP) may reduce cardiac output and total hepatic blood flow after liver transplantation. Pulse pressure variation is useful in predicting the PEEP-induced decrease in cardiac output. The aim of the study was to examine the relationships between stroke volume variations (SVV) obtained with the Vigileo monitor (Edwards Lifesciences, Irvine, CA), and the hemodynamic effects of PEEP.
Over 2 yr, patients presenting an acute lung injury or an acute respiratory distress syndrome in the 72 h after liver transplantation were prospectively enrolled. Patients were monitored with a pulmonary artery catheter (stroke volume) and with the Vigileo system (stroke volume and SVV). Measurements were performed in duplicate, first during zero end-expiratory pressure and then 10 min after the addition of 10 cm H2O PEEP.
Twenty-six patients were included. Six patients were excluded from analysis. On PEEP, SVV and pulse pressure variation increased significantly and stroke volume decreased significantly. PEEP-induced changes in stroke volume measured by pulmonary artery catheter were significantly correlated with SVV (r = 0.69; P < 0.001) and pulse pressure variation on zero end-expiratory pressure (r = 0.66, P < 0.001). PEEP-induced decrease in stroke volume measured by pulmonary artery catheter > or = 15% was predicted by an SVV > 7% (sensitivity = 100%, specificity = 80%) and by a pulse pressure variation > 8% (sensitivity = 80%, specificity = 100%). PEEP-induced changes in stroke volume measured by pulmonary artery catheter and Vigileo device were correlated (r = 0.51, P < 0.005).
SVV obtained with Vigileo monitor is useful to predict decrease in stroke volume induced by PEEP. Moreover, this device is able to track changes in stroke volume induced by PEEP.
呼气末正压（PEEP）可能会降低肝移植后的心输出量和总肝血流量。脉搏压变异在预测 PEEP 引起的心输出量下降方面很有用。本研究的目的是研究脉搏指示连续心排血量监测仪（Edwards Lifesciences，Irvine，CA）获得的每搏量变异（SVV）与 PEEP 的血流动力学效应之间的关系。
在 2 年多的时间里，前瞻性地招募了肝移植后 72 小时内出现急性肺损伤或急性呼吸窘迫综合征的患者。患者接受肺动脉导管（每搏量）和脉搏指示连续心排血量监测仪（每搏量和 SVV）监测。测量进行了两次，一次在零呼气末正压时，另一次在加用 10cmH2O PEEP 10min 后。
共纳入 26 例患者。6 例患者被排除在分析之外。在 PEEP 时，SVV 和脉搏压变异显著增加，而每搏量显著降低。肺动脉导管测量的 PEEP 引起的每搏量变化与 SVV（r=0.69；P<0.001）和零呼气末正压时的脉搏压变异（r=0.66，P<0.001）显著相关。肺动脉导管测量的 PEEP 引起的每搏量下降>15%可通过 SVV>7%（灵敏度=100%，特异性=80%）和脉搏压变异>8%（灵敏度=80%，特异性=100%）来预测。肺动脉导管和脉搏指示连续心排血量监测仪测量的 PEEP 引起的每搏量变化相关（r=0.51，P<0.005）。
脉搏指示连续心排血量监测仪获得的 SVV 可用于预测 PEEP 引起的每搏量下降。此外，该设备能够跟踪 PEEP 引起的每搏量变化。
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