de Oliveira Marcos Antonio, Otsuki Denise Aya, Noel-Morgan Jessica, Leite Victor Figueiredo, Fantoni Denise Tabacchi, Auler Jose Otavio Costa
LIM08-Anesthesia, Faculdade de Medicina da Universidade de São Paulo, Laboratory of Medical Investigation LIM/08, São Paulo, Brazil.
J Trauma. 2009 Dec;67(6):1225-32; discussion 1232. doi: 10.1097/TA.0b013e3181b845e4.
Different hemodynamic parameters including static indicators of cardiac preload as right ventricular end-diastolic volume index (RVEDVI) and dynamic parameters as pulse pressure variation (PPV) have been used in the decision-making process regarding volume expansion in critically ill patients. The objective of this study was to compare fluid resuscitation guided by either PPV or RVEDVI after experimentally induced hemorrhagic shock.
Twenty-six anesthetized and mechanically ventilated pigs were allocated into control (group I), PPV (group II), or RVEDVI (group III) group. Hemorrhagic shock was induced by blood withdrawal to target mean arterial pressure of 40 mm Hg, maintained for 60 minutes. Parameters were measured at baseline, time of shock, 60 minutes after shock, immediately after resuscitation with hydroxyethyl starch 6% (130/0.4), 1 hour and 2 hours thereafter. The endpoint of fluid resuscitation was determined as the baseline values of PPV and RVEDVI. Statistical analysis of data was based on analysis of variance for repeated measures followed by the Bonferroni test (p < 0.05).
Volume and time to resuscitation were higher in group III than in group II (group III = 1,305 +/- 331 mL and group II = 965 +/- 245 mL, p < 0.05; and group III = 24.8 +/- 4.7 minutes and group II = 8.8 +/- 1.3 minutes, p < 0.05, respectively). All static and dynamic parameters and biomarkers of tissue oxygenation were affected by hemorrhagic shock and nearly all parameters were restored after resuscitation in both groups.
In the proposed model of hemorrhagic shock, resuscitation to the established endpoints was achieved within a smaller amount of time and with less volume when guided by PPV than when guided by pulmonary artery catheter-derived RVEDVI.
不同的血流动力学参数，包括作为心脏前负荷静态指标的右心室舒张末期容积指数（RVEDVI）和作为动态参数的脉压变异度（PPV），已被用于危重症患者容量扩充的决策过程。本研究的目的是比较实验性诱导失血性休克后以PPV或RVEDVI指导的液体复苏情况。
将26只麻醉并机械通气的猪分为对照组（I组）、PPV组（II组）或RVEDVI组（III组）。通过抽血使平均动脉压达到40 mmHg诱导失血性休克，并维持60分钟。在基线、休克时、休克后60分钟、用6%羟乙基淀粉（130/0.4）复苏后即刻、此后1小时和2小时测量各项参数。液体复苏的终点确定为PPV和RVEDVI的基线值。数据的统计分析基于重复测量方差分析，随后进行Bonferroni检验（p<0.05）。
III组的复苏容量和时间高于II组（III组=1305±331 mL，II组=965±245 mL，p<0.05；III组=24.8±4.7分钟，II组=8.8±1.3分钟，p<0.05）。所有静态和动态参数以及组织氧合生物标志物均受失血性休克影响，两组复苏后几乎所有参数均恢复。
在本研究提出的失血性休克模型中，与肺动脉导管衍生的RVEDVI指导相比，PPV指导下在更短时间内以更少容量实现了既定终点的复苏。
