被动抬腿试验可预测行静脉-静脉体外膜肺氧合的患者的液体反应性。
Passive leg raising can predict fluid responsiveness in patients placed on venovenous extracorporeal membrane oxygenation.
机构信息
Department of Anesthesiology and Critical Care, Amiens University Hospital, Place Victor Pauchet, Amiens, F-80054, France.
出版信息
Crit Care. 2011;15(5):R216. doi: 10.1186/cc10451. Epub 2011 Sep 18.
INTRODUCTION
In ICUs, fluid administration is frequently used to treat hypovolaemia. Because volume expansion (VE) can worsen acute respiratory distress syndrome (ARDS) and volume overload must be avoided, predictive indicators of fluid responsiveness are needed. The purpose of this study was to determine whether passive leg raising (PLR) can be used to predict fluid responsiveness in patients with ARDS treated with venovenous extracorporeal membrane oxygenation (ECMO).
METHODS
We carried out a prospective study in a university hospital surgical ICU. All patients with ARDS treated with venovenous ECMO and exhibiting clinical and laboratory signs of hypovolaemia were enrolled. We measured PLR-induced changes in stroke volume (ΔPLRSV) and cardiac output (ΔPLRCO) using transthoracic echocardiography. We also assessed PLR-induced changes in ECMO pump flow (ΔPLRPO) and PLR-induced changes in ECMO pulse pressure (ΔPLRPP) as predictors of fluid responsiveness. Responders were defined by an increase in stroke volume (SV) > 15% after VE.
RESULTS
Twenty-five measurements were obtained from seventeen patients. In 52% of the measurements (n = 13), SV increased by > 15% after VE (responders). The patients' clinical characteristics appeared to be similar between responders and nonresponders. In the responder group, PLR significantly increased SV, cardiac output and pump flow (P < 0.001). ΔPLRSV values were correlated with VE-induced SV variations (r² = 0.72, P = 0.0001). A 10% increased ΔPLRSV predicted fluid responsiveness with an area under the receiver operating characteristic curve (AUC) of 0.88 ± 0.07 (95% confidence interval (CI95): 0.69 to 0.97; P < 0.0001), 62% sensitivity and 92% specificity. On the basis of AUCs of 0.62 ± 0.11 (CI₉₅: 0.4 to 0.8; P = 0.31) and 0.53 ± 0.12 (CI₉₅: 0.32 to 0.73, P = 0.79), respectively, ΔPLRPP and ΔPLRPO did not predict fluid responsiveness.
CONCLUSIONS
In patients treated with venovenous ECMO, a > 10% ΔPLRSV may predict fluid responsiveness. ΔPLRPP and ΔPLRPO cannot predict fluid responsiveness.
背景
在 ICU 中，经常使用液体治疗来治疗低血容量。由于容量扩张（VE）可能会使急性呼吸窘迫综合征（ARDS）恶化，必须避免容量过载，因此需要预测液体反应性的指标。本研究旨在确定被动抬腿（PLR）是否可用于预测接受静脉-静脉体外膜肺氧合（ECMO）治疗的 ARDS 患者的液体反应性。
方法
我们在一家大学医院的外科 ICU 进行了一项前瞻性研究。所有接受静脉-静脉 ECMO 治疗且出现低血容量临床和实验室征象的 ARDS 患者均被纳入研究。我们使用经胸超声心动图测量被动抬腿引起的每搏量变化（ΔPLRSV）和心输出量变化（ΔPLRCO）。我们还评估了被动抬腿引起的 ECMO 泵流量变化（ΔPLRPO）和被动抬腿引起的 ECMO 脉搏压变化（ΔPLRPP）作为液体反应性的预测指标。通过 VE 后每搏量增加>15%来定义反应者。
结果
从 17 名患者中获得了 25 次测量值。在 52%的测量值（n=13）中，VE 后 SV 增加>15%（反应者）。反应者和非反应者的患者临床特征似乎相似。在反应者组中，PLR 显著增加了 SV、心输出量和泵流量（P<0.001）。ΔPLRSV 值与 VE 诱导的 SV 变化相关（r²=0.72，P=0.0001）。10%的ΔPLRSV 增加预测液体反应性的曲线下面积（AUC）为 0.88±0.07（95%置信区间（CI95）：0.69 至 0.97；P<0.0001），敏感性为 62%，特异性为 92%。基于 AUC 值为 0.62±0.11（CI₉₅：0.4 至 0.8；P=0.31）和 0.53±0.12（CI₉₅：0.32 至 0.73，P=0.79），ΔPLRPP 和 ΔPLRPO 均不能预测液体反应性。
结论
在接受静脉-静脉 ECMO 治疗的患者中，>10%的 ΔPLRSV 可能预测液体反应性。ΔPLRPP 和 ΔPLRPO 不能预测液体反应性。
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