Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
Br J Anaesth. 2013 Apr;110(4):586-91. doi: 10.1093/bja/aes467. Epub 2012 Dec 18.
The purpose of this study was to evaluate the clinical usefulness of static and dynamic variables for the prediction of fluid responsiveness in children under general anaesthesia.
Thirty-three mechanically ventilated children received 10 ml kg(-1) colloid for 10 min while stable during surgery. Arterial pressure, heart rate, central venous pressure (CVP), and pleth variability index (PVI), in addition to variation in systolic pressure, pulse pressure (including Δdown and Δup), respiratory aortic blood flow velocity (ΔVpeak), and inferior vena cava diameter were measured before and after volume expansion. Patients were classified as responders to fluid loading if their stroke volume index (SVI) increased by at least 10%.
There were 15 volume responders and 18 non-responders. Of the variables examined, ΔVpeak (r=0.516, P=0.004) and PVI (r=0.49, P=0.004) before volume expansion were significantly correlated with changes in SVI. The receiver-operating characteristic (ROC) curve analysis showed that PVI and ΔVpeak predicted fluid responsiveness. Areas under the ROC curves of PVI and ΔVpeak were statistically larger than that of CVP (P=0.006 and 0.014, respectively). However, those of other variables were similar to that of CVP.
ΔVpeak and PVI can be used to predict fluid responsiveness in mechanically ventilated children under general anaesthesia. The other static and dynamic variables assessed in this study were not found to predict fluid responsiveness significantly in children.
ClinicalTrials.gov, NCT01364103.
本研究旨在评估静态和动态变量在预测全身麻醉下儿童液体反应性方面的临床实用性。
33 例机械通气的儿童在手术过程中保持稳定时，接受 10ml/kg 的胶体液 10 分钟。在容量扩充前后测量动脉压、心率、中心静脉压（CVP）和容积指数（PVI）以及收缩压变化、脉压（包括 Δdown 和 Δup）、呼吸主动脉血流速度（ΔVpeak）和下腔静脉直径。如果其每搏量指数（SVI）增加至少 10%，则将患者分类为对液体负荷有反应者。
有 15 例患者为容量反应者，18 例为非容量反应者。在检查的变量中，ΔVpeak（r=0.516，P=0.004）和 PVI（r=0.49，P=0.004）在容量扩充前与 SVI 的变化显著相关。接收者操作特征（ROC）曲线分析表明，PVI 和 ΔVpeak 可预测液体反应性。PVI 和 ΔVpeak 的 ROC 曲线下面积均明显大于 CVP（分别为 P=0.006 和 0.014）。然而，其他变量的曲线下面积与 CVP 相似。
ΔVpeak 和 PVI 可用于预测全身麻醉下机械通气儿童的液体反应性。本研究评估的其他静态和动态变量在儿童中并未发现对液体反应性有显著预测作用。
ClinicalTrials.gov，NCT01364103。
