Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO Box 30 001, Groningen 9700 RB, The Netherlands.
Br J Anaesth. 2013 Jun;110(6):940-6. doi: 10.1093/bja/aes508. Epub 2013 Jan 24.
Dynamic preload variables to predict fluid responsiveness are based either on the arterial pressure waveform (APW) or on the plethysmographic waveform (PW). We compared the ability of APW-based variations in stroke volume (SVV) and pulse pressure (PPV) and of PW-based plethysmographic variability index (PVI) to predict fluid responsiveness and to track fluid changes in patients undergoing major hepatic resection. Furthermore, we assessed whether the PPV/SVV ratio, as a measure of dynamic arterial elastance (Eadyn), could predict a reduction in norepinephrine requirement after fluid administration.
Thirty patients received i.v. fluid (15 ml kg(-1) in 30 min) after hepatic resection and were considered responders when stroke volume index (SVI) increased ≥20% after fluid administration. SVV and SVI were measured by the FloTrac-Vigileo(®) device, and PVI was measured by the Masimo Radical 7 pulse co-oximeter(®).
The areas under a receiver operating characteristic curve for SVV, PPV, and PVI were 0.81, 0.77, and 0.78, respectively. In responders, all dynamic variables, except PVI, decreased after fluid administration. Eadyn predicted a reduced norepinephrine requirement (AUC = 0.81).
In patients undergoing major hepatic resection, both APW- and PW-based dynamic preload variables predict fluid responsiveness (preload) to a similar extent. Most variables (except PVI) also tracked fluid changes. Eadyn, as a measure of arterial elastance (afterload), might be helpful to distinguish the origin of hypotension.
ClinicalTrials.gov, NCT01060683.
预测液体反应性的动态前负荷变量基于动脉压力波形（APW）或容积描记波形（PW）。我们比较了基于 APW 的每搏量变异（SVV）和脉压变异（PPV）以及基于 PW 的容积描记变异指数（PVI）预测液体反应性和跟踪行大肝切除术患者液体变化的能力。此外，我们评估了作为动态动脉弹性(Eadyn)的衡量标准的 PPV/SVV 比值是否可以预测液体给药后去甲肾上腺素需求的减少。
30 例患者在肝切除术后接受静脉输液（30 分钟内 15ml/kg），当输液后心排量指数（SVI）增加≥20%时被认为是有反应者。SVV 和 SVI 通过 FloTrac-Vigileo®设备测量，PVI 通过 Masimo Radical 7 脉搏血氧仪®测量。
SVV、PPV 和 PVI 的受试者工作特征曲线下面积分别为 0.81、0.77 和 0.78。在有反应者中，除 PVI 外，所有动态变量在输液后均降低。Eadyn 预测去甲肾上腺素需求减少（AUC = 0.81）。
在接受大肝切除术的患者中，基于 APW 和 PW 的动态前负荷变量在预测液体反应性（前负荷）方面具有相似的程度。大多数变量（除 PVI 外）也跟踪液体变化。Eadyn 作为动脉弹性（后负荷）的衡量标准，可能有助于区分低血压的原因。
ClinicalTrials.gov，NCT01060683。
