Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
J Cardiothorac Vasc Anesth. 2013 Dec;27(6):1094-100. doi: 10.1053/j.jvca.2013.05.003. Epub 2013 Aug 22.
The aim of this study was to evaluate the ability of static, volumetric, and dynamic parameters of cardiac preload to predict volume responsiveness during one-lung ventilation (OLV).
Prospective experimental study.
Laboratory of the animal facility of the University Medical Center Hamburg-Eppendorf.
Twenty-three German domestic pigs.
Hypovolemia was induced by withdrawing 20 mL/kg body weight (BW) of blood. OLV was established, and the volume withdrawn was re-transfused in 3 volume-loading steps, each consisting of 7 mL/kg BW. An ultrasonic flow probe around the pulmonary artery was used to measure the stroke-volume index (SVI) and to evaluate the volume response. An increase in the SVI of ≥ 15% was considered a positive response. For each measurement time point, central venous pressure (CVP), left atrial pressure (LAP), the global end-diastolic volume index (GEDI), stroke-volume variation (SVV), and pulse-pressure variation (PPV) were recorded. The ability to predict volume responsiveness was assessed using ROC analysis.
A total of 69 volume loading steps were performed, 48 of which showed a positive volume response. ROC analysis revealed the following area under the curve (AUC) values: CVP, 0.88; LAP, 0.65; GEDI, 0.75; SVV, 0.78; and PPV, 0.83. A comparison of the areas under the ROC curves did not reveal any statistically significant differences (p>0.05), with the exception of LAP compared with CVP (p = 0.005).
Under these OLV experimental conditions, the volumetric and dynamic parameters of preload, as well as CVP, seemed to be of similar value in predicting volume responsiveness.
本研究旨在评估静态、容量和动态的心脏前负荷参数在单肺通气（OLV）期间预测容量反应性的能力。
前瞻性实验研究。
汉堡大学医学中心动物设施的实验室。
23 只德国本地猪。
通过抽取 20 毫升/公斤体重（BW）的血液来诱导低血容量。建立 OLV，并在 3 个容量加载步骤中重新输注抽取的血液，每个步骤包括 7 毫升/公斤 BW。使用围绕肺动脉的超声流量探头来测量每搏量指数（SVI）并评估容量反应。SVI 增加≥15%被认为是阳性反应。在每个测量时间点，记录中心静脉压（CVP）、左心房压（LAP）、全心舒张末期容积指数（GEDI）、每搏量变异（SVV）和脉搏压变异（PPV）。使用 ROC 分析评估预测容量反应性的能力。
总共进行了 69 次容量加载步骤，其中 48 次显示出阳性的容量反应。ROC 分析显示以下曲线下面积（AUC）值：CVP，0.88；LAP，0.65；GEDI，0.75；SVV，0.78；PPV，0.83。比较 ROC 曲线下的面积没有发现任何统计学上的显著差异（p>0.05），除了 LAP 与 CVP 之间的差异（p=0.005）。
在这些 OLV 实验条件下，前负荷的容量和动态参数以及 CVP 似乎在预测容量反应性方面具有相似的价值。
