Division of Critical Care Neurology, Department of Neurology, Columbia University, Milstein Hospital 8 Center, 177 Fort Washington Ave, New York, NY, 10032, USA,
Neurocrit Care. 2014 Apr;20(2):247-54. doi: 10.1007/s12028-013-9910-6.
The objective of this study was to investigate the relationship between cardiac index (CI) response to a fluid challenge and changes in brain tissue oxygen pressure (PbtO(2)) in patients with subarachnoid hemorrhage (SAH).
Prospective observational study was conducted in a neurological intensive care unit of a university hospital. Fifty-seven fluid challenges were administered to ten consecutive comatose SAH patients that underwent multimodality monitoring of CI, intracranial pressure (ICP), and PbtO(2), according to a standardized fluid management protocol.
The relationship between CI and PbtO(2) was analyzed with logistic regression utilizing generalized estimating equations. Of the 57 fluid boluses analyzed, 27 (47 %) resulted in a ≥ 10 % increase in CI. Median absolute (+5.8 vs. +1.3 mmHg) and percent (20.7 vs. 3.5 %) changes in PbtO(2) were greater in CI responders than in non-responders within 30 min after the end of the fluid bolus infusion. In a multivariable model, a CI response was independently associated with PbtO(2) response (adjusted odds ratio 21.5, 95 % CI 1.4-324, P = 0.03) after adjusting for mean arterial pressure change and end-tidal CO(2). Stroke volume variation showed a good ability to predict CI and PbtO(2) response with areas under the ROC curve of 0.86 and 0.81 with the best cut-off values of 9 % for both responses.
Bolus fluid resuscitation resulting in augmentation of CI can improve cerebral oxygenation after SAH.
本研究旨在探讨蛛网膜下腔出血（SAH）患者液体冲击后心指数（CI）的变化与脑组织氧压（PbtO2）变化之间的关系。
这是一项在大学附属医院神经重症监护病房进行的前瞻性观察性研究。根据标准化液体管理方案，对 10 例连续昏迷的 SAH 患者进行了 CI、颅内压（ICP）和 PbtO2 的多模态监测，并对 57 次液体冲击进行了研究。
利用广义估计方程对 CI 与 PbtO2 的关系进行了逻辑回归分析。在分析的 57 个液体冲击中，有 27 个（47%）导致 CI 增加≥10%。在液体冲击输注结束后 30 分钟内，CI 反应者的 PbtO2 绝对值（+5.8 对+1.3mmHg）和百分比变化（20.7 对 3.5%）大于非反应者。在多变量模型中，CI 反应与 PbtO2 反应独立相关（调整后的优势比 21.5，95%CI 为 1.4-324，P=0.03），调整平均动脉压变化和呼气末 CO2 后。每搏量变异度显示出良好的预测 CI 和 PbtO2 反应的能力，ROC 曲线下面积分别为 0.86 和 0.81，最佳截断值分别为 9%。
导致 CI 增加的液体冲击复苏可改善 SAH 后的脑氧合。
