Intensive Care Unit, Department of Anaesthesiology and Critical Care Medicine, Saint-Quentin, France.
Br J Anaesth. 2014 Apr;112(4):681-5. doi: 10.1093/bja/aet442. Epub 2013 Dec 29.
Respiratory variation in pulse pressure (ΔPP) is commonly used to predict the fluid responsiveness of critically ill patients. However, some researchers have demonstrated that this measurement has several limitations. The present study was designed to evaluate the proportion of patients satisfying criteria for valid application of ΔPP at a given time-point.
A 1 day, prospective, observational, point-prevalence study was performed in 26 French intensive care units (ICUs). All patients hospitalized in the ICUs on the day of the study were included. The ΔPP validity criteria were recorded prospectively and defined as follows: (i) mechanical ventilation in the absence of spontaneous respiration; (ii) regular cardiac rhythm; (iii) tidal volume ≥8 ml kg(-1) of ideal body weight; (iv) a heart rate/respiratory rate ratio >3.6; (v) total respiratory system compliance ≥30 ml cm H2O(-1); and (vi) tricuspid annular peak systolic velocity ≥0.15 m s(-1).
The study included 311 patients with a Simplified Acute Physiology Score II of 41 (39-43). Overall, only six (2%) patients satisfied all validity criteria. Of the 170 patients with an arterial line in place, only five (3%) satisfied the validity criteria. During the 24 h preceding the study time-point, fluid responsiveness was assessed for 79 patients. ΔPP had been used to assess fluid responsiveness in 15 of these cases (19%).
A very low percentage of patients satisfied all criteria for valid use of ΔPP in the evaluation of fluid responsiveness. Physicians must consider limitations to the validity of ΔPP before using this variable.
呼吸变化脉压（ΔPP）通常用于预测危重患者的液体反应性。然而，一些研究人员已经证明，这种测量有几个局限性。本研究旨在评估在给定时间点满足ΔPP有效应用标准的患者比例。
这是一项为期 1 天的前瞻性观察性时点患病率研究，在 26 个法国重症监护病房（ICU）进行。研究当天入住 ICU 的所有患者均被纳入研究。ΔPP 的有效性标准是前瞻性记录的，定义如下：（i）无自主呼吸的机械通气；（ii）规则的心律；（iii）潮气量≥8ml/kg 理想体重；（iv）心率/呼吸率比>3.6；（v）总呼吸系统顺应性≥30ml/cmH2O；和（vi）三尖瓣环峰收缩速度≥0.15m/s。
这项研究共纳入了 311 名简化急性生理学评分 II 为 41（39-43）的患者。总体而言，仅有 6 名（2%）患者满足所有有效性标准。在有动脉置管的 170 名患者中，仅有 5 名（3%）满足有效性标准。在研究时间点之前的 24 小时内，对 79 名患者进行了液体反应性评估。在这 15 例患者中，有 15 例（19%）使用ΔPP 评估了液体反应性。
在评估液体反应性时，只有非常低比例的患者满足ΔPP 有效使用的所有标准。在使用该变量之前，医生必须考虑其有效性的局限性。
