Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, # 101 Daehakno, Jongnogu, Seoul 110-744, Republic of Korea.
Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, # 101 Daehakno, Jongnogu, Seoul 110-744, Republic of Korea
Br J Anaesth. 2015 Jul;115(1):38-44. doi: 10.1093/bja/aev109. Epub 2015 Apr 29.
This study evaluated the ability of a non-invasive cardiac output monitoring device (NICOM) to predict fluid responsiveness in paediatric patients undergoing cardiac surgery.
Children aged <5 yr undergoing congenital heart surgery were included. Once the sternum had been closed after repair of the congenital heart defect, 10 ml kg(-1) colloid solution was administered for volume expansion. Transoesophageal echocardiography (TOE) was performed to measure stroke volume (SV) and respiratory variation in aortic blood flow peak velocity (ΔV(peak)) before and after volume expansion. Haemodynamic and NICOM variables, including SV(NICOM), stroke volume variance (SVV(NICOM)), cardiac index (CI(NICOM)), and percentage change in thoracic fluid content compared with baseline (TFCd0%), were also recorded. Patients in whom the stroke volume index (SVI), measured using TOE, increased by >15% were defined as fluid responders.
Twenty-nine patients were included (13 responders and 16 non-responders). Before volume expansion, only ΔV(peak) differed between groups (P=0.036). The SVV(NICOM), HR, and central venous pressure did not predict fluid responsiveness, but ΔV(peak) did. The CI(NICOM) was not correlated with CI(TOE) (r=0.107, P=0.43). Using Bland-Altman analysis, the mean bias between CI(TOE) and CI(NICOM) was 0.89 litre min(-1) m(-2), with a precision of 1.14 litre min(-1) m(-2). Trending ability of NICOM for SVI and CI was poor when TOE was a reference method.
The SVV(NICOM) did not predict fluid responsiveness in paediatric patients during cardiac surgery. In addition, there was no correlation between CI(TOE) and CI(NICOM). Fluid management guided by NICOM should be performed carefully.
ClinicalTrials.gov NCT01996956.
本研究评估了一种非侵入性心输出量监测仪（NICOM）在接受心脏手术的儿科患者中预测液体反应性的能力。
纳入年龄<5 岁的先天性心脏病手术患儿。心脏缺陷修复后胸骨闭合后，给予 10ml/kg 胶体溶液进行容量扩张。在容量扩张前后进行经食管超声心动图（TOE）测量心搏量（SV）和主动脉血流峰值速度（ΔV(peak)）呼吸变化。还记录血流动力学和 NICOM 变量，包括 SV（NICOM）、SVV（NICOM）、心指数（CI（NICOM））和与基线相比胸内液体含量的百分比变化（TFCd0%）。通过 TOE 测量的 SV 指数增加>15%的患者被定义为液体反应者。
共纳入 29 例患者（13 例为液体反应者，16 例为非液体反应者）。在容量扩张前，只有 ΔV(peak)在两组之间存在差异（P=0.036）。SVV（NICOM）、心率和中心静脉压不能预测液体反应性，但 ΔV(peak)可以。CI（NICOM）与 CI（TOE）不相关（r=0.107，P=0.43）。使用 Bland-Altman 分析，CI（TOE）和 CI（NICOM）之间的平均偏差为 0.89L/min/m²，精度为 1.14L/min/m²。当以 TOE 为参考方法时，NICOM 对 SVI 和 CI 的趋势能力较差。
SVV（NICOM）不能预测心脏手术期间儿科患者的液体反应性。此外，CI（TOE）和 CI（NICOM）之间没有相关性。应谨慎使用 NICOM 指导的液体管理。
ClinicalTrials.gov NCT01996956。
