Miller Joseph, Ho Chuan-Xing, Tang Joy, Thompson Richard, Goldberg Jared, Amer Ahmed, Nahab Bashar
Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI.
Wayne State University School of Medicine, Detroit, MI.
Acad Emerg Med. 2016 Feb;23(2):186-90. doi: 10.1111/acem.12864. Epub 2016 Jan 14.
The primary objective of this study was to test if fasting volunteers exhibit fluid responsiveness using noninvasive hemodynamic measurements. The secondary objective was to test a passive leg raise (PLR) maneuver as a diagnostic predictor of fluid responsiveness.
This was a quasi-experimental design involving healthy volunteers. Subjects were excluded for pregnancy and congestive heart failure. Following a 12-hour fast, subjects had baseline hemodynamic monitoring recorded using noninvasive, continuous pulse contour analysis. Subjects then had a PLR maneuver performed, followed by an intravenous bolus of crystalloid. A rise in stroke volume ≥ 10% from baseline with the bolus was considered consistent with fluid responsiveness, and the same rise with a PLR was consistent with a positive PLR maneuver. The primary outcome was the change in stroke volume with a fluid bolus. Univariate analysis assessed changes in hemodynamic parameters. Logistic regression analysis determined the test characteristics of the PLR in predicting subjects who were ultimately fluid responsive.
Forty subjects completed the study. The mean change in stroke volume with a crystalloid bolus was 19% (95% confidence interval [CI] = 16% to 21%). Thirty-six (90%) subjects were fluid responsive. The mean PLR response for the overall cohort was 16% (95% CI = 12% to 19%), and 26 (65%) subjects had a positive PLR maneuver. The PLR was 72% sensitive (95% CI = 55% to 85%) and 100% specific (95% CI = 40% to 100%) for predicting the presence of fluid responsiveness.
Noninvasive assessment of fluid responsiveness in healthy volunteers and prediction of this response with a PLR maneuver is achievable. Further work is indicated to test these methods in acutely ill patients.
本研究的主要目的是通过非侵入性血流动力学测量来测试禁食志愿者是否表现出液体反应性。次要目的是测试被动抬腿（PLR）动作作为液体反应性的诊断预测指标。
这是一项涉及健康志愿者的准实验设计。排除怀孕和充血性心力衰竭的受试者。在禁食12小时后，使用非侵入性连续脉搏轮廓分析记录受试者的基线血流动力学监测数据。然后让受试者进行PLR动作，随后静脉注射晶体液。推注后每搏量较基线增加≥10%被认为与液体反应性一致，PLR动作后相同程度的增加与PLR动作阳性一致。主要结局是推注液体后每搏量的变化。单变量分析评估血流动力学参数的变化。逻辑回归分析确定PLR在预测最终有液体反应性的受试者方面的测试特征。
40名受试者完成了研究。晶体液推注后每搏量的平均变化为19%（95%置信区间[CI]=16%至21%）。36名（90%）受试者有液体反应性。整个队列的PLR平均反应为16%（95%CI=12%至19%），26名（65%）受试者PLR动作阳性。PLR预测液体反应性存在的敏感性为72%（95%CI=55%至85%），特异性为100%（95%CI=40%至100%）。
对健康志愿者进行液体反应性的非侵入性评估以及用PLR动作预测这种反应是可行的。需要进一步开展工作以在急性病患者中测试这些方法。
