Min Jeong Jin, Lee Jong-Hwan, Hong Kwan Young, Choi Soo Joo
Department of Anaesthesiology and Pain Medicine, Samsung Medical Centre, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea.
J Clin Monit Comput. 2017 Apr;31(2):397-405. doi: 10.1007/s10877-016-9859-z. Epub 2016 Mar 10.
The aim of this prospective study was to evaluate the usefulness of stroke volume variation (SVV) derived from NICOM to predict fluid responsiveness in the prone position. Forty adult patients undergoing spinal surgery in the prone position were included in this study. We measured SVV from NICOM (SVV) and FloTrac™/Vigileo™ systems (SVV), and pulse pressure variation (PPV) using automatic (PPV) and manual (PPV) calculations at four time points including supine and prone positions, and before and after fluid loading of 6 ml kg colloid solution. Fluid responsiveness was defined as an increase in the cardiac index from Vigileo™ of ≥12 %. There were 19 responders and 21 non-responders. Prone positioning induced a significant decrease in SVV, SVV, PPV, and PPV. However, all of these parameters successfully predicted fluid responsiveness in the prone position with area under the receiver-operator characteristic curves for SVV, SVV, PPV, and PPV of 0.78 [95 % confidence interval (CI) 0.62-0.90, P = 0.0001], 0.79 (95 % CI 0.63-0.90, P = 0.0001), 0.76 (95 % CI 0.6-0.88, P = 0.0006), and 0.84 (95 % CI 0.69-0.94, P < 0.0001), respectively. The optimal cut-off values were 12 % for SVV, SVV, and PPV, and 10 % for PPV. SVV from NICOM successfully predicts fluid responsiveness during surgery in the prone position. This totally non-invasive technique for assessing individual functional intravenous volume status would be useful in a wide range of surgeries performed in the prone position.
这项前瞻性研究的目的是评估经NICOM得出的每搏量变异（SVV）对预测俯卧位时液体反应性的有效性。本研究纳入了40例接受俯卧位脊柱手术的成年患者。我们在包括仰卧位和俯卧位以及输注6 ml/kg胶体溶液前后的四个时间点，通过NICOM（SVV）和FloTrac™/Vigileo™系统（SVV）测量SVV，并使用自动（PPV）和手动（PPV）计算方法测量脉压变异（PPV）。液体反应性定义为Vigileo™测得的心指数增加≥12%。有19例反应者和21例无反应者。俯卧位导致SVV、SVV、PPV和PPV显著降低。然而，所有这些参数均成功预测了俯卧位时的液体反应性，SVV、SVV、PPV和PPV的受试者工作特征曲线下面积分别为0.78 [95%置信区间（CI）0.62 - 0.90，P = 0.0001]、0.79（95% CI 0.63 - 0.90，P = 0.0001）、0.76（95% CI 0.6 - 0.88，P = 0.0006）和0.84（95% CI 0.69 - 0.94，P < 0.000）。SVV、SVV和PPV的最佳截断值为12%，PPV的最佳截断值为10%。经NICOM得出的SVV成功预测了俯卧位手术期间的液体反应性。这种完全无创的评估个体功能性静脉容量状态的技术在广泛的俯卧位手术中将会很有用。
