Haliloğlu Murat, Bilgili Beliz, Kararmaz Alper, Cinel İsmail
Department of Anesthesiology and Reanimation, Marmara University Faculty of Medicine, İstanbul-Turkey.
Ulus Travma Acil Cerrahi Derg. 2017 Jul;23(4):294-300. doi: 10.5505/tjtes.2016.04832.
Rapid, accurate, and reproducible assessment of intravascular volume status is crucial in order to predict the efficacy of volume expansion in septic patients. The aim of this study was to verify the feasibility and usefulness of the internal jugular vein collapsibility index (IJV-CI) as an adjunct to the inferior vena cava collapsibility index (IVC-CI) to predict fluid responsiveness in spontaneously-breathing patients with sepsis.
Three stages of sonographic scanning were performed. Hemodynamic data were collected using the Ultrasonic Cardiac Output Monitor 1A system (Uscom, Ltd., Sydney, NSW, Australia) coupled with paired assessments of IVC-CI and IJV-CI at baseline, after passive leg raise (PLR), and again in semi-recumbent position. Fluid responsiveness was assessed according to changes in the cardiac index (CI) induced by PLR. Patients were retrospectively divided into 2 groups: fluid responder if an increase in CI (ΔCI) ≥15% was obtained after PLR maneuver, and non-responder if ΔCI was <15%.
Total of 132 paired scans of IJV and IVC were completed in 44 patients who presented with sepsis and who were not receiving mechanical ventilation (mean age: 54.6±16.1 years). Of these, 23 (52.2%) were considered to be responders. Responders had higher IJV-CI and IVC-CI before PLR maneuver than non-responders (p<0.001). IJV-CI of more than 36% before PLR maneuver had 78% sensitivity and 85% specificity to predict responder. Furthermore, less time was needed to measure venous diameters for IJV-CI (30 seconds) compared with IVC-CI (77.5 seconds; p<0.001).
IJV-CI is a precise, easily acquired, non-invasive parameter of fluid responsiveness in patients with sepsis who are not mechanically ventilated, and it appears to be a reasonable adjunct to IVC-CI.
快速、准确且可重复地评估血管内容量状态对于预测脓毒症患者液体复苏的疗效至关重要。本研究的目的是验证颈内静脉塌陷指数（IJV-CI）作为下腔静脉塌陷指数（IVC-CI）的辅助指标，用于预测脓毒症自主呼吸患者液体反应性的可行性和实用性。
进行三个阶段的超声扫描。使用超声心输出量监测仪1A系统（澳大利亚新南威尔士州悉尼市的Uscom有限公司）收集血流动力学数据，并在基线、被动抬腿（PLR）后以及再次半卧位时对IVC-CI和IJV-CI进行配对评估。根据PLR引起的心脏指数（CI）变化评估液体反应性。患者被回顾性分为两组：PLR操作后CI增加（ΔCI）≥15%为液体反应者，ΔCI<15%为无反应者。
44例脓毒症且未接受机械通气的患者（平均年龄：54.6±16.1岁）共完成了132次IJV和IVC的配对扫描。其中，23例（52.2%）被认为是反应者。反应者在PLR操作前的IJV-CI和IVC-CI高于无反应者（p<0.001）。PLR操作前IJV-CI大于36%对预测反应者的敏感性为78%，特异性为85%。此外，与IVC-CI（77.5秒；p<0.001）相比，测量IJV-CI的静脉直径所需时间更短（30秒）。
IJV-CI是未机械通气的脓毒症患者液体反应性的精确、易于获取的非侵入性参数，似乎是IVC-CI的合理辅助指标。
