Han Ding, Pan Shoudong, Wang Xiaonan, Jia Qingyan, Luo Yi, Li Jia, Ou-Yang Chuan
Department of Anesthesiology, Capital Institute of Pediatrics affiliated Children's Hospital, Beijing, China.
Anesthesia Center, Capital Medical University affiliated Beijing Anzhen Hospital, Beijing, China.
Paediatr Anaesth. 2017 Oct;27(10):1056-1063. doi: 10.1111/pan.13218. Epub 2017 Aug 31.
Pulse pressure variation derived from the varied pulse contour method is based on heart-lung interaction during mechanical ventilation. It has been shown that pulse pressure variation is predictive of fluid responsiveness in children undergoing surgical repair of ventricular septal defect. Right ventricle compliance and pulmonary vascular capacitance in children with tetralogy of Fallot are underdeveloped as compared to those in ventricular septal defect. We hypothesized that the difference in the right ventricle-pulmonary circulation in the two groups of children would affect the heart-lung interaction and therefore pulse pressure variation predictivity of fluid responsiveness following cardiac surgery.
Infants undergoing complete repair of ventricular septal defect (n=38, 1.05±0.75 years) and tetralogy of Fallot (n=36, 1.15±0.68 years) clinically presenting with low cardiac output were enrolled. Fluid infusion with 5% albumin or fresh frozen plasma was administered. Pulse pressure variation was recorded using pressure recording analytical method along with cardiac index before and after fluid infusion. Patients were considered as responders to fluid loading when cardiac index increased ≥15%. Receiver operating characteristic curves analysis was used to assess the accuracy and cutoffs of pulse pressure variation to predict fluid responsiveness.
The pulse pressure variation values before and after fluid infusion were lower in tetralogy of Fallot children than those in ventricular septal defect children (15.2±4.4% vs 19.3±4.4%, P<.001; 11.6±3.8 vs 15.4±4.3%, P<.001, respectively). In ventricular septal defect children, 27 were responders and 11 nonresponders. Receiver operating characteristic curve area was 0.89 (95% confidence interval, 0.77-1.01) and cutoff value 17.4% with a sensitivity of 0.89 and a specificity of 0.91. In tetralogy of Fallot children, 26 were responders and 10 were nonresponders. Receiver operating characteristic curve area was 0.79 (95% CI, 0.64-0.94) and cutoff value 13.4% with a sensitivity of 0.81 and a specificity of 0.80.
Pulse pressure variation is predictive of fluid responsiveness in ventricular septal defect and tetralogy of Fallot patients following cardiac surgery.
基于脉波轮廓变化法得出的脉压变异是基于机械通气期间的心肺相互作用。研究表明，脉压变异可预测室间隔缺损手术修复患儿的液体反应性。与室间隔缺损患儿相比，法洛四联症患儿的右心室顺应性和肺血管容量发育不全。我们假设，两组患儿右心室 - 肺循环的差异会影响心肺相互作用，进而影响心脏手术后脉压变异对液体反应性的预测能力。
纳入临床出现低心输出量的室间隔缺损完全修复患儿（n = 38，1.05±0.75岁）和法洛四联症患儿（n = 36，1.15±0.68岁）。给予5%白蛋白或新鲜冰冻血浆进行液体输注。在液体输注前后，使用压力记录分析法记录脉压变异以及心脏指数。当心脏指数增加≥15%时，患者被视为液体负荷反应者。采用受试者工作特征曲线分析来评估脉压变异预测液体反应性的准确性和临界值。
法洛四联症患儿液体输注前后的脉压变异值低于室间隔缺损患儿（分别为15.2±4.4%对19.3±4.4%，P <.001；11.6±3.8对15.4±4.3%，P <.001）。在室间隔缺损患儿中，27例为反应者，11例为无反应者。受试者工作特征曲线面积为0.89（95%置信区间，0.77 - 1.01），临界值为17.4%，敏感性为0.89，特异性为0.91。在法洛四联症患儿中，26例为反应者，10例为无反应者。受试者工作特征曲线面积为0.79（95%CI，0.64 - 0.94），临界值为13.4%，敏感性为0.81，特异性为0.80。
脉压变异可预测室间隔缺损和法洛四联症患儿心脏手术后的液体反应性。
