Schloss Brian, Tumin Dmitry, Naguib Aymen, Rice Julie, Galantowicz Mark, Tobias Joseph D
Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.
Department of Pediatric Cardiothoracic Surgery, Nationwide Children's Hospital, Columbus, OH, USA.
Cardiol Res. 2017 Dec;8(6):276-279. doi: 10.14740/cr634w. Epub 2017 Dec 22.
The aim of this study was to evaluate the response of the LiDCO-rapid™ during intraoperative phlebotomy in anesthetized children prior to surgery for congenital heart disease.
After the induction of general anesthesia and endotracheal intubation, baseline vital signs were recorded, along with pulse pressure variability (PPV) and stroke volume variability (SVV) from the LiDCO-rapid™ and cerebral oxygenation (rSO) using near-infrared spectroscopy (NIRS). Phlebotomy was performed over 5 - 10 min with the volume of blood removed calculated to achieve a hematocrit of 24-28% on cardiopulmonary bypass. The primary outcome was a decline in rSO ≥ 5 between the baseline value and the end of phlebotomy. At that time, the correlation of the starting and ending values of SVV and PPV with the NIRS was determined.
The study cohort included 30 patients (mean age of 21 ± 11 years). Statistically significant changes during the study period were observed in rSO, but not in the LiDCO-rapid™ parameters. In analysis of continuous NIRS data, the change in NIRS did not correlate with either baseline (r = 0.10, P = 0.644) or final (r = 0.02, P = 0.914) SVV. Likewise, the change in NIRS did not correlate with baseline (r = 0.01, P = 0.953) or final (r = 0.00, P = 0.982) PPV.
Baseline values as well as changes in the PVV and SVV from the LiDCO-rapid™ did not predict or correlate with changes in cerebral oxygenation measured by NIRS during intraoperative phlebotomy. Our preliminary data suggest that these parameters (PVV and SVV) are not useful in monitoring patient stability or the need for volume replacement during intraoperative phlebotomy prior to cardiac surgery.
本研究的目的是评估LiDCO-rapid™在先天性心脏病手术前对麻醉儿童进行术中放血时的反应。
在全身麻醉诱导和气管插管后，记录基线生命体征，以及LiDCO-rapid™的脉压变异度（PPV）和每搏量变异度（SVV），并使用近红外光谱（NIRS）测量脑氧合（rSO）。放血在5 - 10分钟内进行，计算放出血液量以在体外循环时使血细胞比容达到24 - 28%。主要结局是放血结束时rSO较基线值下降≥5。此时，确定SVV和PPV的起始值与终末值与NIRS的相关性。
研究队列包括30例患者（平均年龄21±11岁）。研究期间rSO有统计学显著变化，但LiDCO-rapid™参数无变化。在连续NIRS数据分析中，NIRS的变化与基线（r = 0.10，P = 0.644）或最终（r = 0.02，P = 0.914）的SVV均无相关性。同样，NIRS的变化与基线（r = 0.01，P = 0.953）或最终（r = 0.00，P = 0.982）的PPV也无相关性。
LiDCO-rapid™的基线值以及PVV和SVV的变化在术中放血期间不能预测或与NIRS测量的脑氧合变化相关。我们的初步数据表明，这些参数（PVV和SVV）在心脏手术前术中放血期间监测患者稳定性或判断容量补充需求方面并无用处。
