Rudas László, Hankovszky Péter, Lovas András, Zöllei Éva, Molnár Zsolt
Department of Anesthesiology and Intensive Care, Faculty of Medicine, University of Szeged, Szeged, Hungary.
Case Rep Crit Care. 2017;2017:7647069. doi: 10.1155/2017/7647069. Epub 2017 Nov 29.
Dynamic preload assessment tests, especially pulse pressure variation (PPV) and stroke volume variation (SVV), are increasingly acknowledged in mechanically ventilated patients as being predictors of fluid responsiveness. However, the limitations of this method are often neglected or overlooked. One of the prerequisites for PPV and SVV evaluation, in addition to intermittent positive pressure ventilation, is a "regular heart rhythm," which may be an ambiguous term. We present a case where, despite a regular (paced) rhythm, atrioventricular dissociation was present and resulted in marked PPV elevation, which subsequently disappeared once sinus rhythm returned. Our case indicates that PPV and SVV should be interpreted with caution when atrioventricular dissociation is present.
动态预负荷评估测试，尤其是脉压变异度（PPV）和每搏输出量变异度（SVV），在机械通气患者中越来越被认为是液体反应性的预测指标。然而，这种方法的局限性常常被忽视或忽略。除间歇性正压通气外，PPV和SVV评估的前提条件之一是“规则的心律”，这可能是一个模糊的术语。我们报告一例，尽管心律规则（起搏心律），但存在房室分离，导致PPV显著升高，而当窦性心律恢复后PPV随后消失。我们的病例表明，存在房室分离时，应谨慎解释PPV和SVV。
