Long Elliot, Duke Trevor, Oakley Ed, O'Brien Adam, Sheridan Bennett, Babl Franz E
Department of Emergency Medicine, The Royal Children's Hospital, Melbourne, Victoria, Australia.
Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
Emerg Med Australas. 2018 Aug;30(4):556-563. doi: 10.1111/1742-6723.12948. Epub 2018 Mar 8.
The intent of fluid bolus therapy (FBT) is to increase cardiac output and tissue perfusion, yet only 50% of septic children are fluid responsive. We evaluated respiratory variation of inferior vena cava (IVC) diameter as a predictor of fluid responsiveness.
A prospective observational study in the ED of The Royal Children's Hospital, Melbourne, Australia. Patients were spontaneously ventilating children treated with FBT for sepsis-induced acute circulatory failure. IVC ultrasound was performed prior to FBT. Trans-thoracic echocardiography was performed prior to, 5 and 60 min after FBT. IVC collapsibility index and stroke distance were calculated by a blinded Paediatric Emergency Physician and blinded Paediatric Cardiologist, respectively.
Thirty-nine fluid boluses were recorded in 33 children, 28/39 (72%) of which met criteria for fluid responsiveness at 5 min, which was sustained in 2/28 (7%) of initial fluid responders at 60 min. Sensitivity and specificity (95% confidence interval) of IVC collapsibility index were 0.44 (0.25-0.65) and 0.33 (0.10-0.65) with an area under the receiver operator characteristics curve (95% confidence interval) of 0.38 (0.23-0.55) at 5 min. Test characteristics 60 min after fluid bolus administration were not meaningful because of the infrequency of sustained fluid responsiveness in this patient group. There was no significant correlation between IVC collapsibility and fluid responsiveness at 5 or 60 min.
IVC collapsibility has poor test characteristics for predicting fluid responsiveness in spontaneously ventilating children with sepsis.
液体冲击疗法（FBT）的目的是增加心输出量和组织灌注，但仅有50%的脓毒症患儿对液体有反应。我们评估了下腔静脉（IVC）直径的呼吸变化作为液体反应性的预测指标。
在澳大利亚墨尔本皇家儿童医院急诊科进行的一项前瞻性观察研究。患者为因脓毒症诱发急性循环衰竭接受FBT治疗的自主呼吸儿童。在FBT前进行IVC超声检查。在FBT前、FBT后5分钟和60分钟进行经胸超声心动图检查。IVC可塌陷指数和搏出距离分别由一名不知情的儿科急诊医生和一名不知情的儿科心脏病专家计算得出。
记录了33名儿童的39次液体冲击，其中28/39（72%）在5分钟时符合液体反应性标准，在60分钟时，最初有反应的28名患者中只有2/28（7%）仍保持反应。在5分钟时，IVC可塌陷指数的敏感性和特异性（95%置信区间）分别为0.44（0.25 - 0.65）和0.33（0.10 - 0.65），受试者操作特征曲线下面积（95%置信区间）为0.38（0.23 - 0.55）。由于该患者群体中持续液体反应性的情况较少，液体冲击给药60分钟后的检测特征无意义。在5分钟或60分钟时，IVC可塌陷性与液体反应性之间无显著相关性。
对于脓毒症自主呼吸儿童，IVC可塌陷性在预测液体反应性方面检测特征不佳。
