Enevoldsen Johannes, Potes Cristhian, Xu-Wilson Minnan, Vistisen Simon T
Research Centre for Emergency Medicine, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark.
Acute Care Solutions Department, Philips Research North America, Boston, MA, USA.
Crit Care Res Pract. 2018 Oct 1;2018:5697092. doi: 10.1155/2018/5697092. eCollection 2018.
Extrasystoles may be useful for predicting the response to fluid therapy in hemodynamically unstable patients but their prevalence is unknown. The aim of this study was to estimate the availability of extrasystoles in intensive care unit patients diagnosed with sepsis. The study aim was not to validate the fluid responsiveness prediction ability of extrasystoles.
Twenty-four-hour ECG recordings from a convenience sample of 50 patients diagnosed with sepsis were extracted from the MIMIC-II waveform database, and ECGs were visually examined for correct QRS complex detection. Custom-made algorithms identified potential extrasystoles based on RR intervals. Two raters visually confirmed or rejected the potential extrasystoles and then classified them as ventricular, supraventricular, or unknown origin. Extrasystole availability was calculated as for each 24 h ECG recording, that is, the percentage of the 24 h recording where an extrasystole had occurred in the preceding 30 minutes.
Mean was 53.3% (confidence interval: [42.8; 63.6]%) and ventricular extrasystolic coverage was 21.4 [13.5; 29.8]%. Interrater reliability was strong for confirming/rejecting extrasystoles.
Extrasystoles are available for fluid responsiveness prediction in septic patients in about half of the time. With this extrasystolic availability, we believe the method to be considered for clinical use, provided that future studies validate the method's fluid responsiveness prediction ability.
早搏可能有助于预测血流动力学不稳定患者对液体治疗的反应，但其发生率尚不清楚。本研究的目的是估计诊断为脓毒症的重症监护病房患者中早搏的发生率。本研究目的并非验证早搏对液体反应性的预测能力。
从MIMIC-II波形数据库中提取了50例诊断为脓毒症患者的便利样本的24小时心电图记录，并对心电图进行视觉检查以正确检测QRS波群。定制算法根据RR间期识别潜在的早搏。两名评估者通过视觉确认或排除潜在的早搏，然后将其分类为室性、室上性或起源不明。计算每次24小时心电图记录的早搏发生率，即在前30分钟内出现早搏的24小时记录的百分比。
平均早搏发生率为53.3%（置信区间：[42.8；63.6]%），室性早搏发生率为21.4 [13.5；29.8]%。在确认/排除早搏方面，评估者间的可靠性很强。
在大约一半的时间里，早搏可用于预测脓毒症患者的液体反应性。鉴于这种早搏发生率，我们认为如果未来的研究验证了该方法对液体反应性的预测能力，该方法可考虑用于临床。
