Département d'Anesthésie Réanimation, Centre Hospitalier Louis Pradel, Bron, France; Université Claude-Bernard Lyon 1, Campus Lyon Santé Est, Lyon, France.
Département d'Anesthésie Réanimation, Centre Hospitalier Louis Pradel, Bron, France.
Br J Anaesth. 2018 Dec;121(6):1323-1331. doi: 10.1016/j.bja.2018.06.030. Epub 2018 Sep 6.
Fluid administration to increase stroke volume index (SVi) is a cornerstone of haemodynamic resuscitation. We assessed the accuracy of SVi variation during a calibrated abdominal compression manoeuvre (ΔSVi-CAC) to predict fluid responsiveness in children.
Patients younger than 8 yr with acute circulatory failure, regardless of their ventilation status, were selected. SVi, calculated as the average of five velocity-time integrals multiplied by the left ventricular outflow tract surface area, was recorded at four different steps: baseline, after an abdominal compression with a calibrated pressure of 25 mm Hg, after return to baseline, and then after a volume expansion (VE) of 10 ml kg lactated Ringer solution over 10 min. Patients were classified as responders if SVi variation after volume expansion (ΔSVi-VE) increased by at least 15%.
The 39 children included had a median [inter-quartile range (IQR)] age of 9 [5-31] months. Twenty patients were fluid responders and 19 were non-responders. ΔSVi-CAC correlated with ΔSVi-VE (r=0.829; P<0.001). The area under the receiver operating characteristic curve (ROC) was 0.94 [95% confidence interval (CI), 0.85-0.99]. The best threshold for ΔSVi-CAC was 11% with a specificity of 95% [95% CI, 84-100] and a sensitivity of 75% [95% CI, 55-95]. ROC of respiratory variation of IVC diameter (ΔIVC) was 0.53 [95% CI, 0.32-0.72].
ΔSVi-CAC during abdominal compression was a reliable method to predict fluid responsiveness in children with acute circulatory failure regardless of their ventilation status.
CPP Lyon sud est II: n° ANSM 2015-A00388-41 Clinicaltrial.gov: NCT02505646.
增加每搏量指数（SVi）的液体输注是血流动力学复苏的基石。我们评估了校准腹部加压（ΔSVi-CAC）过程中 SVi 变化预测儿童液体反应性的准确性。
选择年龄小于 8 岁且伴有急性循环衰竭的患儿，无论其通气状态如何。SVi 作为五个速度-时间积分的平均值乘以左心室流出道表面积计算得出，在四个不同步骤中记录：基线、25mmHg 校准压力腹部加压后、返回基线后，然后在 10 分钟内输注 10ml/kg 乳酸林格液。如果容量扩张后 SVi 变化（ΔSVi-VE）至少增加 15%，则患者被归类为有反应者。
39 名患儿的中位（四分位距（IQR））年龄为 9（5-31）个月。20 名患儿为液体有反应者，19 名患儿为液体无反应者。ΔSVi-CAC 与 ΔSVi-VE 相关（r=0.829；P<0.001）。受试者工作特征曲线（ROC）下面积为 0.94（95%置信区间（CI），0.85-0.99）。ΔSVi-CAC 的最佳阈值为 11%，特异性为 95%（95%CI，84-100），敏感性为 75%（95%CI，55-95）。下腔静脉直径呼吸变异度（ΔIVC）的 ROC 为 0.53（95%CI，0.32-0.72）。
腹部加压期间的 ΔSVi-CAC 是预测急性循环衰竭患儿液体反应性的可靠方法，无论其通气状态如何。
CPP Lyon sud est II：n° ANSM 2015-A00388-41；Clinicaltrial.gov：NCT02505646。
