危重症患者的容积描记血氧饱和度信号可探测被动抬腿的效果。
The effects of passive leg raising may be detected by the plethysmographic oxygen saturation signal in critically ill patients.
机构信息
Service de réanimation-médecine intensive, Centre Hospitalier Universitaire de Bicêtre, Hôpitaux universitaires Paris-Sud, Assistance publique - Hôpitaux de Paris, 78, rue du Général Leclerc, F-94 270, Le Kremlin-Bicêtre, France.
Inserm UMR S_999, Université Paris-Sud, Le Kremlin-Bicêtre, France.
出版信息
Crit Care. 2019 Jan 18;23(1):19. doi: 10.1186/s13054-019-2306-z.
BACKGROUND
A passive leg raising (PLR) test is positive if the cardiac index (CI) increased by > 10%, but it requires a direct measurement of CI. On the oxygen saturation plethysmographic signal, the perfusion index (PI) is the ratio between the pulsatile and the non-pulsatile portions. We hypothesised that the changes in PI could predict a positive PLR test and thus preload responsiveness in a totally non-invasive way.
METHODS
In patients with acute circulatory failure, we measured PI (Radical-7) and CI (PiCCO2) before and during a PLR test and, if decided, before and after volume expansion (500-mL saline).
RESULTS
Three patients were excluded because the plethysmography signal was absent and 3 other ones because it was unstable. Eventually, 72 patients were analysed. In 34 patients with a positive PLR test (increase in CI ≥ 10%), CI and PI increased during PLR by 21 ± 10% and 54 ± 53%, respectively. In the 38 patients with a negative PLR test, PI did not significantly change during PLR. In 26 patients in whom volume expansion was performed, CI and PI increased by 28 ± 14% and 53 ± 63%, respectively. The correlation between the PI and CI changes for all interventions was significant (r = 0.64, p < 0.001). During the PLR test, if PI increased by > 9%, a positive response of CI (≥ 10%) was diagnosed with a sensitivity of 91 (76-98%) and a specificity of 79 (63-90%) (area under the receiver operating characteristics curve 0.89 (0.80-0.95), p < 0.0001).
CONCLUSION
An increase in PI during PLR by 9% accurately detects a positive response of the PLR test.
TRIAL REGISTRATION
ID RCB 2016-A00959-42. Registered 27 June 2016.
背景
被动抬腿（PLR）试验阳性的标准为心指数（CI）增加>10%，但需要直接测量 CI。在氧饱和度容积描记信号中，灌注指数（PI）是脉动部分与非脉动部分的比值。我们假设 PI 的变化可以预测 PLR 试验和容量反应性，且完全是无创的方法。
方法
在急性循环衰竭患者中，我们在 PLR 试验前后测量 PI（Radical-7）和 CI（PiCCO2），如果需要，在容量扩张（500 毫升生理盐水）前后也进行测量。
结果
3 例患者因容积描记信号缺失而被排除，另外 3 例患者因信号不稳定而被排除。最终，72 例患者被纳入分析。在 34 例 PLR 试验阳性（CI 增加≥10%）的患者中，CI 和 PI 在 PLR 期间分别增加了 21±10%和 54±53%。在 38 例 PLR 试验阴性的患者中，PI 在 PLR 期间没有明显变化。在 26 例接受容量扩张的患者中，CI 和 PI 分别增加了 28±14%和 53±63%。所有干预措施的 PI 和 CI 变化之间存在显著相关性（r=0.64，p<0.001）。在 PLR 试验期间，如果 PI 增加>9%，则可以诊断为 CI（≥10%）阳性反应，其敏感性为 91%（76-98%），特异性为 79%（63-90%）（受试者工作特征曲线下面积 0.89（0.80-0.95），p<0.0001）。
结论
PLR 期间 PI 增加 9%可以准确检测 PLR 试验的阳性反应。
临床试验注册号
ID RCB 2016-A00959-42。注册日期：2016 年 6 月 27 日。
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