University of Medicine and Pharmacy "Carol Davila" Bucharest, Bulevardul Eroii Sanitari Nr. 8, 050474, Bucharest, Romania.
1-st Department of Cardiovascular Anaesthesiology and Intensive Care, "Prof. C. C. Iliescu" Emergency Institute for Cardiovascular Diseases, Șos. Fundeni Nr. 258, 022328, Bucharest, Romania.
J Clin Monit Comput. 2020 Jun;34(3):491-499. doi: 10.1007/s10877-019-00346-4. Epub 2019 Jul 5.
Superior vena cava collapsibility index (SVC-CI) and stroke volume variation (SVV) have been shown to predict fluid responsiveness. SVC-CI has been validated only with conventional transoesophageal echocardiography (TEE) in the SVC long axis, on the basis of SVC diameter variations, but not in the SVC short axis or by SVC area variations. SVV was not previously tested in vascular surgery patients. Forty consecutive adult patients undergoing open major vascular surgical procedures received 266 intraoperative volume loading tests (VLTs), with 500 ml of gelatine over 10 min. The hSVC-CI was measured using a miniaturized transoesophageal echocardiography probe (hTEE). The SVV and cardiac index (CI) were measured using Vigileo-FloTrac technology. VLTs were considered 'positive' (≥ 11% increase in CI) or 'negative' (< 11% increase in CI). We compared SVV and hSVC-CI measurements in the SVC short axis to predict fluid responsiveness. Areas under the receiver operating characteristic curves for hSVC-CI and SVV were not significantly different (P = 0.56), and both showed good predictivity at values of 0.92 (P < 0.001) and 0.89 (P < 0.001), respectively. The cutoff values for hSVC-CI and SVV were 37% (sensitivity 90%, specificity of 83%) and 15% (sensitivity 78%, specificity of 100%), respectively. Our study validated the value of the SVC-CI measured as area variations in the SVC short axis to predict fluid responsiveness in anesthetized patients. An hTEE probe was used to monitor and measure the hSVC-CI but conventional TEE may also offer this new dynamic parameter. In our cohort of significant preoperative hypovolemic patients undergoing major open vascular surgery, hSVC-CI and SVV cutoff values of 37% and 15%, respectively, predicted fluid responsiveness with good accuracy.
上腔静脉塌陷指数（SVC-CI）和每搏量变异度（SVV）已被证明可预测液体反应性。SVC-CI 仅在 SVC 长轴上通过传统经食管超声心动图（TEE）基于 SVC 直径变化进行了验证，但尚未在 SVC 短轴或通过 SVC 面积变化进行验证。SVV 此前并未在血管外科患者中进行过测试。40 例连续成年患者接受了开放式主要血管手术，术中进行了 266 次容量负荷试验（VLT），在 10 分钟内输注 500ml 明胶。使用微型经食管超声心动图探头（hTEE）测量 hSVC-CI。使用 Vigileo-FloTrac 技术测量 SVV 和心指数（CI）。VLT 被认为是“阳性”（CI 增加≥11%）或“阴性”（CI 增加<11%）。我们比较了 SVC 短轴中 SVV 和 hSVC-CI 的测量值，以预测液体反应性。hSVC-CI 和 SVV 的受试者工作特征曲线下面积没有显著差异（P=0.56），并且两者的预测值分别为 0.92（P<0.001）和 0.89（P<0.001）。hSVC-CI 和 SVV 的截断值分别为 37%（灵敏度 90%，特异性 83%）和 15%（灵敏度 78%，特异性 100%）。我们的研究验证了在麻醉患者中，通过测量 SVC 短轴中的面积变化来预测液体反应性的 SVC-CI 的价值。使用 hTEE 探头来监测和测量 hSVC-CI，但传统 TEE 也可以提供这个新的动态参数。在我们的重大开放性血管手术前有明显低血容量的患者队列中，hSVC-CI 和 SVV 的截断值分别为 37%和 15%，具有良好的准确性预测液体反应性。
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