Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan.
Paediatr Anaesth. 2020 Apr;30(4):455-461. doi: 10.1111/pan.13819. Epub 2020 Jan 20.
We have previously reported that dynamic preload variables predicted fluid responsiveness in adult patients with liver cirrhosis. However, pediatric patients with cirrhosis may present with unique hemodynamic characteristics, and therefore, the predictive accuracy of these variables in such patients must be clarified.
To investigate the accuracy of dynamic preload variables for predicting fluid responsiveness in pediatric patients with cirrhosis.
A total of 27 pediatric patients with cirrhosis undergoing orthotopic liver transplantation were enrolled in this study. Patients' pulse pressure variation, stroke volume variation, stroke volume index, and central venous pressure were measured using the calibrated pulse contour cardiac output system. The plethysmographic variability index was measured using a Masimo Radical 7 co-oximeter. During the hepatic dissection phase of the surgery, repeated intraoperative fluid challenges with 10 mL kg of crystalloid within 15 minutes were administered. Fluid responsiveness was defined as an increase in stroke volume index of ≥15% after fluid challenge.
A total of 61 fluid challenges were administered resulting in 15 fluid responders and 46 fluid nonresponders. Fluid challenge induced significant decreases in all three dynamic preload variables but not in the fluid nonresponders. However, the area under the receiver operating characteristic curves for pulse pressure variation, stroke volume variation, plethysmographic variability index, and central venous pressure for predicting fluid responsiveness were 0.67 (95% confidence interval: 0.52-0.82; P = .0255), 0.68 (95% confidence interval: 0.54-0.83; P = .0140), 0.56 (95% confidence interval: 0.40-0.71; P = .4724), and 0.57 (95% confidence interval: 0.40-0.74; P = .4192), respectively.
Dynamic preload variables do not predict fluid responsiveness in pediatric patients with liver cirrhosis.
我们之前曾报道过，动态前负荷变量可预测肝硬化成人患者的液体反应性。然而，肝硬化的儿科患者可能表现出独特的血流动力学特征，因此，必须明确这些变量在这些患者中的预测准确性。
探讨动态前负荷变量预测肝硬化儿科患者液体反应性的准确性。
本研究共纳入 27 例接受原位肝移植的肝硬化儿科患者。使用校准脉搏轮廓心输出量系统测量患者的脉压变化、每搏量变化、每搏量指数和中心静脉压。使用 Masimo Radical 7 协氧仪测量容积描记变异指数。在手术的肝解剖阶段，在 15 分钟内给予 10ml/kg 的晶体液进行重复的术中液体挑战。将液体反应性定义为液体挑战后每搏量指数增加≥15%。
共进行了 61 次液体挑战，其中 15 次为液体反应者，46 次为液体无反应者。液体挑战引起所有三种动态前负荷变量的显著下降，但在液体无反应者中没有下降。然而，脉压变化、每搏量变化、容积描记变异指数和中心静脉压预测液体反应性的受试者工作特征曲线下面积分别为 0.67（95%置信区间：0.52-0.82；P=0.0255）、0.68（95%置信区间：0.54-0.83；P=0.0140）、0.56（95%置信区间：0.40-0.71；P=0.4724）和 0.57（95%置信区间：0.40-0.74；P=0.4192）。
动态前负荷变量不能预测肝硬化儿科患者的液体反应性。
