Kenny Jon-Émile S, Barjaktarevic Igor, Eibl Andrew M, Parrotta Matthew, Long Bradley F, Eibl Joseph K, Michard Frederic
Health Sciences North Research Institute, Sudbury ON, Canada.
Division of Pulmonary and Critical Care, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA.
Crit Care Explor. 2020 Jan 29;2(1):e0072. doi: 10.1097/CCE.0000000000000072. eCollection 2020 Jan.
Detecting instantaneous stroke volume change in response to altered cardiac preload is the physiologic foundation for determining preload responsiveness.
Proof-of-concept physiology study.
Research simulation laboratory.
Twelve healthy volunteers.
A wireless continuous wave Doppler ultrasound patch was used to measure carotid velocity time integral and carotid corrected flow time during a squat maneuver. The Doppler patch measurements were compared with simultaneous stroke volume measurements obtained from a noninvasive cardiac output monitor.
From stand to squat, stroke volume increased by 24% while carotid velocity time integral and carotid corrected flow time increased by 32% and 9%, respectively. From squat to stand, stroke volume decreased by 13%, while carotid velocity time integral and carotid corrected flow time decreased by 24% and 10%, respectively. Both changes in carotid velocity time integral and corrected flow time were closely correlated with changes in stroke volume ( = 0.81 and 0.62, respectively). The four-quadrant plot found a 100% concordance rate between changes in stroke volume and both changes in carotid velocity time integral and changes in corrected flow time. A change in carotid velocity time integral greater than 15% predicted a change in stroke volume greater than 10% with a sensitivity of 95% and a specificity of 92%. A change in carotid corrected flow time greater than 4% predicted a change in stroke volume greater than 10% with a sensitivity of 90% and a specificity of 92%.
In healthy volunteers, both carotid velocity time integral and carotid corrected flow time measured by a wireless Doppler patch were useful to track changes in stroke volume induced by a preload-modifying maneuver with high sensitivity and specificity.
检测因心脏前负荷改变而引起的瞬时每搏量变化是确定前负荷反应性的生理基础。
概念验证生理学研究。
研究模拟实验室。
12名健康志愿者。
使用无线连续波多普勒超声贴片在蹲位动作期间测量颈动脉速度时间积分和颈动脉校正血流时间。将多普勒贴片测量结果与从无创心输出量监测仪获得的同时期每搏量测量结果进行比较。
从站立到蹲位，每搏量增加24%，而颈动脉速度时间积分和颈动脉校正血流时间分别增加32%和9%。从蹲位到站立，每搏量减少13%，而颈动脉速度时间积分和颈动脉校正血流时间分别减少24%和10%。颈动脉速度时间积分和校正血流时间的变化均与每搏量变化密切相关（分别为 = 0.81和0.62）。四象限图显示每搏量变化与颈动脉速度时间积分变化以及校正血流时间变化之间的一致性率为100%。颈动脉速度时间积分变化大于15%预测每搏量变化大于10%，敏感性为95%，特异性为92%。颈动脉校正血流时间变化大于4%预测每搏量变化大于10%，敏感性为90%，特异性为92%。
在健康志愿者中，通过无线多普勒贴片测量的颈动脉速度时间积分和颈动脉校正血流时间对于追踪由前负荷改变动作引起的每搏量变化具有高敏感性和特异性，非常有用。
