Service de Médecine Intensive-Réanimation, Hôpital Bicêtre, AP-HP, Université Paris-Saclay, Le Kremlin-Bicêtre.
INSERM UMR_S999 LabEx - LERMIT, Hôpital Marie-Lannelongue, Le Plessis Robinson, France.
Curr Opin Crit Care. 2020 Jun;26(3):319-326. doi: 10.1097/MCC.0000000000000723.
On the basis of recent literature, we summarized the new advances on the use of available dynamic indices of fluid responsiveness.
Reliability of passive leg raising to assess fluid responsiveness is well established provided that a real-time haemodynamic assessment is available. Recent studies have focused on totally noninvasive techniques to assess its haemodynamic effects with promising results. Presence of intra-abdominal hypertension is associated with false-negative cases of passive leg raising. Use of pulse pressure and stroke volume variations is limited and other heart-lung interaction tests have been developed. The tidal volume challenge may overcome the limitation of low tidal volume ventilation. Preliminary data suggest that changes in pulse pressure variation during this test well predict fluid responsiveness. Growing evidence confirms the good predictive performance of the end-expiratory occlusion test. All these dynamic tests allow selecting appropriate fluid responders and preventing excessive fluid administration. Performance of a mini-fluid challenge may help for the decision-making process of fluid management if other tests are not available.
Several new dynamic variables and monitoring techniques to predict fluid responsiveness were investigated in the past years. Nevertheless, further research investigating their reliability and feasibility in larger cohorts is warranted. VIDEO ABSTRACT.
基于最近的文献，我们总结了使用现有液体反应性的动态指标的新进展。
只要能够进行实时血流动力学评估，被动抬腿试验（PLR）评估液体反应性的可靠性就已得到充分证实。最近的研究集中在完全非侵入性技术上，以评估其血流动力学效应，结果有一定的前景。存在腹腔内高压与假阴性的 PLR 相关。脉搏压和每搏量变化的应用受到限制，其他心肺相互作用的测试已经开发出来。潮气量挑战可能克服低潮气量通气的局限性。初步数据表明，在此测试期间的脉搏压变化可以很好地预测液体反应性。越来越多的证据证实了呼气末阻断试验的良好预测性能。所有这些动态测试都可以选择合适的液体反应者，并防止过度输液。如果其他测试不可用，迷你液体挑战的性能可能有助于液体管理的决策过程。
视频摘要。
