Tokunaga Kurato, Nakamura Kensuke, Inokuchi Ryota, Hayase Naoki, Terada Rui, Tomioka Yuji, Ikeda Toshiyuki, Kobayashi Etsuko, Okazaki Hitoshi, Sakuma Ichiro, Doi Kent, Morimura Naoto
Department of Acute Medicine, The University of Tokyo Hospital, Tokyo, Japan.
Department of Blood Transfusion, The University of Tokyo Hospital, Tokyo, Japan.
Shock. 2020 Dec;54(6):717-722. doi: 10.1097/SHK.0000000000001548.
Fluid resuscitation, which is critical to counter acute hemorrhagic shock, requires prompt and accurate intravascular volume estimation for optimal fluid administration. This study aimed to evaluate whether cardiac variation of internal jugular vein (IJV), evaluated by ultrasonography, could detect hypovolemic status and predict response to fluid resuscitation.
Patients undergoing autologous blood transfusion for elective surgery who were prospectively enrolled at the study blood donation center between August 2014 and January 2015. Vertical B-mode ultrasonography movies of IJV were recorded at five timepoints during blood donation: before donation, during donation, end of donation, end of fluid replacement, and after hemostasis. Cardiac variation of the IJV area and circumference were objectively measured using an automated extraction program together with blood pressure and heart rate.
A total of 140 patients were screened, and data from 104 patients were included in the final analyses. Among the variables analyzed, only collapse index area and collapse index circumference could detect both intravascular volume loss and response to fluid administration.
Cardiac variation of IJV may be a reliable indicator of intravascular volume loss and response to fluid administration in hemorrhagic shock.
液体复苏对于对抗急性失血性休克至关重要，需要迅速且准确地估计血管内容量以实现最佳液体输注。本研究旨在评估通过超声检查评估的颈内静脉（IJV）的心脏变化是否能够检测低血容量状态并预测对液体复苏的反应。
2014年8月至2015年1月期间在研究献血中心前瞻性纳入接受择期手术自体输血的患者。在献血期间的五个时间点记录IJV的垂直B型超声电影：献血前、献血期间、献血结束时、液体补充结束时和止血后。使用自动提取程序以及血压和心率客观测量IJV面积和周长的心脏变化。
共筛选了140例患者，104例患者的数据纳入最终分析。在分析的变量中，只有塌陷指数面积和塌陷指数周长能够检测血管内容量损失和对液体输注的反应。
IJV的心脏变化可能是失血性休克中血管内容量损失和对液体输注反应的可靠指标。
