容量复苏后呼气末二氧化碳变化对评估手术室患者液体反应性的作用：一项前瞻性观察研究。

Utility of changes in end-tidal carbon dioxide after volume expansion to assess fluid responsiveness in the operating room: a prospective observational study.

机构信息

Department of Anaesthesiology and Critical Care Pellegrin, Bordeaux University Hospital, Bordeaux, France; Institut National de la Santé et de la Recherche Médicale, Université de Bordeaux, UMR 1219, Bordeaux Population Health Research Center, CHU Bordeaux, Bordeaux, France.

Department of Anaesthesiology and Critical Care Pellegrin, Bordeaux University Hospital, Bordeaux, France.

出版信息

Br J Anaesth. 2020 Nov;125(5):672-679. doi: 10.1016/j.bja.2020.07.018. Epub 2020 Aug 27.

DOI:10.1016/j.bja.2020.07.018

PMID:32863016

Abstract

BACKGROUND

From a physiological viewpoint, changes in end-tidal carbon dioxide (EtCO) could be a simple, noninvasive, and inexpensive way to monitor changes in cardiac index. This study aimed to assess the utility of changes in EtCO as a marker of fluid responsiveness after volume expansion in the operating room.

METHODS

A prospective observational study was conducted in a tertiary university teaching hospital, from August 2018 to February 2019. A total of 109 non-consecutive, mechanically ventilated adults undergoing neurosurgery in the supine position with cardiac output monitors were included. Patients with major respiratory disease, arrhythmia, or heart failure were excluded. Volume expansion with 250 ml of saline 0.9% was performed over 10 min to maximise cardiac output during surgery, according to current guidelines. A positive fluid challenge was defined as an increase in stroke volume index of more than 10% from baseline. Changes in stroke volume index (monitored using pulse contour analysis) and EtCO were recorded before and after infusion.

RESULTS

A total of 242 fluid challenges in 114 patients were performed, of which 26.9% were positive. Changes in EtCO > 1.1% induced by infusions had utility for identifying fluid responsiveness, with a sensitivity of 62.9% (95% confidence interval [CI], 62.5-63.3%) and a specificity of 77.8% (95% CI, 77.6-78.1%). The area under the receiver operating characteristic curve for changes in EtCO after volume expansion was 0.683 (95% CI, 0.680-0.686).

CONCLUSIONS

Changes in EtCO induced by rapid infusion of 250 ml saline 0.9% lacked accuracy for identifying fluid responsiveness in mechanically ventilated patients in the operating room.

CLINICAL TRIAL REGISTRATION

NCT03635307.

摘要

背景

从生理学角度来看，呼气末二氧化碳（EtCO）的变化可能是一种简单、无创且经济的监测心指数变化的方法。本研究旨在评估在手术室中进行容量扩充后，EtCO 变化作为液体反应性标志物的效用。

方法

这是一项 2018 年 8 月至 2019 年 2 月在一家三级大学教学医院进行的前瞻性观察性研究。共纳入 109 例接受心脏输出监测的、仰卧位行神经外科手术的、非连续机械通气的成年人。排除有重大呼吸系统疾病、心律失常或心力衰竭的患者。根据现行指南，在手术期间通过 10 分钟内输注 250 毫升生理盐水 0.9%来最大限度地增加心输出量。阳性液体挑战定义为从基线开始，每搏量指数增加超过 10%。输液前后记录使用脉搏轮廓分析监测的每搏量指数和 EtCO 的变化。

结果

在 114 例患者中进行了 242 次液体挑战，其中 26.9%为阳性。输液引起的 EtCO 变化>1.1%对识别液体反应性具有一定的作用，其敏感性为 62.9%（95%置信区间[CI]，62.5-63.3%），特异性为 77.8%（95% CI，77.6-78.1%）。容量扩充后 EtCO 变化的受试者工作特征曲线下面积为 0.683（95% CI，0.680-0.686）。