Kim Eun-Hee, Lee Ji-Hyun, Jang Young-Eun, Ji Sang-Hwan, Kim Hee-Soo, Cho Sung-Ae, Kim Jin-Tae
From the Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea (E-HK, J-HL, Y-EJ, S-HJ, H-SK, S-AC, J-TK).
Eur J Anaesthesiol. 2021 May 1;38(5):452-458. doi: 10.1097/EJA.0000000000001387.
Pressure-based dynamic variables are poor predictors of fluid responsiveness in children, and their predictability is expected to reduce further during lung-protective ventilation with a low tidal volume.
We hypothesised that lung recruitment manoeuvre (LRM)-induced changes in dynamic variables improve their ability to predict fluid responsiveness in children.
Prospective observational study.
Tertiary care children's hospital, single-centre study performed from June 2017 to May 2019.
We included patients less than 7 years of age undergoing cardiac surgery. Neonates and patients with pulmonary hypertension, significant dysrhythmia, ventricular ejection fraction of less than 30% or pulmonary disease were excluded.
All patients were provided with lung-protective volume-controlled ventilation (tidal volume 6 ml kg-1, positive end-expiratory pressure 6 cmH2O). A LRM was applied with a continuous inspiratory pressure of 25 cmH2O for 20 s.
The ability of dynamic variables to predict fluid responsiveness was evaluated by the area under the receiver operating characteristic curve [area under the curve (AUC)]. Fluid responsiveness was defined as an increase in the cardiac index by more than 15% with crystalloid administration (10 ml kg-1).
Thirty patients were included in the final analysis, of whom 19 were responders. The baseline pleth variability index (PVI) (AUC 0.794, 95% confidence interval 0.608 to 0.919, P < 0.001) and LRM-induced PVI (AUC 0.711, 95% confidence interval 0.517 to 0.861, P = 0.026) could predict fluid responsiveness. The respiratory variation of pulse oximetry photoplethysmographic waveform and pulse pressure variation did not predict fluid responsiveness regardless of the LRM.
The PVI is effective in predicting fluid responsiveness in paediatric patients with lung-protective ventilation regardless of a LRM. However, the LRM did not improve the ability of the other dynamic variables to predict fluid responsiveness in these patients.
www.clinicaltrials.gov identifier: NCT03184961.
基于压力的动态变量对儿童液体反应性的预测能力较差，并且在低潮气量肺保护性通气期间其预测能力预计会进一步降低。
我们假设肺复张手法（LRM）引起的动态变量变化可提高其预测儿童液体反应性的能力。
前瞻性观察性研究。
三级护理儿童医院，于2017年6月至2019年5月进行的单中心研究。
我们纳入了接受心脏手术的7岁以下患者。排除新生儿以及患有肺动脉高压、严重心律失常、心室射血分数低于30%或肺部疾病的患者。
所有患者均接受肺保护性容量控制通气（潮气量6 ml/kg，呼气末正压6 cmH₂O）。应用LRM，持续吸气压力为25 cmH₂O，持续20秒。
通过受试者工作特征曲线下面积[曲线下面积（AUC）]评估动态变量预测液体反应性的能力。液体反应性定义为给予晶体液（10 ml/kg）后心脏指数增加超过15%。
最终分析纳入30例患者，其中19例为反应者。基线脉氧饱和度容积变异指数（PVI）（AUC 0.794，95%置信区间0.608至0.919，P<0.001）和LRM诱导的PVI（AUC 0.711，95%置信区间0.517至0.861，P = 0.026）可预测液体反应性。无论是否进行LRM，脉搏血氧饱和度光电容积脉搏波波形的呼吸变异和脉压变异均不能预测液体反应性。
无论是否进行LRM，PVI均可有效预测接受肺保护性通气的儿科患者的液体反应性。然而，LRM并未提高其他动态变量预测这些患者液体反应性的能力。
