在手术室中评估液体反应性的小容量液体挑战和呼气末阻断试验（MANEUVER 研究）：一项多中心队列研究。

Mini fluid chAllenge aNd End-expiratory occlusion test to assess flUid responsiVEness in the opeRating room (MANEUVER study): A multicentre cohort study.

机构信息

From the Humanitas Clinical and Research Center - IRCCS -, via Manzoni 56, 20089 Rozzano (Mi) - Italy; Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele - Milan, Italy (AM, GL, AP, MC), Department of Biomedical Sciences, Humanitas University, Milan (AM, AP, MC), Section of Anesthesia and Critical Care, Department of Health Science, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence (LF, SR), Department of Anesthesia and Intensive Care Medicine, Maggiore della Carità University Hospital, Novara, Italy (EB, NM, GC, FDC), Department of Intensive Care Medicine, St George's Healthcare NHS Trust, London, UK (VB), Clinical Epidemiology and Medical Statistics Unit, Department of Biomedical Sciences, University of Sassari, Sassari, Italy (LS, GS) and Unidad de Cuidados Intensivos, Hospital Universitario SAS de Jerez, Jerez de la Frontera, Spain (MIMG).

出版信息

Eur J Anaesthesiol. 2021 Apr 1;38(4):422-431. doi: 10.1097/EJA.0000000000001406.

DOI:10.1097/EJA.0000000000001406

PMID:33399372

Abstract

BACKGROUND

The fluid challenge response in surgical patients can be predicted by functional haemodynamic tests. Two tests, the mini-fluid challenge (mini-FC) and end-expiratory occlusion test (EEOT), have been assessed in a few small single-centre studies with conflicting results. In general, functional haemodynamic tests have not performed reliably in predicting fluid responsiveness in patients undergoing laparotomy.

OBJECTIVE

This trial is designed to address and compare the reliability of the EEOT and the mini-FC in predicting fluid responsiveness during laparotomy.

DESIGN

Prospective, multicentre study.

SETTING

Three university hospitals in Italy.

PATIENTS

A total of 103 adults patients scheduled for elective laparotomy with invasive arterial monitoring.

INTERVENTIONS

The study protocol evaluated the changes in the stroke volume index (SVI) 20 s (EEOT20) and 30 s (EEOT30) after an expiratory hold and after a mini-FC of 100 ml over 1 min. Fluid responsiveness required an increase in SVI at least 10% following 4 ml kg-1 of Ringer's solution fluid challenge infused over 10 min.

MAIN OUTCOME MEASUREMENTS

Haemodynamic data, including SVI, were obtained from pulse contour analysis. The area under the receiver operating characteristic curves of the tests were compared with assess fluid responsiveness.

RESULTS

Fluid challenge administration induced an increase in SVI at least 10% in 51.5% of patients. The rate of fluid responsiveness was comparable among the three participant centres (P = 0.10). The area under the receiver operating characteristic curves (95% CI) of the changes in SVI after mini-FC was 0.95 (0.88 to 0.98), sensitivity 98.0% (89.5 to 99.6) and specificity 86.8% (75.1 to 93.4) for a cut-off value of 4% of increase in SVI. This was higher than the SVI changes after EEOT20, 0.67 (0.57 to 0.76) and after EEOT30, 0.73 (0.63 to 0.81).

CONCLUSION

In patients undergoing laparotomy the mini-FC reliably predicted fluid responsiveness with high-sensitivity and specificity. The EEOT showed poor discriminative value and cannot be recommended for assessment of fluid responsiveness in this surgical setting.

TRIAL REGISTRATION

NCT03808753.

摘要

背景

手术患者的液体挑战反应可以通过功能性血流动力学测试来预测。两项测试，迷你液体挑战（mini-FC）和呼气末阻断试验（EEOT），已在少数小型单中心研究中进行了评估，但结果存在冲突。一般来说，功能性血流动力学测试在预测剖腹手术患者的液体反应性方面表现并不可靠。

目的

本试验旨在解决并比较 EEOT 和 mini-FC 在预测剖腹手术期间液体反应性方面的可靠性。

设计

前瞻性、多中心研究。

地点

意大利的三家大学医院。

患者

共纳入 103 例择期行剖腹手术并接受有创动脉监测的成年患者。

干预措施

研究方案评估了呼气末阻断后 20 秒（EEOT20）和 30 秒（EEOT30）的每搏量指数（SVI）变化，以及 mini-FC 后 1 分钟内 100ml 的变化。液体反应性需要在 10 分钟内输注 4ml/kg 的林格氏液进行 4ml/kg 的容量挑战后，SVI 至少增加 10%。

主要观察测量

血流动力学数据，包括 SVI，通过脉搏轮廓分析获得。比较测试的受试者工作特征曲线下面积，以评估液体反应性。

结果

液体冲击治疗使 51.5%的患者 SVI 至少增加 10%。三个参与中心的液体反应性率相当（P=0.10）。mini-FC 后 SVI 变化的受试者工作特征曲线下面积（95%CI）为 0.95（0.88 至 0.98），灵敏度为 98.0%（89.5%至 99.6%），特异性为 86.8%（75.1%至 93.4%），SVI 增加 4%为截断值。这高于 EEOT20 的 SVI 变化，为 0.67（0.57 至 0.76），EEOT30 的 SVI 变化为 0.73（0.63 至 0.81）。