Luo Jing-Chao, Su Ying, Dong Li-Li, Hou Jun-Yi, Li Xin, Zhang Ying, Ma Guo-Guang, Zheng Ji-Li, Hao Guang-Wei, Wang Huan, Zhang Yi-Jie, Luo Zhe, Tu Guo-Wei
Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.
Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China.
Ann Intensive Care. 2021 Jan 26;11(1):16. doi: 10.1186/s13613-021-00811-x.
Evaluation of fluid responsiveness during veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support is crucial. The aim of this study was to investigate whether changes in left ventricular outflow tract velocity-time integral (ΔVTI), induced by a Trendelenburg maneuver, could predict fluid responsiveness during VA-ECMO.
This prospective study was conducted in patients with VA-ECMO support. The protocol included four sequential steps: (1) baseline-1, a supine position with a 15° upward bed angulation; (2) Trendelenburg maneuver, 15° downward bed angulation; (3) baseline-2, the same position as baseline-1, and (4) fluid challenge, administration of 500 mL gelatin over 15 min without postural change. Hemodynamic parameters were recorded at each step. Fluid responsiveness was defined as ΔVTI of 15% or more, after volume expansion.
From June 2018 to December 2019, 22 patients with VA-ECMO were included, and a total of 39 measurements were performed. Of these, 22 measurements (56%) met fluid responsiveness. The R of the linear regression was 0.76, between ΔVTIs induced by Trendelenburg maneuver and the fluid challenge. The area under the receiver operating characteristic curve of ΔVTI induced by Trendelenburg maneuver to predict fluid responsiveness was 0.93 [95% confidence interval (CI) 0.81-0.98], with a sensitivity of 82% (95% CI 60-95%), and specificity of 88% (95% CI 64-99%), at a best threshold of 10% (95% CI 6-12%).
Changes in VTI induced by the Trendelenburg maneuver could effectively predict fluid responsiveness in VA-ECMO patients. Trial registration ClinicalTrials.gov, NCT03553459 (the TEMPLE study). Registered on May 30, 2018.
在静脉 - 动脉体外膜肺氧合（VA - ECMO）支持期间评估液体反应性至关重要。本研究的目的是调查由头低脚高位诱发的左心室流出道速度 - 时间积分（ΔVTI）变化是否能够预测VA - ECMO期间的液体反应性。
本前瞻性研究在接受VA - ECMO支持的患者中进行。方案包括四个连续步骤：（1）基线 - 1，仰卧位，床头抬高15°；（2）头低脚高位，床头向下倾斜15°；（3）基线 - 2，与基线 - 1相同的体位；以及（4）液体负荷试验，在15分钟内输注500 mL明胶且不改变体位。在每个步骤记录血流动力学参数。液体反应性定义为扩容后ΔVTI达到15%或更高。
2018年6月至2019年12月，纳入22例接受VA - ECMO的患者，共进行了39次测量。其中，22次测量（56%）符合液体反应性标准。头低脚高位诱发的ΔVTI与液体负荷试验之间的线性回归R值为0.76。头低脚高位诱发的ΔVTI预测液体反应性的受试者工作特征曲线下面积为0.93 [95%置信区间（CI）0.81 - 0.98]，最佳阈值为10%（95% CI 6 - 12%）时，敏感性为82%（95% CI 60 - 95%），特异性为88%（95% CI 64 - 99%）。
头低脚高位诱发的VTI变化能够有效预测VA - ECMO患者的液体反应性。试验注册ClinicalTrials.gov，NCT03553459（TEMPLE研究）。于2018年5月30日注册。
