Erciyes University Medical Faculty, Department of Pediatrics, Division of Pediatric Intensive Care Unit, Kayseri, Turkey.
Erciyes University Medical Faculty, Department of Pediatrics, Division of Pediatric Intensive Care Unit, Kayseri, Turkey.
J Pediatr (Rio J). 2022 Jan-Feb;98(1):99-103. doi: 10.1016/j.jped.2021.04.005. Epub 2021 May 27.
In this study, the authors aimed to evaluate the effectiveness of the vena cava distensibility index and pulse pressure variation as dynamic parameters for estimating intravascular volume in critically ill children.
Patients aged 1 month to 18 years, who were hospitalized in the present study's pediatric intensive care unit, were included in the study. The patients were divided into two groups according to central venous pressure: hypovolemic (< 8 mmHg) and non-hypovolemic (central venous pressure ≥ 8 mmHg) groups. In both groups, vena cava distensibility index was measured using bedside ultrasound and pulse pressure variation. Measurements were recorded and evaluated under arterial monitoring.
In total, 19 (47.5%) of the 40 subjects included in the study were assigned to the central venous pressure ≥ 8 mmHg group, and 21 (52.5%) to the central venous pressure < 8 mmHg group. A moderate positive correlation was found between pulse pressure variation and vena cava distensibility index (r = 0.475, p < 0.01), while there were strong negative correlations of central venous pressure with pulse pressure variation and vena cava distensibility index (r = -0.628, p < 0.001 and r = -0.760, p < 0.001, respectively). In terms of predicting hypovolemia, the predictive power for vena cava distensibility index was > 16% (sensitivity, 90.5%; specificity, 94.7%) and that for pulse pressure variation was > 14% (sensitivity, 71.4%; specificity, 89.5%).
Vena cava distensibility index has higher sensitivity and specificity than pulse pressure variation for estimating intravascular volume, along with the advantage of non-invasive bedside application.
本研究旨在评估下腔静脉顺应性指数和脉压变异率作为评估危重症儿童血管内容量的动态参数的有效性。
纳入本研究儿科重症监护病房住院的 1 个月至 18 岁的患者。根据中心静脉压（CVP）将患者分为低血容量（<8mmHg）和非低血容量（CVP≥8mmHg）两组。在两组中，使用床旁超声测量下腔静脉顺应性指数和脉压变异率。在动脉监测下记录并评估测量值。
本研究共纳入 40 例患者，其中 19 例（47.5%）患者被分配到 CVP≥8mmHg 组，21 例（52.5%）患者被分配到 CVP<8mmHg 组。脉压变异率与下腔静脉顺应性指数呈中度正相关（r=0.475，p<0.01），而 CVP 与脉压变异率和下腔静脉顺应性指数呈强负相关（r=-0.628，p<0.001 和 r=-0.760，p<0.001）。在预测低血容量方面，下腔静脉顺应性指数的预测能力>16%（敏感性 90.5%，特异性 94.7%），脉压变异率的预测能力>14%（敏感性 71.4%，特异性 89.5%）。
与脉压变异率相比，下腔静脉顺应性指数在评估血管内容量方面具有更高的敏感性和特异性，并且具有非侵入性床旁应用的优势。
