Intensive Care Unit, University of Ottawa/The Ottawa Hospital, Ottawa, Ontario, Canada.
Kent Hospital, Warwick, RI, USA.
J Intensive Care Med. 2021 Oct;36(10):1223-1227. doi: 10.1177/08850666211024176. Epub 2021 Jun 25.
Determining whether a patient in shock is in a state of fluid responsiveness (FR) has long been the Holy Grail for clinicians who care for acutely ill patients. While various tools have been put forth as solutions to this important problem, ultrasound assessment of the inferior vena cava has received particular attention of late. Dozens of studies have examined its ability to determine whether a patient should receive volume expansion, and general enthusiasm has been strengthened by the fact that it is easy to perform and non-invasive, unlike many competing FR tests. A deeper examination of the technique, however, reveals important concerns regarding inaccuracies in measurement and a high prevalence of confounding factors. Furthermore, a detailed review of the evidence (small individual studies, multiple meta-analyses, and a single large trial) reveals that the tool performs poorly in general and is unlikely to be helpful at the bedside in circumstances where genuine clinical uncertainty exists.
确定休克患者是否存在液体反应性（FR）一直是临床医生关注的焦点。尽管已经提出了各种工具来解决这个重要问题，但最近对下腔静脉超声评估的关注特别多。数十项研究已经检查了其确定患者是否应该接受容量扩张的能力，并且由于它易于操作且非侵入性，与许多竞争性 FR 测试不同，因此普遍受到了更多的关注。然而，对该技术的更深入检查揭示了测量不准确和混杂因素高发的重要问题。此外，对证据（小型个体研究、多项荟萃分析和一项大型试验）的详细审查表明，该工具总体表现不佳，在存在真正临床不确定性的情况下，在床边使用时可能没有帮助。
