评估急性循环衰竭危重症患者液体反应性的累积液体挑战量的准确性：药效学方法。

Accuracy of cumulative volumes of fluid challenge to assess fluid responsiveness in critically ill patients with acute circulatory failure: a pharmacodynamic approach.

机构信息

AP-HP, Hôpital Lariboisière, Department of Anesthesia and Critical Care, DMU Parabol, Paris, France.

出版信息

Br J Anaesth. 2022 Feb;128(2):236-243. doi: 10.1016/j.bja.2021.10.049. Epub 2021 Dec 8.

DOI:10.1016/j.bja.2021.10.049

PMID:34895718

Abstract

BACKGROUND

The relationship between the dose (volume of fluid) and the effect (increase of stroke volume [SV]) has been poorly described. We hypothesised that the analysis of the dynamic response of SV during fluid challenge (FC) helps to determine the optimal volume of FC, along with its diagnostic accuracy parameters for fluid responsiveness.

METHODS

A prospective observational study was conducted in critically ill patients with circulatory failure. Patients monitored with oesophageal Doppler and assigned to an FC of 500 ml of crystalloid were included. The areas under the curve (AUC) and 95% confidence intervals (CI) of the receiver operating characteristic curves for cumulative volumes from 50 to 450 ml were determined for fluid responsiveness (SV increase ≥15% from baseline) along with other parameters of diagnostic accuracy. In the pharmacodynamic analysis, dose-effect and dose-response models were constructed, with determination of median and 90% effective dose (ED and ED).

RESULTS

Forty-five patients were included. The AUC increased with cumulative volumes of FC up to 250 ml (AUC 0.93 [CI: 0.85-1.00]), followed by a plateau above 0.95 of AUC. The optimal volume was 250 ml, associated with a specificity of 0.89 [CI: 0.78-1.00], a sensitivity of 0.92 [CI: 0.69-1.00], and a threshold of 9.6% increase in SV. The ED was 156 [CI: 136-177] ml and the ED was 312 [CI: 269-352] ml.

CONCLUSIONS

A volume of FC of 250 ml with a threshold of 9.6% increase in SV showed the highest accuracy in detecting fluid responsiveness in critically ill patients with shock.

摘要

背景

剂量（液体量）与效应（每搏量增加[SV]）之间的关系描述得很差。我们假设在液体冲击（FC）期间分析 SV 的动态反应有助于确定 FC 的最佳容量及其对液体反应性的诊断准确性参数。

方法

对有循环衰竭的危重患者进行前瞻性观察性研究。纳入监测食管多普勒并分配到 500ml 晶体液 FC 的患者。确定了从 50 到 450ml 的累积容量的受试者工作特征曲线的曲线下面积（AUC）和 95%置信区间（CI），以确定液体反应性（SV 从基线增加≥15%）的诊断准确性参数。在药效学分析中，构建了剂量-效应和剂量-反应模型，确定了中位数和 90%有效剂量（ED 和 ED）。

结果

共纳入 45 例患者。FC 的累积量增加到 250ml 时，AUC 增加（AUC 0.93 [CI：0.85-1.00]），随后 AUC 超过 0.95 后出现平台。最佳容量为 250ml，特异性为 0.89 [CI：0.78-1.00]，敏感性为 0.92 [CI：0.69-1.00]，SV 增加阈值为 9.6%。ED 为 156 [CI：136-177]ml，ED 为 312 [CI：269-352]ml。