Department of Anesthesiology and Intensive Care, Elsan Alpes-Belledonne Clinic, Grenoble, France.
Department of Anesthesiology and Intensive Care, Etienne University Hospital, Jean-Monnet University, SaintSaint-Etienne, France.
BMC Anesthesiol. 2022 Jan 3;22(1):4. doi: 10.1186/s12871-021-01544-x.
Assessment of fluid responsiveness is problematic in intensive care unit patients. Lung recruitment maneuvers (LRM) can be used as a functional test to predict fluid responsiveness. We propose a new test to predict fluid responsiveness in mechanically ventilated patients by analyzing the variations in central venous pressure (CVP) and systemic arterial parameters during a prolonged sigh breath LRM without the use of a cardiac output measuring device.
Prospective observational cohort study.
Intensive Care Unit, Saint-Etienne University Central Hospital.
Patients under mechanical ventilation, equipped with invasive arterial blood pressure, CVP, pulse contour analysis (PICCO™), requiring volume expansion, with no right ventricular dysfunction.
None.
CVP, systemic arterial parameters and stroke volume (SV) were recorded during prolonged LRM followed by a 500 mL fluid expansion to asses fluid responsiveness. 25 patients were screened and 18 patients analyzed. 9 patients were responders to volume expansion and 9 were not. Evaluation of hemodynamic parameters suggested the use of a linear regression model. Slopes for systolic arterial pressure, pulse pressure (PP), CVP and SV were all significantly different between responders and non-responders during the pressure increase phase of LRM (STEP-UP) (p = 0.022, p = 0.014, p = 0.006 and p = 0.038, respectively). PP and CVP slopes during STEP-UP were strongly predictive of fluid responsiveness with an AUC of 0.926 (95% CI, 0.78 to 1.00), sensitivity = 100%, specificity = 89% and an AUC = 0.901 (95% CI, 0.76 to 1.00), sensibility = 78%, specificity = 100%, respectively. Combining sensitivity of PP and specificity of CVP, prediction of fluid responsiveness can be achieved with 100% sensitivity and 100% specificity (AUC = 0.96; 95% CI, 0.90 to 1.00). One patient showed inconclusive values using the grey zone approach (5.5%).
In patients under mechanical ventilation with no right heart dysfunction, the association of PP and CVP slope analysis during a prolonged sigh breath LRM seems to offer a very promising method for prediction of fluid responsiveness without the use and associated cost of a cardiac output measurement device.
NCT04304521 , IRBN902018/CHUSTE. Registered 11 March 2020, Fluid responsiveness predicted by a stepwise PEEP elevation recruitment maneuver in mechanically ventilated patients (STEP-PEEP).
在重症监护病房患者中，评估液体反应性存在问题。肺复张手法（LRM）可用作预测液体反应性的功能测试。我们提出了一种新的测试方法，通过分析长时间叹气呼吸 LRM 期间中心静脉压（CVP）和全身动脉参数的变化，在不使用心输出量测量设备的情况下预测机械通气患者的液体反应性。
前瞻性观察队列研究。
圣艾蒂安大学中心医院重症监护病房。
机械通气下的患者，配备有侵入性动脉血压、CVP、脉搏轮廓分析（PICCO™），需要容量扩张，无右心室功能障碍。
无。
在长时间 LRM 后记录 CVP、全身动脉参数和每搏量（SV），然后进行 500 毫升液体扩张以评估液体反应性。对 25 名患者进行了筛选，对 18 名患者进行了分析。9 名患者对容量扩张有反应，9 名患者没有反应。血流动力学参数评估表明需要使用线性回归模型。在 LRM 的压力升高阶段（STEP-UP），收缩压、脉搏压（PP）、CVP 和 SV 的斜率在有反应者和无反应者之间均有显著差异（p=0.022，p=0.014，p=0.006 和 p=0.038，分别）。STEPU 期间的 PP 和 CVP 斜率对液体反应性具有很强的预测能力，AUC 为 0.926（95%CI，0.78 至 1.00），灵敏度为 100%，特异性为 89%，AUC 为 0.901（95%CI，0.76 至 1.00），敏感性为 78%，特异性为 100%。结合 PP 的敏感性和 CVP 的特异性，可以达到 100%的敏感性和 100%的特异性来预测液体反应性（AUC=0.96；95%CI，0.90 至 1.00）。有 1 名患者使用灰色区域方法得出了不确定的结果（5.5%）。
在无右心功能障碍的机械通气患者中，在长时间叹气呼吸 LRM 期间联合分析 PP 和 CVP 斜率似乎提供了一种非常有前途的方法，可在不使用和不考虑心输出量测量设备的情况下预测液体反应性。
NCT04304521，IRBN902018/CHUSTE。2020 年 3 月 11 日注册，机械通气患者中逐步 PEEP 升高募集手法预测液体反应性（STEP-PEEP）。
