Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Department of Cardiovascular Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
J Clin Monit Comput. 2022 Dec;36(6):1817-1825. doi: 10.1007/s10877-022-00830-4. Epub 2022 Mar 1.
Predicting fluid responsiveness is essential when treating surgical or critically ill patients. When using a pulmonary artery catheter, pulse pressure variation and systolic pressure variation can be calculated from right ventricular and pulmonary artery pressure waveforms.
We conducted a prospective interventional study investigating the ability of right ventricular pulse pressure variation (PPV) and systolic pressure variation (SPV) as well as pulmonary artery pulse pressure variation (PPV) and systolic pressure variation (SPV) to predict fluid responsiveness in coronary artery bypass (CABG) surgery patients. Additionally, radial artery pulse pressure variation (PPV) and systolic pressure variation (SPV) were calculated. The area under the receiver operating characteristics (AUROC) curve with 95%-confidence interval (95%-CI) was used to assess the capability to predict fluid responsiveness (defined as an increase in cardiac index of > 15%) after a 500 mL crystalloid fluid challenge.
Thirty-three patients were included in the final analysis. Thirteen patients (39%) were fluid-responders with a mean increase in cardiac index of 25.3%. The AUROC was 0.60 (95%-CI 0.38 to 0.81) for PPV, 0.63 (95%-CI 0.43 to 0.83) for SPV, 0.58 (95%-CI 0.38 to 0.78) for PPV, and 0.71 (95%-CI 0.52 to 0.89) for SPV. The AUROC for PPV was 0.71 (95%-CI 0.53 to 0.89) and for SPV 0.78 (95%-CI 0.62 to 0.94). The correlation between pulse pressure variation and systolic pressure variation measurements derived from the different waveforms was weak.
Right ventricular and pulmonary artery pulse pressure variation and systolic pressure variation seem to be weak predictors of fluid responsiveness in CABG surgery patients.
在治疗外科或危重症患者时，预测液体反应性至关重要。使用肺动脉导管时，可以从右心室和肺动脉压力波形计算出脉压变化和收缩压变化。
我们进行了一项前瞻性干预研究，研究了右心室脉压变化（PPV）和收缩压变化（SPV）以及肺动脉脉压变化（PPV）和收缩压变化（SPV）预测冠状动脉旁路（CABG）手术患者液体反应性的能力。此外，还计算了桡动脉脉压变化（PPV）和收缩压变化（SPV）。使用接受者操作特征（ROC）曲线下面积（95%置信区间[95%CI]）评估预测液体反应性（定义为心指数增加> 15%）的能力在接受 500 毫升晶体液冲击后。
最终分析纳入 33 例患者。13 例患者（39%）为液体反应者，心指数平均增加 25.3%。PPV 的 AUC 为 0.60（95%CI 0.38 至 0.81），SPV 的 AUC 为 0.63（95%CI 0.43 至 0.83），PPV 的 AUC 为 0.58（95%CI 0.38 至 0.78），SPV 的 AUC 为 0.71（95%CI 0.52 至 0.89）。PPV 的 AUC 为 0.71（95%CI 0.53 至 0.89），SPV 的 AUC 为 0.78（95%CI 0.62 至 0.94）。不同波形衍生的脉压变化和收缩压变化测量值之间的相关性较弱。
右心室和肺动脉脉压变化和收缩压变化似乎是 CABG 手术患者液体反应性的弱预测指标。
