Fot Evgeniia V, Izotova Natalia N, Smetkin Aleksei A, Kuzkov Vsevolod V, Kirov Mikhail Y
Department of Anaesthesiology and Intensive Care Medicine, Northern State Medical University, Arkhangelsk, Russian Federation.
Turk J Anaesthesiol Reanim. 2022 Feb;50(1):59-64. doi: 10.5152/TJAR.2021.20411.
This study aimed to assess the predictive value of invasive and non-invasive dynamic parameters for evaluation of fluid responsiveness after off-pump coronary artery bypass grafting.
Thirty-two adult patients after off-pump coronary surgery were enrolled into a single-center pilot prospective observational study. After arrival to the intensive care unit, all patients received standard fluid challenge test to assess fluid responsiveness. The patients with an increase in cardiac index ≥ 15% after the test were defined as fluid responders. We measured pulse pressure variation using 2 monitoring systems (PPVPiCCO and PPVNK), stroke volume variation, heart-lung interaction index, and plethysmogram variability index before and after standard fluid challenge test.
After intensive care unit admission, the absolute values of stroke volume variation, PPVPiCCO, PPVNK, and heart-lung interaction index were significantly higher among fluid responders (P < .05). Response to standard fluid challenge test was predicted by dynamic assessment of PPVPiCCO (area under the curve 0.84), PPVNK (area under the curve 0.71), stroke volume variation (area under the curve 0.77), and heart-lung interaction index (area under the curve 0.77) (P < .05). The plethysmogram variability index value did not demonstrate any predictive ability regarding fluid responsiveness (area under the curve 0.5, P =.1).
In patients after off-pump coronary surgery, both invasive parameters such as pulse pressure and stroke volume variations and non-invasive parameter such as heart-lung interaction index are able to predict fluid responsiveness. Thus, these dynamic parameters can be used to guide fluid therapy during the early postoperative period after off-pump coronary surgery.
本研究旨在评估有创和无创动态参数对非体外循环冠状动脉搭桥术后液体反应性评估的预测价值。
32例非体外循环冠状动脉手术后的成年患者纳入一项单中心前瞻性观察性试验研究。进入重症监护病房后，所有患者均接受标准液体冲击试验以评估液体反应性。试验后心脏指数增加≥15%的患者被定义为液体反应者。我们在标准液体冲击试验前后测量了使用2种监测系统（脉搏压力变异PiCCO和脉搏压力变异NK）测得的脉搏压力变异、每搏量变异、心肺相互作用指数和体积描记图变异指数。
进入重症监护病房后，液体反应者的每搏量变异、脉搏压力变异PiCCO、脉搏压力变异NK和心肺相互作用指数的绝对值显著更高（P<.05）。通过对脉搏压力变异PiCCO（曲线下面积0.84）、脉搏压力变异NK（曲线下面积0.71）、每搏量变异（曲线下面积0.77）和心肺相互作用指数（曲线下面积0.77）的动态评估可预测对标准液体冲击试验的反应（P<.05）。体积描记图变异指数值未显示出对液体反应性的任何预测能力（曲线下面积0.5，P=.1）。
在非体外循环冠状动脉手术后的患者中，诸如脉搏压力和每搏量变异等有创参数以及诸如心肺相互作用指数等无创参数均能够预测液体反应性。因此，这些动态参数可用于指导非体外循环冠状动脉手术后早期的液体治疗。
