不同呼气末正压水平下左心室流出道速度时间积分的变化可预测机械通气危重症患者的液体反应性。

Variation of Left Ventricular Outflow Tract Velocity Time Integral at Different Positive End-Expiratory Pressure Levels Can Predict Fluid Responsiveness in Mechanically Ventilated Critically Ill Patients.

机构信息

Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

出版信息

J Cardiothorac Vasc Anesth. 2022 Aug;36(8 Pt B):3101-3108. doi: 10.1053/j.jvca.2022.04.033. Epub 2022 Apr 29.

DOI:10.1053/j.jvca.2022.04.033

PMID:35599102

Abstract

OBJECTIVES

To explore whether the variation of left ventricular outflow tract velocity time integral (LVOT VTI) between positive end-expiratory pressure (PEEP) 10 cmHO and PEEP 0 cmHO can predict fluid responsiveness in mechanically ventilated critically ill patients.

DESIGN

An observational study.

SETTING

A tertiary hospital intensive care unit.

PARTICIPANTS

A total of 79 critically ill patients who were on controlled mechanical ventilation.

INTERVENTIONS

Transthoracic echocardiography was performed at different PEEP levels and was also performed before and after passive leg raising (PLR).

MEASUREMENTS AND MAIN RESULTS

The patients were classified as the fluid responders (n = 45) and the fluid nonresponders (n = 34) according to the LVOT VTI change after PLR (ΔVTI). The difference of LVOT VTI between PEEP 10 cmHO and PEEP 0 cmHO (ΔVTI) was much higher in responders than in nonresponders (17.9% v 2.1%, p < 0.001). The ΔVTI and ΔVTI were correlated among all patients (r = 0.582, p < 0.001). The receiver operating characteristic curve analysis revealed that the ΔVTI was a good predictor of fluid responsiveness, with an area under the curve of 0.935 (95% confidence interval: 0.885-0.986, p < 0.001), and the optimal cutoff value was 10.5%.

CONCLUSIONS

Variation of LVOT VTI between PEEP 10 cmHO and PEEP 0 cmHO can be used to predict fluid responsiveness in critically ill patients on controlled mechanical ventilation.

摘要

目的

探讨呼气末正压（PEEP）从 10cmH₂O 改变至 0cmH₂O 时左心室流出道速度时间积分（LVOT VTI）的变化能否预测机械通气危重症患者的液体反应性。

设计

观察性研究。

地点

一家三级医院的重症监护病房。

参与者

共纳入 79 名接受有创机械通气的危重症患者。

干预措施

在不同 PEEP 水平下进行经胸超声心动图检查，并在被动抬腿（PLR）前后进行检查。

测量和主要结果

根据 PLR 后 LVOT VTI 的变化（ΔVTI），将患者分为液体反应者（n=45）和液体无反应者（n=34）。反应者的 LVOT VTI 在 PEEP 10cmH₂O 与 PEEP 0cmH₂O 之间的差异（ΔVTI）明显高于无反应者（17.9%比 2.1%，p<0.001）。所有患者的 ΔVTI 与 ΔVTI 之间存在相关性（r=0.582，p<0.001）。受试者工作特征曲线分析显示，ΔVTI 是液体反应性的良好预测指标，曲线下面积为 0.935（95%置信区间：0.885-0.986，p<0.001），最佳截断值为 10.5%。