Department of Mechanical Engineering, University of Maryland, College Park, USA.
Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Hyattsville, Maryland, USA.
J Burn Care Res. 2023 May 2;44(3):599-609. doi: 10.1093/jbcr/irac097.
While urinary output (UOP) remains the primary endpoint for titration of intravenous fluid resuscitation, it is an insufficient indicator of fluid responsiveness. Although advanced hemodynamic monitoring (including arterial pulse wave analysis [PWA]) is of recent interest, the validity of PWA-derived indices in burn resuscitation extremes has not been established. The goal of this paper is to test the hypothesis that PWA-derived cardiac output (CO) and stroke volume (SV) indices as well as pulse pressure variation (PPV) and systolic pressure variation (SPV) can play a complementary role to UOP in burn resuscitation. Swine were instrumented with a Swan-Ganz catheter for reference CO and underwent a 40% TBSA burns with varying resuscitation paradigms, and were monitored for 24 hours in an ICU setting under mechanical ventilation. The longitudinal changes in PWA-derived indices were investigated, and resuscitation adequacy was compared as determined by UOP vs PWA indices. The results indicated that PWA-derived indices exhibited trends consistent with reference CO and SV measurements: CO and SV indices were proportional to reference CO and SV, respectively (CO: postcalibration limits of agreement [LoA] = ±24.7 [ml/min/kg], SV: postcalibration LoA = ±0.30 [ml/kg]) while PPV and SPV were inversely proportional to reference SV (PPV: postcalibration LoA = ±0.32 [ml/kg], SPV: postcalibration LoA = ±0.31 [ml/kg]). The results also indicated that PWA-derived indices exhibited notable discrepancies from UOP in determining adequate burn resuscitation. Hence, it was concluded that the PWA-derived indices may have complementary value to UOP in assessing and guiding burn resuscitation.
虽然尿排出量（UOP）仍然是静脉液体复苏滴定的主要终点，但它是液体反应性的不足指标。尽管先进的血流动力学监测（包括动脉脉搏波分析[PWA]）是最近的研究热点，但 PWA 衍生指数在烧伤复苏极端情况下的有效性尚未得到证实。本文的目的是检验假设，即 PWA 衍生的心输出量（CO）和每搏量（SV）指数以及脉搏压变异（PPV）和收缩压变异（SPV）可以在烧伤复苏中与 UOP 一起发挥补充作用。猪被植入 Swan-Ganz 导管作为参考 CO，并接受 40%TBSA 烧伤，具有不同的复苏方案，并在 ICU 环境下进行机械通气监测 24 小时。研究了 PWA 衍生指数的纵向变化，并比较了通过 UOP 与 PWA 指数确定的复苏充足性。结果表明，PWA 衍生指数的变化趋势与参考 CO 和 SV 测量值一致：CO 和 SV 指数分别与参考 CO 和 SV 成正比（CO：校准后界限协议[LoA]为±24.7[ml/min/kg]，SV：校准后 LoA 为±0.30[ml/kg]），而 PPV 和 SPV 与参考 SV 成反比（PPV：校准后 LoA 为±0.32[ml/kg]，SPV：校准后 LoA 为±0.31[ml/kg]）。结果还表明，PWA 衍生指数在确定适当的烧伤复苏方面与 UOP 存在显著差异。因此，得出结论，PWA 衍生指数在评估和指导烧伤复苏方面可能与 UOP 具有互补价值。
