Department of Critical Care Medicine, Arras Hospital, Arras, France; Critical Care Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA; Normandy University, UNICAEN, Ecole Doctorale NBISE 497, Caen, France.
Normandy University, UNICAEN, CHU de Caen Normandie, Ecole Doctorale NBISE 497, Service d'Anesthésie Réanimation, Caen, France.
Br J Anaesth. 2022 Sep;129(3):308-316. doi: 10.1016/j.bja.2022.04.031. Epub 2022 Jul 14.
Passive leg raising-induced changes in cardiac index can be used to predict fluid responsiveness. We investigated whether passive leg raising-induced changes in pulse pressure variation (ΔPPV) can also predict fluid responsiveness in mechanically ventilated patients.
In this multicentre prospective observational study, we included 270 critically ill patients on mechanical ventilation in whom volume expansion was indicated because of acute circulatory failure. We did not include patients with cardiac arrythmias. Cardiac index and PPV were measured before/during a passive leg raising test and before/after volume expansion. A volume expansion-induced increase in cardiac index of >15% defined fluid responsiveness. To investigate whether ΔPPV can predict fluid responsiveness, we determined areas under the receiver operating characteristic curves (AUROCs) and grey zones for relative and absolute ΔPPV.
Of the 270 patients, 238 (88%) were on controlled mechanical ventilation with no spontaneous breathing activity and 32 (12%) were on pressure support ventilation. The median tidal volume was 7.1 (inter-quartile range [IQR], 6.6-7.6) ml kg ideal body weight. One hundred sixty-four patients (61%) were fluid responders. Relative and absolute ΔPPV predicted fluid responsiveness with an AUROC of 0.92 (95% confidence interval [95% CI], 0.88-0.95; P<0.001) each. The grey zone for relative and absolute ΔPPV included 4.8% and 22.6% of patients, respectively. These results were not affected by ventilatory mode and baseline characteristics (type of shock, centre, vasoactive treatment).
Passive leg raising-induced changes in pulse pressure variation accurately predict fluid responsiveness with a small grey zone in critically ill patients on mechanical ventilation.
NCT03225378.
被动抬腿引起的心指数变化可用于预测液体反应性。我们研究了被动抬腿引起的脉压变化（ΔPPV）是否也可以预测机械通气患者的液体反应性。
在这项多中心前瞻性观察研究中，我们纳入了 270 例机械通气的危重症患者，这些患者因急性循环衰竭需要进行容量扩张。我们不包括有心律失常的患者。在被动抬腿试验前后和容量扩张前后测量心指数和脉压。心指数增加>15%定义为液体反应性。为了研究 ΔPPV 是否可以预测液体反应性，我们确定了相对和绝对 ΔPPV 的接受者操作特征曲线（AUROCs）和灰色区域。
270 例患者中，238 例（88%）接受控制机械通气，无自主呼吸活动，32 例（12%）接受压力支持通气。潮气量中位数为 7.1（四分位距 [IQR]，6.6-7.6）ml·kg 理想体重。164 例（61%）患者为液体反应者。相对和绝对 ΔPPV 预测液体反应性的 AUROC 分别为 0.92（95%置信区间 [95%CI]，0.88-0.95；P<0.001）。相对和绝对 ΔPPV 的灰色区域分别包括 4.8%和 22.6%的患者。这些结果不受通气模式和基线特征（休克类型、中心、血管活性药物治疗）的影响。
在机械通气的危重症患者中，被动抬腿引起的脉压变化准确预测液体反应性，灰色区域较小。
NCT03225378。
