下腔静脉直径呼吸变异度对感染性休克通气儿童的预测价值

Predictive Value of the Respiratory Variation in Inferior Vena Cava Diameter for Ventilated Children With Septic Shock.

作者信息

Xiong Zihong, Zhang Guoying, Zhou Qin, Lu Bing, Zheng Xuemei, Wu Mengjun, Qu Yi

机构信息

Department of Pediatrics/Key Laboratory of Birth Defects and Related Diseases of Women and Children (Ministry of Education), West China Second University Hospital, Sichuan University, Chengdu, China.

Department of Pediatric Intensive Care Unit, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.

出版信息

Front Pediatr. 2022 Jul 7;10:895651. doi: 10.3389/fped.2022.895651. eCollection 2022.

DOI:10.3389/fped.2022.895651

PMID:35874570

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9301070/

Abstract

OBJECTIVES

This study aimed to investigate the predictive utility of respiratory variations of inferior vena cava diameters on fluid responsiveness in children with septic shock.

DESIGN

A prospective observational single-center study.

SETTING

A pediatric intensive care unit in a tertiary hospital in China.

PARTICIPANTS

Patients with sepsis shock who require invasive mechanical ventilation were recruited between 1 December 2017 and 1 November 2021.

INTERVENTIONS AND MEASUREMENTS

Volume expansion (VE) was induced by a 30-min infusion of 20 ml/kg of normal saline. Hemodynamics indexes were obtained through bedside transthoracic echocardiography (TTE) measurement and calculation.

RESULTS

A total of 86 patients were enrolled in this study, among them, 45 patients (52.3%) were considered to be non-responders (NR), with an increase in stroke volume variation (SVV) <15% after VE. Multivariate logistic analysis showed that ΔIVC (adjusted OR = 1.615, 95% CI 1.092-2.215, = 0.012) was the significant predictor associated with the fluid responsiveness. The area under the ROC of ΔIVC was 0.922 (95% CI: 0.829-1.000, < 0.01), and the cutoff value of ΔIVC used to predict fluid responsiveness was 28.5%, with a sensitivity and specificity of 95.4 and 68.5%, respectively.

CONCLUSIONS

The ΔIVC was found to have a potential value in predicting fluid responsiveness in mechanically ventilated children with septic shock.

摘要

目的

本研究旨在探讨脓毒性休克患儿下腔静脉直径呼吸变化对液体反应性的预测效用。

设计

一项前瞻性观察性单中心研究。

地点

中国一家三级医院的儿科重症监护病房。

参与者

2017年12月1日至2021年11月1日期间招募需要有创机械通气的脓毒症休克患者。

干预措施与测量

通过30分钟输注20ml/kg生理盐水诱导容量扩充（VE）。通过床旁经胸超声心动图（TTE）测量和计算获得血流动力学指标。

结果

本研究共纳入86例患者，其中45例（52.3%）被认为是无反应者（NR），容量扩充后每搏输出量变异（SVV）增加<15%。多因素逻辑分析显示，ΔIVC（校正OR=1.615，95%CI 1.092-2.215，P=0.012）是与液体反应性相关的显著预测因素。ΔIVC的ROC曲线下面积为0.922（95%CI：0.829-1.000，P<0.01），用于预测液体反应性的ΔIVC临界值为28.5%，敏感性和特异性分别为95.4%和68.5%。