通过肋下视图利用右心室流出道速度时间积分进行被动抬腿试验以预测液体反应性。
Passive leg raising test to predict fluid responsiveness using the right ventricle outflow tract velocity-time integral through a subcostal view.
作者信息
Cheong Issac, Otero Castro Victoria, Brizuela Matías, Früchtenicht María Florencia, Merlo Pablo Martín, Tamagnone Francisco Marcelo
机构信息
Department of Critical Care Medicine, Sanatorio De los Arcos, Juan B. Justo 909, CABA, Buenos Aires, Argentina.
Argentinian Critical Care Ultrasonography Association (ASARUC), Buenos Aires, Argentina.
出版信息
J Ultrasound. 2025 Mar;28(1):19-25. doi: 10.1007/s40477-022-00719-7. Epub 2022 Sep 21.
PURPOSE
The passive leg raising test (PLR) produces a reversible increase in venous return and, if the patient's ventricles are preload dependent, in the cardiac output. As this effect occurs in seconds, the transthoracic echocardiography is optimal for its real time assessment. The utility of the PLR for monitoring fluid responsiveness through the measurement of the left ventricle outflow tract velocity-time integral (LVOT VTI) in an apical 5-chamber view is well stablished. To achieve this view in critically ill patients is often challenging. The aim of this study is to explore the accuracy for predicting fluid responsiveness of the change in the right ventricle outflow tract velocity-time integral (RVOT VTI) from a subcostal view during a PLR.
METHODS
This is a diagnostic accuracy study carried out in two centers in Argentina. We included patients admitted to the intensive care unit from January 2022 to April 2022, that required fluid expansion due to signs of tissular hypoperfusion. We measured the RVOT VTI from a subcostal view in a semi-recumbent position and during the PLR, and the LVOT VTI in an apical 5-chamber view before and after a fluid bolus. If the LVOT VTI increased by 15% after the fluid bolus, the patients were considered fluid responders.
RESULTS
We included 43 patients. The area under the ROC curve for a change in the RVOT VTI during the PLR was 0.879 (95% CI 0.744-0.959). A change of 15.36% in the RVOT VTI with the PLR predicted fluid responsiveness with a sensitivity of 85.7% (95% CI 57.2%-98.2%) and specificity of 93.1% (95% CI 77.2-99.2). The positive predictive value was 85.7% (95% CI 60.8%-95.9%) and the negative predictive value was 93.1% (95% CI 78.8%-98%). The positive likelihood ratio was 12.43 and the negative predictive value was 0.15.
CONCLUSION
The RVOT VTI change during a PLR is suitable for the prediction of fluid responsiveness in critically ill patients.
目的
被动抬腿试验（PLR）可使静脉回心血量可逆性增加，若患者心室依赖前负荷，则心输出量也会增加。由于这种效应在数秒内即可出现，经胸超声心动图是对其进行实时评估的最佳方法。通过测量心尖五腔视图中的左心室流出道速度时间积分（LVOT VTI），PLR在监测液体反应性方面的效用已得到充分证实。在危重症患者中获得该视图通常具有挑战性。本研究的目的是探讨在PLR期间从肋下视图预测右心室流出道速度时间积分（RVOT VTI）变化的液体反应性的准确性。
方法
这是一项在阿根廷两个中心进行的诊断准确性研究。我们纳入了2022年1月至2022年4月入住重症监护病房、因组织灌注不足体征需要补液的患者。我们在半卧位和PLR期间从肋下视图测量RVOT VTI，并在补液前后从心尖五腔视图测量LVOT VTI。如果补液后LVOT VTI增加15%，则患者被视为液体反应者。
结果
我们纳入了43例患者。PLR期间RVOT VTI变化的ROC曲线下面积为0.879（95%CI 0.744-0.959）。PLR时RVOT VTI变化15.36%预测液体反应性的敏感性为85.7%（95%CI 57.2%-98.2%），特异性为93.1%（95%CI 77.2-99.2%）。阳性预测值为85.7%（95%CI 60.8%-95.9%），阴性预测值为93.1%（95%CI 78.8%-98%）。阳性似然比为12.43，阴性预测值为0.15。
结论
PLR期间RVOT VTI的变化适用于预测危重症患者的液体反应性。
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