Li Yaru, Jiang Luyang, Wang Lu, Dou Dou, Feng Yi
Department of Anesthesiology, Peking University People's Hospital, 11 Xi Zhi Men South Street, Beijing, 100044, China.
Perioper Med (Lond). 2023 Apr 10;12(1):10. doi: 10.1186/s13741-023-00298-z.
This study aimed to evaluate the predictive accuracy of the superior vena cava collapsibility index measured by transesophageal echocardiography and compare the index with stroke volume variation measured by FloTrac™/Vigileo™ in mechanically ventilated patients.
In the prospective study, a total of 60 patients were enrolled for elective general surgery under mechanical ventilation, where all patients received 10 ml/kg of Ringer's lactate. Five kinds of related data were recorded before and after the fluid challenge, including the superior vena cava collapsibility index (SVC-CI), the ratio of E/e', cardiac index (CI), stroke volume variation (SVV), and central venous pressure (CVP). Based on the collected data after the fluid challenge, we classified the patients as responders (FR group) if their CI increased by at least 15% and the rest were non-responders (NR).
Twenty-five of 52 (48%) of the patients were responders, and 27 were non-responders (52%). The SVC-CI was higher in the responders (41.90 ± 11.48 vs 28.92 ± 9.05%, P < 0.01). SVC-CI was significantly correlated with △CI (r = 0.568, P < 0.01). The area under the ROC curve (AUROC) of SVC-CI was 0.838 (95% CI 0.728 ~ 0.947, P < 0.01) with the optimal cutoff value of 39.4% (sensitivity 64%, specificity 92.6%). And there was no significant difference in E/e' between the two groups (P > 0.05). The best cutoff value for SVV was 12.5% (sensitivity 40%, specificity 89%) with the AUROC of 0.68 (95% CI 0.53 ~ 0.826, P < 0.05).
The SVC-CI and SVV can predict fluid responsiveness effectively in mechanically ventilated patients. And SVC-CI is superior in predicting fluid responsiveness compared with SVV. The E/e' ratio and CVP cannot predict FR effectively.
Chinese clinical trial registry (ChiCTR2000034940).
本研究旨在评估经食管超声心动图测量的上腔静脉塌陷指数的预测准确性，并将该指数与机械通气患者中通过FloTrac™/Vigileo™测量的每搏量变异进行比较。
在这项前瞻性研究中，共有60例接受机械通气的择期普外科手术患者入组，所有患者均接受10ml/kg的乳酸林格氏液。在液体负荷前后记录五种相关数据，包括上腔静脉塌陷指数（SVC-CI）、E/e'比值、心脏指数（CI）、每搏量变异（SVV）和中心静脉压（CVP）。根据液体负荷后收集的数据，如果患者的CI至少增加15%，则将其分类为反应者（FR组），其余为无反应者（NR）。
52例患者中有25例（48%）为反应者，27例为无反应者（52%）。反应者的SVC-CI更高（41.90±11.48 vs 28.92±9.05%，P<0.01）。SVC-CI与△CI显著相关（r=0.568，P<0.01）。SVC-CI的ROC曲线下面积（AUROC）为0.838（95%CI 0.7280.947，P<0.01），最佳截断值为39.4%（敏感性64%，特异性92.6%）。两组之间的E/e'无显著差异（P>0.05）。SVV的最佳截断值为12.5%（敏感性40%，特异性89%），AUROC为0.68（95%CI 0.530.826，P<0.05）。
SVC-CI和SVV可有效预测机械通气患者的液体反应性。与SVV相比，SVC-CI在预测液体反应性方面更具优势。E/e'比值和CVP不能有效预测FR。
中国临床试验注册中心（ChiCTR2000034940）。
