Department of Pediatrics, 3rd floor, Teaching Block, All India Institute of Medical Sciences, New Delhi, India.
Department of Research & Development, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India.
Indian J Pediatr. 2023 Nov;90(11):1077-1082. doi: 10.1007/s12098-023-04585-x. Epub 2023 Jun 6.
To evaluate the sensitivity and specificity of inferior vena cava (IVC) distensibility index (∆IVC) and respiratory variation in peak aortic blood flow velocity (∆Vpeak) to predict fluid responsiveness in ventilated children with shock and to find out the best cut-off values for predicting fluid responsiveness.
In this prospective observational study, conducted in a pediatric ICU from January 2019 through May 2020, consecutive children aged 2 mo to 17 y with shock requiring fluid bolus were included. ∆IVC and ∆Vpeak were measured before and immediately after 10 ml/kg fluid bolus administration. ∆IVC and ∆Vpeak were compared between responders and non-responders, defined by a change in stroke volume index (SVI) of ≥10%.
Thirty-seven ventilated children [26 (70.4%) boys] with median age of 60 (36, 108) mo were included. The median (IQR) ∆IVC was 21.7% (14.3, 30.9) and the median (IQR) ΔVpeak was 11.3% (7.2, 15.2). Twenty-three (62%) children were fluid responsive. The median (IQR) ∆IVC was higher in responders compared to non-responders [26% (16.9, 36.5) vs. 17.2% (8.4, 21.9); p = 0.018] and mean (SD) ΔVpeak was higher in responders [13.9% (6.1) vs. 8.4% (3.9), p = 0.004]. The prediction of fluid responsiveness with ΔIVC [ROC curve area 0.73 (0.56-0.9), p = 0.01] and ΔVpeak [ROC curve area 0.78 (0.63-0.94), p = 0.002] was similar. The best cut-off of ∆IVC to predict fluid responsiveness was 23% (sensitivity, 60.8%; specificity, 85.7%) and ΔVpeak was 11.3% (sensitivity, 74%; specificity, 86%).
In this study, authors found that ∆IVC and ΔVpeak were good predictors of fluid responsiveness in ventilated children with shock.
评估下腔静脉（IVC）扩张指数（ΔIVC）和峰值主动脉血流速度（ΔVpeak）的呼吸变化预测机械通气休克患儿液体反应性的敏感性和特异性，并确定预测液体反应性的最佳截断值。
这是一项前瞻性观察性研究，于 2019 年 1 月至 2020 年 5 月在儿科重症监护病房进行，纳入了需要液体冲击的休克且接受机械通气的年龄在 2 个月至 17 岁的连续患儿。在给予 10ml/kg 液体冲击前后测量 ΔIVC 和 ΔVpeak。根据每搏量指数（SVI）的变化来定义应答者和无应答者，即 SVI 变化≥10%。
共纳入 37 名接受机械通气的患儿[26 名（70.4%）男孩]，中位年龄为 60（36，108）个月。ΔIVC 的中位数（IQR）为 21.7%（14.3，30.9），ΔVpeak 的中位数（IQR）为 11.3%（7.2，15.2）。23 名（62%）患儿对液体有反应。与无反应者相比，应答者的 ΔIVC 中位数更高[26%（16.9，36.5）比 17.2%（8.4，21.9）；p=0.018]，且应答者的平均（SD）ΔVpeak 更高[13.9%（6.1）比 8.4%（3.9）；p=0.004]。ΔIVC [ROC 曲线下面积 0.73（0.56-0.9），p=0.01]和 ΔVpeak [ROC 曲线下面积 0.78（0.63-0.94），p=0.002]预测液体反应性的效果相似。预测液体反应性的最佳 ΔIVC 截断值为 23%（敏感性 60.8%；特异性 85.7%），ΔVpeak 为 11.3%（敏感性 74%；特异性 86%）。
本研究发现，ΔIVC 和 ΔVpeak 是机械通气休克患儿液体反应性的良好预测指标。
