Zhang Yang, Ding Yinyin, Zhang Jiatong, Huang Tianfeng, Gao Ju
Department of Anesthesiology, Northern Jiangsu People's Hospital, Yangzhou, China.
Front Med (Lausanne). 2023 Aug 9;10:1169912. doi: 10.3389/fmed.2023.1169912. eCollection 2023.
To evaluate the ability of tidal volume challenge (VC)-induced hemodynamic changes to predict fluid responsiveness in patients during one-lung ventilation (OLV).
80 patients scheduled for elective thoracoscopic surgery with OLV were enrolled. The inclusion criteria were: age ≥ 18 years, American Society of Anesthesiologists physical status I-III, normal right ventricular function, normal left ventricular systolic function (ejection fraction ≥55%), and normal or slightly impaired diastolic function. The study protocol was implemented 15 min after starting OLV. Simultaneous recordings were performed for hemodynamic variables of diameter of left ventricular outflow tract, velocity time integral (VTI) of aortic valve, and stroke volume (SV), and ΔSV-VC, ΔVTI-VC, and ΔMAP-VC were calculated at four time points: with V 5 mL/kg (T1); after V increased from 5 mL/kg to 8 mL/kg and maintained at this level for 2 min (T2); after V was adjusted back to 5 mL/kg for 2 min (T3); and after volume expansion (250 mL of 0.9% saline infused over 10-15 min) (T4). Patients were considered as responders to fluid administration if SV increased by ≥10%. Receiver operating characteristic (ROC) curves for percent decrease in SV, VTI, and MAP by VC were generated to evaluate their ability to discriminate fluid responders from nonresponders.
Of the 58 patients analyzed, there were 32 responders (55%) and 26 nonresponders (45%). The basic characteristics were comparable between the two groups ( > 0.05). The area under the curve (AUC) for ΔSV-VC, ΔVTI-VC, and ΔMAP-VC to discriminate responders from nonresponders were 0.81 (95% CI: 0.68-0.90), 0.79 (95% CI: 0.66-0.89), and 0.56 (95% CI: 0.42-0.69). The best threshold for ΔSV-VC was -16.1% (sensitivity, 78.1%; specificity, 84.6%); the best threshold for ΔVTI-VC was -14.5% (sensitivity, 78.1%; specificity, 80.8%).
Tidal volume challenge-induced relative change of stroke volume and velocity time integral can predict fluid responsiveness in patients during one-lung ventilation. Chinese Clinical Trial Registry, No: chictr210051310.
评估潮气量挑战（VC）诱导的血流动力学变化预测单肺通气（OLV）期间患者液体反应性的能力。
纳入80例计划行择期胸腔镜手术并接受OLV的患者。纳入标准为：年龄≥18岁，美国麻醉医师协会身体状况分级I - III级，右心室功能正常，左心室收缩功能正常（射血分数≥55%），舒张功能正常或轻度受损。研究方案在OLV开始15分钟后实施。同时记录左心室流出道直径、主动脉瓣速度时间积分（VTI）和每搏量（SV）等血流动力学变量，并在四个时间点计算ΔSV - VC、ΔVTI - VC和ΔMAP - VC：V为5 mL/kg时（T1）；V从5 mL/kg增加至8 mL/kg并维持2分钟后（T2）；V调回5 mL/kg并维持2分钟后（T3）；以及容量扩充后（10 - 15分钟内输注250 mL 0.9%生理盐水）（T4）。若SV增加≥10%，则患者被视为对液体输注有反应者。绘制VC引起的SV、VTI和MAP百分比下降的受试者工作特征（ROC）曲线，以评估其区分有反应者和无反应者的能力。
在分析的58例患者中，有32例有反应者（55%）和26例无反应者（45%）。两组间基本特征具有可比性（P>0.05）。用于区分有反应者和无反应者的ΔSV - VC、ΔVTI - VC和ΔMAP - VC的曲线下面积（AUC）分别为0.81（95%CI：0.68 - 0.90）、0.79（95%CI：0.66 - 0.89）和0.56（95%CI：0.42 - 0.69）。ΔSV - VC的最佳阈值为 - 16.1%（敏感性，78.1%；特异性，84.6%）；ΔVTI - VC的最佳阈值为 - 14.5%（敏感性，78.1%；特异性，80.8%）。
潮气量挑战诱导的每搏量和速度时间积分的相对变化可预测单肺通气期间患者的液体反应性。中国临床试验注册中心，注册号：chictr210051310。
