静脉-动脉体外膜肺氧合患者液体冲击后毛细血管再充盈时间评估：一项回顾性研究。

Capillary refill time assessment after fluid challenge in patients on venoarterial extracorporeal membrane oxygenation: A retrospective study.

作者信息

Hariri Geoffroy, Luxey Xavier, Wenger Stefanie, Dureau Pauline, Hariri Sarah, Charfeddine Ahmed, Lebreton Guillaume, Djavidi Nima, Lancelot Aymeric, Duceau Baptiste, Bouglé Adrien

机构信息

Sorbonne Université, GRC 29, Assistance Publique-Hôpitaux de Paris (AP-HP), DMU DREAM, Département d'anesthésie et réanimation, Institut de Cardiologie, Hôpital La Pitié-Salpêtrière, Paris F-75013, France; Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, AP-HP. Sorbonne Université, Hôpital Pitié-Salpêtrière, Département de Santé Publique, Paris, France..

出版信息

J Crit Care. 2024 Aug;82:154770. doi: 10.1016/j.jcrc.2024.154770. Epub 2024 Mar 11.

DOI:10.1016/j.jcrc.2024.154770

PMID:38461658

Abstract

BACKGROUND

Monitoring fluid therapy is challenging in patients assisted with Veno-arterial ECMO. The aim of our study was to evaluate the usefulness of capillary refill time to assess the response to fluid challenge in patients assisted with VA-ECMO.

METHODS

Retrospective monocentric study in a cardiac surgery ICU. We assess fluid responsiveness after a fluid challenge in patients on VA-ECMO. We recorded capillary refill time before and after fluid challenge and the evolution of global hemodynamic parameters.

RESULTS

A total of 27 patients were included. The main indications for VA-ECMO were post-cardiotomy cardiogenic shock (44%). Thirteen patients (42%) were responders and 14 non-responders (58%). In the responder group, the index CRT decreased significantly (1.7 [1.5; 2.1] vs. 1.2 [1; 1.3] s; p = 0.01), whereas it remained stable in the non-responder group (1.4 [1.1; 2.5] vs. 1.6 [0.9; 1.9] s; p = 0.22). Diagnosis performance of CRT variation to assess response after fluid challenge shows an AUC of 0.68 (p = 0.10) with a sensitivity of 79% [95% CI, 52-92] and a specificity of 69% [95% CI, 42-87], with a threshold at 23%.

CONCLUSION

In patients treated with VA-ECMO index capillary refill time is a reliable tool to assesses fluid responsiveness.

SPECIALTY

Critical care, Cardiac surgery, ECMO.

摘要

背景

对于接受静脉-动脉体外膜肺氧合（Veno-arterial ECMO）辅助的患者，监测液体治疗具有挑战性。我们研究的目的是评估毛细血管再充盈时间在评估接受VA-ECMO辅助患者对液体冲击反应中的有用性。

方法

在心脏外科重症监护病房进行的回顾性单中心研究。我们评估了接受VA-ECMO治疗的患者在液体冲击后的液体反应性。我们记录了液体冲击前后的毛细血管再充盈时间以及整体血流动力学参数的变化。

结果

共纳入27例患者。VA-ECMO的主要适应证是心脏术后心源性休克（44%）。13例患者（42%）有反应，14例无反应（58%）。在有反应组中，指数CRT显著降低（1.7 [1.5；2.1] 秒对1.2 [1；1.3] 秒；p = 0.01），而在无反应组中保持稳定（1.4 [1.1；2.5] 秒对1.6 [0.9；1.9] 秒；p = 0.22）。液体冲击后评估反应的CRT变化的诊断性能显示AUC为0.68（p = 0.10），敏感性为79% [95% CI，52 - 92]，特异性为69% [95% CI，42 - 87]，阈值为23%。