液体负荷试验期间中心静脉压的变化对指导液体治疗的价值有限。

Changes in central venous pressure during a fluid challenge have limited value for guiding fluid therapy.

作者信息

de Oliveira Priscilla Souza, Ramos Fernando José da Silva, Tomotani Daniere Yurie Vieira, Machado Flávia Ribeiro, de Freitas Flávio Geraldo Rezende

机构信息

Department of Anesthesiology, Pain and Intensive Care Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo - São Paulo (SP), Brazil.

出版信息

Crit Care Sci. 2024 Dec 2;36:e20240073en. doi: 10.62675/2965-2774.20240073-en. eCollection 2024.

DOI:10.62675/2965-2774.20240073-en

PMID:39630827

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11634234/

Abstract

OBJECTIVE

To evaluate whether changes in central venous pressure during fluid expansion and baseline cyclic respiratory variation in the central venous pressure amplitude (RespCVP) curve could be used to discriminate between fluid responders and nonresponders.

METHODS

This prospective observational study included critically ill adult patients who underwent fluid expansion in the form of a fluid bolus or fluid challenge with crystalloids. All patients were under mechanical ventilation and adequately sedated. We determined the central venous pressure at baseline (CVPT0) and the changes at 5 (ΔCVPT5), 10 (ΔCVPT10) and 15 (ΔCVPT15) minutes during fluid infusion. We also measured the RespCVP at baseline. Fluid responsiveness was defined as a cardiac index increase of ≥ 15%.

RESULTS

The study included 30 patients (11 responders and 19 nonresponders). The CVPT0 and the changes after a fluid challenge at all three time points did not adequately predict fluid responsiveness, as determined by their area under the curve values (CVPT0: 0.70, (95%CI: 0.49 - 0.90; ΔCVPT5: 0.78, (95%CI: 0.57 - 0.99; ΔCVPT10: 0.63, (95%CI: 0.39 - 0.88; ΔCVPT15: 0.68, ((95%CI: 0.45 - 0.92). The RespCVP at baseline also had a poor performance (area under the curve: 0.70; 95%CI: 0.50 - 0.91).

CONCLUSION

Changes in central venous pressure have limited value in predicting fluid responsiveness.

摘要

目的

评估液体扩容期间中心静脉压的变化以及中心静脉压幅度（RespCVP）曲线的基线周期性呼吸变化是否可用于区分液体反应者和无反应者。

方法

这项前瞻性观察性研究纳入了接受晶体液推注或液体激发形式的液体扩容的成年危重症患者。所有患者均接受机械通气并充分镇静。我们测定了基线时的中心静脉压（CVPT0）以及液体输注期间5分钟（ΔCVPT5）、10分钟（ΔCVPT10）和15分钟（ΔCVPT15）时的变化。我们还测量了基线时的RespCVP。液体反应性定义为心脏指数增加≥15%。

结果

该研究纳入了30例患者（11例反应者和19例无反应者）。通过曲线下面积值确定，CVPT0以及所有三个时间点液体激发后的变化均不能充分预测液体反应性（CVPT0：0.70，（95%CI：0.49 - 0.90；ΔCVPT5：0.78，（95%CI：0.57 - 0.99；ΔCVPT10：0.63，（95%CI：0.39 - 0.88；ΔCVPT15：0.68，（95%CI：0.45 - 0.92）。基线时的RespCVP表现也不佳（曲线下面积：0.70；95%CI：0.50 - 0.91）。