Koh Won Uk, Lee Dong-Ho, Ro Young-Jin, Park Hee-Sun
Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea.
Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea.
Medicina (Kaunas). 2024 Dec 7;60(12):2018. doi: 10.3390/medicina60122018.
: The modified prone position, which is an alteration of the standard prone position, reduces cardiac preload. Dynamic variables including stroke volume variation (SVV), pulse pressure variation (PPV), and pleth variability index (PVI) are reliable predictors for fluid responsiveness during surgery. To the best of our knowledge, no studies assessing dynamic variables for fluid responsiveness have been conducted in the modified prone position. This study aimed to evaluate the ability of PVI to predict fluid responsiveness in the modified prone position during cervical spine surgery. PVI, SVV, and PPV were recorded at the following times: before and after a 4 mL/kg crystalloid load in the supine position (T1, T2); after placement in the modified prone position (T3); and before and after a 4 mL/kg crystalloid administration in the modified prone position (T4, T5). Fluid responsiveness was defined as stroke volume (SV) ≥ 15%, assessed by the FloTrac/Vigileo™ (Edwards Lifesciences Corp, Irvine, CA, USA). Receiver operating characteristic (ROC) curves were analyzed to identify changes in each dynamic variable that could predict fluid responsiveness in the modified prone position. Data from a total of 43 subjects were analyzed. In the supine position, 21 subjects were responders. After subjects were placed in the modified prone position, SV significantly decreased, while PVI, SVV, and PPV significantly increased ( < 0.001 for all). In the modified prone position, 13 subjects were responders, and the areas under the ROC curves for ΔPVI, ΔSVV, and ΔPPV after fluid loading were 0.524 (95% confidence interval [CI] 0.329-0.730, = 0.476), 0.749 (95% CI 0.566-0.931, = 0.004), and 0.790 (95% CI 0.641-0.938, < 0.001), respectively. Crystalloid pre-loading could not mitigate the decrease in SV caused by the modified prone position. Changes in PVI were less reliable in predicting fluid responsiveness in the modified prone position.
改良俯卧位是标准俯卧位的一种变体，可降低心脏前负荷。包括每搏量变异（SVV）、脉压变异（PPV）和 pleth 变异指数（PVI）在内的动态变量是手术期间液体反应性的可靠预测指标。据我们所知，尚未有研究在改良俯卧位下评估用于预测液体反应性的动态变量。本研究旨在评估 PVI 在颈椎手术改良俯卧位期间预测液体反应性的能力。在以下时间记录 PVI、SVV 和 PPV：仰卧位给予 4 mL/kg 晶体液负荷前后（T1、T2）；置于改良俯卧位后（T3）；以及在改良俯卧位给予 4 mL/kg 晶体液前后（T4、T5）。液体反应性定义为每搏量（SV）增加≥15%，通过 FloTrac/Vigileo™（美国加利福尼亚州尔湾市爱德华兹生命科学公司）进行评估。分析受试者工作特征（ROC）曲线，以确定每个动态变量中可预测改良俯卧位下液体反应性的变化。共分析了 43 名受试者的数据。在仰卧位时，21 名受试者有反应。在受试者置于改良俯卧位后，SV 显著降低，而 PVI、SVV 和 PPV 显著升高（所有 P 值均<0.001）。在改良俯卧位时，13 名受试者有反应，液体负荷后 ΔPVI、ΔSVV 和 ΔPPV 的 ROC 曲线下面积分别为 0.524（置信区间[CI]95%：0.329 - 0.730，P = 0.476）、0.749（95%CI：0.566 - 0.931，P = 0.004）和 0.790（95%CI：0.641 - 0.938，P < 0.001）。晶体液预负荷无法减轻改良俯卧位导致的 SV 降低。在改良俯卧位下，PVI 的变化在预测液体反应性方面可靠性较低。
