Boontoterm Panu, Sakoolnamarka Siraruj, Naklaor Peera, Urasyanandana Karanarak
Neurological Surgery, Phramongkutklao Hospital, Bangkok, THA.
Cureus. 2025 Mar 14;17(3):e80581. doi: 10.7759/cureus.80581. eCollection 2025 Mar.
Fluid management in critically ill patients, particularly those with severe traumatic brain injury (TBI), septic shock, and acute respiratory distress syndrome (ARDS), presents a complex and multifaceted challenge. Dynamic tests such as the end-expiratory occlusion (EEO) test and tidal volume challenge (TVC) test are commonly used to assess fluid responsiveness, providing valuable insights into cardiovascular responses to changes in volume status. However, due to the unique risks and complications associated with these conditions, there is an increasing need to explore and evaluate alternative methods for predicting fluid responsiveness more safely and accurately in these critically ill patients.
This study presents a prospective investigation conducted on patients with severe TBI, septic shock, and ARDS. Before administering a 100 mL colloid bolus, both the EEO and TVC tests were performed. Initial measurements of cardiac output (CO), cardiac index (CI), and pulse pressure variation (PPV) were recorded, followed by subsequent measurements after each test to assess the fluid responsiveness and cardiovascular changes in these critically ill patients.
Among the 180 participants, a more than 5% increase in CI during the EEO test was indicative of fluid responsiveness. Similarly, a 3.5% absolute increase in PPV during the TVC test suggested fluid responsiveness. The interrater reliability for the EEO test was observed to be 0.915, indicating strong agreement between raters, while for PPV, it was 0.637, reflecting moderate agreement. These values suggest that the EEO test shows a high degree of consistency between different evaluators, whereas the PPV measurement demonstrates a more moderate level of reliability.
In patients with severe TBI, septic shock, and ARDS who are receiving low tidal volume (VT) ventilation, both the EEO test for 15 seconds and the TVC method can be used to assess fluid responsiveness. However, it is important to note that the EEO test demonstrates greater reliability in this context.
重症患者的液体管理，尤其是那些患有严重创伤性脑损伤（TBI）、感染性休克和急性呼吸窘迫综合征（ARDS）的患者，是一项复杂且多方面的挑战。诸如呼气末阻断（EEO）试验和潮气量挑战（TVC）试验等动态测试通常用于评估液体反应性，为心血管系统对容量状态变化的反应提供有价值的见解。然而，由于与这些病症相关的独特风险和并发症，越来越需要探索和评估更安全、准确地预测这些重症患者液体反应性的替代方法。
本研究对患有严重TBI、感染性休克和ARDS的患者进行了一项前瞻性调查。在给予100 mL胶体推注之前，进行了EEO和TVC试验。记录心输出量（CO）、心脏指数（CI）和脉压变异（PPV）的初始测量值，然后在每次试验后进行后续测量，以评估这些重症患者的液体反应性和心血管变化。
在180名参与者中，EEO试验期间CI增加超过5%表明有液体反应性。同样，TVC试验期间PPV绝对增加3.5%表明有液体反应性。EEO试验的评分者间信度为0.915，表明评分者之间有很强的一致性，而PPV的评分者间信度为0.637，反映出中等一致性。这些值表明EEO试验在不同评估者之间显示出高度一致性，而PPV测量显示出中等程度的可靠性。
在接受低潮气量（VT）通气的严重TBI、感染性休克和ARDS患者中，15秒的EEO试验和TVC方法均可用于评估液体反应性。然而，需要注意的是，在这种情况下EEO试验显示出更高的可靠性。
