Messina Antonio, Calabrò Lorenzo, Benedetto Francesco, Villa Aurora, Matronola Guia Margherita, Brunati Andrea, Teboul Jean-Louis, Monnet Xavier, Cecconi Maurizio
IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy.
Department of Biomedical Sciences, Humanitas University, Via Levi Montalcini 4,, Pieve Emanuele, Milan, Italy.
Crit Care. 2025 May 2;29(1):176. doi: 10.1186/s13054-025-05398-4.
Assessing fluid responsiveness is problematic for critically ill patients with spontaneous breathing activity, such as during Pressure Support Ventilation (PSV), since spontaneous breathing activity physiologically affects heart-lung interplay. We compared the reliability of two hemodynamic tests in predicting fluid responsiveness in this clinical setting: SIGH, based on a ventilator-generated sigh applied at 35 cmHO for 4 s and the end-expiratory occlusion test (EEOT).
Prospective study conducted in a general intensive care unit (ICU) and enrolling patients in PSV showing different inspiratory effort [assessed by airway occlusion pressure (P0.1)] and requiring volume expansion (VE). Hemodynamic variables were recorded by means of the MOSTCARE system, patient received a VE using 4 ml/kg of crystalloids over 10 min and were considered responders if a cardiac output (CO) ≥ 10% was observed. The reliability of SIGH and EEOT in discriminating fluid responsiveness was assessed using receiver operating characteristic (ROC) curve approach and the area (AUC) under ROC curves was compared. For the EEOT, we considered the percent changes of CO between baseline the end of the test, while for the SIGH, the percent changes of pulse pressure (PP) between baseline and the lowest value recorded after SIGH application.
Sixty ICU patients were enrolled, and 56 patients analysed. The AUC of PP changes after SIGH was 0.93 (0.84-0.99) [sensitivity of 93.1% (78.0-98.7%); specificity of 91.6 (73.0-98.9%)]; best threshold - 25% PP from baseline (grey zone - 15%/35%)]; and greater than the AUC of CO changes after EEOT [0.67 (0.52-0.81); sensitivity of 72.4% (54.3-85.3%) specificity of 70.3% (73.0-98.9%)]; best threshold 4% of CO increase from baseline (grey zone - 1%/10%)]. In the subgroup having a P0.1 < 1.5 cmHO, the AUC of SIGH [0.98 (0.94-0.99)] and of EEOT [0.89 (0.72-0.99] were comparable (p = 0.26).
In a selected ICU population undergoing PSV, SGH reliably predicted fluid responsiveness and performed better than the EEOT, which is, however, still reliable in the subgroup of ICU patients having a small extent of inspiratory efforts.
对于有自主呼吸活动的危重症患者，如在压力支持通气（PSV）期间评估液体反应性存在问题，因为自主呼吸活动会在生理上影响心肺相互作用。我们比较了两种血流动力学测试在这种临床情况下预测液体反应性的可靠性：基于在35 cmH₂O施加4秒的呼吸机产生的叹息的叹息试验（SIGH）和呼气末阻断试验（EEOT）。
在一家综合重症监护病房（ICU）进行的前瞻性研究，纳入接受PSV且表现出不同吸气努力[通过气道阻断压（P0.1）评估]并需要扩容（VE）的患者。通过MOSTCARE系统记录血流动力学变量，患者在10分钟内使用4 ml/kg晶体液进行扩容，如果观察到心输出量（CO）增加≥10%则被视为反应者。使用受试者工作特征（ROC）曲线方法评估SIGH和EEOT在区分液体反应性方面的可靠性，并比较ROC曲线下的面积（AUC）。对于EEOT，我们考虑测试结束时与基线相比CO的变化百分比，而对于SIGH，考虑叹息应用后与基线相比脉压（PP）的变化百分比。
60名ICU患者入组，56名患者进行分析。叹息后PP变化的AUC为0.93（0.84 - 0.99）[敏感性为93.1%（78.0 - 98.7%）；特异性为91.6%（73.0 - 98.9%）]；最佳阈值为基线PP降低25%（灰色区域为 - 15%/35%）]；且大于EEOT后CO变化的AUC[0.67（0.52 - 0.81）；敏感性为72.4%（54.3 - 85.3%），特异性为70.3%（73.0 - 98.9%）]；最佳阈值为基线CO增加4%（灰色区域为 - 1%/10%）]。在P0.1 < 1.5 cmH₂O的亚组中，SIGH的AUC[0.98（0.94 - 0.99）]和EEOT的AUC[0.89（0.72 - 0.99）]相当（p = 0.26）。
在接受PSV的特定ICU人群中，SIGH能可靠地预测液体反应性，且比EEOT表现更好，不过EEOT在吸气努力程度较小的ICU患者亚组中仍可靠。
