校准腹部加压联合经胸超声心动图预测危重症婴儿液体反应性的临床价值：一项诊断准确性研究
Clinical value of calibrated abdominal compression plus transthoracic echocardiography to predict fluid responsiveness in critically ill infants: a diagnostic accuracy study.
作者信息
Gotchac Julien, Navion Anouk, Belaroussi Yaniss, Klifa Roman, Amedro Pascal, Guichoux Julie, Brissaud Olivier
机构信息
Department of Pediatric and Congenital Cardiology, M3C National Reference Center, Bordeaux University Hospital, Bordeaux, France.
IHU Liryc, INSERM 1045, University of Bordeaux, Bordeaux, France.
出版信息
BMC Pediatr. 2025 May 7;25(1):361. doi: 10.1186/s12887-025-05728-z.
BACKGROUND
Predicting fluid responsiveness is challenging in infants. It is however crucial to avoid unnecessary volume expansion, which can lead to fluid overload. We tested the hypothesis that the stroke volume changes induced by a calibrated abdominal compression (ΔSV-AC) could predict fluid responsiveness in infants without cardiac disease.
METHODS
This prospective single center study of diagnostic test accuracy was conducted in a general pediatric intensive care unit (PICU). Children under the age of two with acute circulatory failure and requiring a 10 mL.kg crystalloid volume expansion over 20 min, ventilated or not ventilated, were eligible. Stroke volume was measured by transthoracic echocardiography at baseline, during a gentle calibrated abdominal compression (22 mmHg for 30 s), and after volume expansion. The area under the receiver operating characteristic curve (AUROC) of ΔSV-AC was measured to predict fluid responsiveness, defined as a 15% stroke volume increase after volume expansion.
RESULTS
Twenty-seven cases of volume expansion were analyzed, in 21 patients. Seventeen VE cases were administrated to spontaneously breathing children. Fluid responsiveness was observed in 12 cases. The AUROC of ΔSV-AC was 0.93 (95% confidence interval (95%CI) 0.82-1). The best threshold value for ΔSV-AC was 9.5%. At this threshold value, sensitivity was 92% (95%CI 62-100), specificity was 87% (95%CI 60-98), positive and negative predictive values were 85% (95%CI 60-95) and 93% (95%CI 66-99) respectively.
CONCLUSIONS
Echocardiographic assessment of stroke volume changes induced by a calibrated abdominal compression is a promising method to predict fluid responsiveness in infants without cardiac disease hospitalized in PICU.
TRIAL REGISTRATION
ClinicalTrials.gov registration number NCT05919719, June 22, 2023, retrospectively registered, https://clinicaltrials.gov/study/NCT05919719 .
背景
预测婴儿的液体反应性具有挑战性。然而，避免不必要的容量扩张至关重要，因为这可能导致液体过载。我们检验了这样一个假设，即校准腹部按压引起的每搏量变化（ΔSV-AC）可以预测无心脏病婴儿的液体反应性。
方法
这项关于诊断试验准确性的前瞻性单中心研究在一家普通儿科重症监护病房（PICU）进行。纳入2岁以下患有急性循环衰竭且在20分钟内需输注10 mL/kg晶体液进行容量扩张的儿童，无论是否进行机械通气。在基线、轻柔校准腹部按压期间（22 mmHg持续30秒）以及容量扩张后，通过经胸超声心动图测量每搏量。测量ΔSV-AC的受试者工作特征曲线下面积（AUROC）以预测液体反应性，液体反应性定义为容量扩张后每搏量增加15%。
结果
分析了21例患者的27次容量扩张情况。17次容量扩张给予自主呼吸的儿童。观察到12例有液体反应性。ΔSV-AC的AUROC为0.93（95%置信区间（95%CI）0.82-1）。ΔSV-AC的最佳阈值为9.5%。在此阈值下，敏感性为92%（95%CI 62-100），特异性为87%（95%CI 60-98），阳性预测值和阴性预测值分别为85%（95%CI 60-95）和93%（95%CI 66-99）。
结论
通过超声心动图评估校准腹部按压引起的每搏量变化是一种有前景的方法，可用于预测入住PICU的无心脏病婴儿的液体反应性。
试验注册
ClinicalTrials.gov注册号NCT05919719，2023年6月22日，回顾性注册，https://clinicaltrials.gov/study/NCT05919719 。
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