Echocardiographic prediction of volume responsiveness in critically ill patients with spontaneously breathing activity
Echocardiographic prediction of volume responsiveness in critically ill patients with spontaneously breathing activity
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DOI：
10.1007/s00134-007-0646-7
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发表时间：
2007-07-01
影响因子：
38.9
通讯作者：
Teboul, Jean-Louis
中科院分区：
文献类型：
--
作者：
Lamia, Bouchra;Ochagavia, Ana;Teboul, Jean-Louis
目的：对于有自主呼吸活动的血流动力学不稳定的患者，预测容量反应性是一个困难的挑战，因为无法使用动脉压的呼吸变化。我们的目的是测试是否可以通过经胸超声心动图测量的每搏输出量对自主呼吸活动患者被动抬腿的反应来预测容量反应性。我们还检查了心脏充盈状态的常见超声心动图指数是否有助于预测此类患者的容量反应性。设计和设置：在一所大学医院的医疗重症监护病房进行的前瞻性研究。患者：24 名考虑进行容量扩张的自主呼吸活动患者。测量：我们测量了超声心动图每搏输出量对被动抬腿和盐水输注（15 分钟内 500 毫升）的反应。在输注生理盐水之前和之后还测量了左心室舒张末期面积以及二尖瓣流入E波速度与舒张早期二尖瓣环速度的比值（E/Ea）。结果：被动抬腿引起每搏输出量增加12.5%或更多，可预测扩容后每搏输出量增加15%或更多，敏感性为77%，特异性为100%。左心室舒张末期面积和 E/Ea 均不能预测容量反应性。结论：在有自主呼吸活动的危重患者中，超声心动图每搏输出量对被动抬腿的反应是容量反应性的良好预测因子。另一方面，心脏充盈状态的常见超声心动图标记物对于此目的没有价值。
Objective: In hemodynamically unstable patients with spontaneous breathing activity, predicting volume responsiveness is a difficult challenge since the respiratory variation in arterial pressure cannot be used. Our objective was to test whether volume responsiveness can be predicted by the response of stroke volume measured with transthoracic echocardiography to passive leg raising in patients with spontaneous breathing activity. We also examined whether common echocardiographic indices of cardiac filling status are valuable to predict volume responsiveness in this category of patients.Design and setting: Prospective study in the medical intensive care unit of a university hospital.Patients: 24 patients with spontaneously breathing activity considered for volume expansion.Measurements: We measured the response of the echocardiographic stroke volume to passive leg raising and to saline infusion (500ml over 15min). The left ventricular end-diastolic area and the ratio of mitral inflow E wave velocity to early diastolic mitral annulus velocity (E/Ea) were also measured before and after saline infusion.Results: A passive leg raising induced increase in stroke volume of 12.5% or more predicted an increase in stroke volume of 15% or more after volume expansion with a sensitivity of 77% and a specificity of 100%. Neither left ventricular end-diastolic area nor E/Ea predicted volume responsiveness.Conclusions: In our critically ill patients with spontaneous breathing activity the response of echocardiographic stroke volume to passive leg raising was a good predictor of volume responsiveness. On the other hand, the common echocardiographic markers of cardiac filling status were not valuable for this purpose.