Dynamic arterial elastance as a predictor of arterial pressure response to fluid administration: a validation study.
Dynamic arterial elastance as a predictor of arterial pressure response to fluid administration: a validation study.
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DOI：
10.1186/s13054-014-0626-6
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发表时间：
2014-11-19
期刊：
影响因子：
--
通讯作者：
Cecconi M
中科院分区：
文献类型：
--
作者：
García MI;Romero MG;Cano AG;Aya HD;Rhodes A;Grounds RM;Cecconi M
通过动态动脉弹性（Eadyn）对动脉负荷进行功能评估，动态动脉弹性（Eadyn）定义为脉压变化（PPV）与每搏输出量变化（SVV）之间的比率，最近已被证明可以预测低血压、前负荷依赖性患者的动脉压对容量扩张（VE）的反应。然而，由于 SVV 和 PPV 都是通过脉压分析获得的，因此不能排除数学耦合因素。因此，我们设计这项研究是为了确认从两个独立信号获得的 Eadyn 是否可以预测液体反应性患者对 VE 的动脉压反应。我们分析了 53 名患有急性循环衰竭且保留前负荷依赖性的机械通气患者静脉输注 500 毫升生理盐水后的动脉压反应。 Eadyn 计算为 PPV（从动脉导管获得）和 SVV（通过食管多普勒成像获得）之间的同时比率。总共进行了 80 次液体挑战（中位值，每位患者 1.5 次；四分位数范围，1 至 2）。根据输液后平均动脉压（MAP）的增加对压力有反应者（≥10%）和无反应者进行分类。 33 次液体挑战 (41.2%) 显着增加了 MAP。在基线时，Eadyn 的压力反应者较高（1.04±0.28 对比 0.60±0.14；P <0.0001）。输注前 Eadyn 与输液后 MAP 的变化相关（R2 = 0.60；P <0.0001）。在基线时，Eadyn 预测动脉压增加会导致容量扩张（受试者工作特征曲线下面积，0.94；95% 置信区间 (CI)：0.86 至 0.98；P <0.0001）。输注前 Eadyn 值≥0.73（灰色区域：0.72 至 0.88）可区分压力反应患者，敏感性为 90.9%（95% CI：75.6 至 98.1%），特异性为 91.5%（95% CI：79.6 至 97.6%）。 Eadyn 从两个独立信号获得的动脉负荷功能评估能够预测机械通气、前负荷依赖性急性循环衰竭患者对输液的动脉压反应。本文的在线版本 (doi:10.1186/s13054-014-0626-6) 包含补充材料，可供授权用户使用。
Functional assessment of arterial load by dynamic arterial elastance (Eadyn), defined as the ratio between pulse pressure variation (PPV) and stroke volume variation (SVV), has recently been shown to predict the arterial pressure response to volume expansion (VE) in hypotensive, preload-dependent patients. However, because both SVV and PPV were obtained from pulse pressure analysis, a mathematical coupling factor could not be excluded. We therefore designed this study to confirm whether Eadyn, obtained from two independent signals, allows the prediction of arterial pressure response to VE in fluid-responsive patients. We analyzed the response of arterial pressure to an intravenous infusion of 500 ml of normal saline in 53 mechanically ventilated patients with acute circulatory failure and preserved preload dependence. Eadyn was calculated as the simultaneous ratio between PPV (obtained from an arterial line) and SVV (obtained by esophageal Doppler imaging). A total of 80 fluid challenges were performed (median, 1.5 per patient; interquartile range, 1 to 2). Patients were classified according to the increase in mean arterial pressure (MAP) after fluid administration in pressure responders (≥10%) and non-responders. Thirty-three fluid challenges (41.2%) significantly increased MAP. At baseline, Eadyn was higher in pressure responders (1.04 ± 0.28 versus 0.60 ± 0.14; P <0.0001). Preinfusion Eadyn was related to changes in MAP after fluid administration (R2 = 0.60; P <0.0001). At baseline, Eadyn predicted the arterial pressure increase to volume expansion (area under the receiver operating characteristic curve, 0.94; 95% confidence interval (CI): 0.86 to 0.98; P <0.0001). A preinfusion Eadyn value ≥0.73 (gray zone: 0.72 to 0.88) discriminated pressure responder patients with a sensitivity of 90.9% (95% CI: 75.6 to 98.1%) and a specificity of 91.5% (95% CI: 79.6 to 97.6%). Functional assessment of arterial load by Eadyn, obtained from two independent signals, enabled the prediction of arterial pressure response to fluid administration in mechanically ventilated, preload-dependent patients with acute circulatory failure. The online version of this article (doi:10.1186/s13054-014-0626-6) contains supplementary material, which is available to authorized users.
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DOI：
10.1186/cc12785
发表时间：
2013-06-20
期刊：
Critical care (London, England)
影响因子：
--
作者：
Monge García MI;Romero MG;Cano AG;Rhodes A;Grounds RM;Cecconi M
通讯作者：
Cecconi M
DOI：
10.1186/cc9420
发表时间：
2011
期刊：
Critical care (London, England)
影响因子：
--
作者：
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通讯作者：
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DOI：
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发表时间：
2014-05-12
期刊：
Critical care (London, England)
影响因子：
--
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影响因子：
38.9
作者：
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影响因子：
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