Assessment of fluid responsiveness in mechanically ventilated cardiac surgical patients
Assessment of fluid responsiveness in mechanically ventilated cardiac surgical patients
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DOI：
10.1017/s0265021505001092
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发表时间：
2005-09-01
影响因子：
3.6
通讯作者：
Keyl, C
中科院分区：
文献类型：
--
作者：
Wiesenack, C;Fiegl, C;Keyl, C
背景和目的：准确评估前负荷反应性是临床医生的一个重要目标，以避免与机械通气患者发病率和死亡率增加相关的有害容量置换。本研究旨在评估使用改进的脉搏轮廓分析算法同时评估每搏输出量变化和脉压变化的准确性（PiCCO plus（R），V 5.2.2），与经食管超声心动图导出的主动脉血流速度的呼吸变化相比（Δ Vpeak），胸内血容量指数，中心静脉压和肺毛细血管楔压预测每搏输出量指数对正常通气心脏手术患者容量替代的反应。方法：我们研究了20例择期冠状动脉旁路移植术患者。麻醉诱导后，在以1 mL kg（-1）min（-1）速率输注6%羟乙基淀粉200/0.5（7 mL kg（-1））进行容量替代之前和之后进行血流动力学测量。结果如下：基线每搏输出量变异与每搏输出量指数（Delta SVI）变化显著相关（r（2）= 0.66; P < 0.05），基线脉压变异也是如此（r（2）= 0.65; P < 0.05），而Delta Vpeak、胸内血容量指数、中心静脉压和肺动脉楔压的基线值与Delta SVI无相关性。脉搏波形分析低估了经皮热稀释法测得的容量引起的心脏指数增加（P < 0.05）。结论：我们的研究结果表明，每搏输出量的变化和它的替代脉压变化来自脉冲轮廓分析，使用改进的算法可以作为正常通气的心脏手术患者的液体反应性的指标。当预期全身血管阻力发生变化时，应重新校准PiCCO plus（R）系统。
Background and objective: Accurate assessment of preload responsiveness is an important goal of the clinician to avoid deleterious volume replacement associated with increased morbidity and mortality in mechanically ventilated patients. This study was designed to evaluate the accuracy of simultaneously assessed stroke volume variation and pulse pressure variation using an improved algorithm for pulse contour analysis (PiCCO plus (R), V 5.2.2), compared to the respiratory changes in transoesophageal echo-derived aortic blood velocity (Delta Vpeak), intrathoracic blood volume index, central venous pressure and pulmonary capillary wedge pressure to predict the response of stroke volume index to volume replacement in normoventilated cardiac surgical patients. Methods: We studied 20 patients undergoing elective coronary artery bypass grafting. After induction of anaesthesia, haemodynamic measurements were performed before and after volume replacement by infusion of 6% hydroxyethyl starch 200/0.5 (7 mL kg(-1)) with a rate of I mL kg(-1) min(-1). Results: Baseline stroke volume variation correlated significantly with changes in stroke volume index (Delta SVI) (r(2) = 0.66; P < 0.05) as did baseline pulse pressure variation (r(2) = 0.65; P < 0.05), whereas baseline values of Delta Vpeak, intrathoracic blood volume index, central venous pressure and pulmonary artery wedge pressure showed no correlation to Delta SVI. Pulse contour analysis underestimated the volume-induced increase in cardiac index measured by transpulmonary thermodilution (P < 0.05). Conclusions: The results of our study suggest that stroke volume variation and its surrogate pulse pressure variation derived from pulse contour analysis using an improved algorithm can serve as indicators of fluid responsiveness in normoventilated cardiac surgical patients. Whenever changes in systemic vascular resistance are expected, the PiCCO plus (R) system should be recalibrated.