Prediction of Volume-Responsiveness During One-Lung Ventilation: A Comparison of Static, Volumetric, and Dynamic Parameters of Cardiac Preload
Prediction of Volume-Responsiveness During One-Lung Ventilation: A Comparison of Static, Volumetric, and Dynamic Parameters of Cardiac Preload
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DOI：
10.1053/j.jvca.2013.05.003
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发表时间：
2013-12-01
影响因子：
2.8
通讯作者：
Reuter, Daniel A.
中科院分区：
文献类型：
--
作者：
Trepte, Constantin J. C.;Haas, Sebastian A.;Reuter, Daniel A.
目的：本研究的目的是评估心脏前负荷的静态、容积和动态参数预测单肺通气（OLV）期间容积反应性的能力。设计：前瞻性实验研究。设置：汉堡-艾本德大学医学中心动物设施的实验室。参与者：23只德国家猪。干预：通过抽取20 mL/kg体重（BW）的血液诱导低血容量。建立OLV，并将抽取的体积分3个体积负荷步骤回输，每个步骤包括7 mL/kg BW。采用肺动脉超声血流探头测量每搏输出量指数（SVI），评价容量反应。SVI增加>= 15%被认为是积极反应。在每个测量时间点，记录中心静脉压（CVP）、左心房压（LVEF）、整体舒张末期容积指数（GEDI）、每搏输出量变异度（SVV）和脉压变异度（PPV）。预测容量反应性的能力进行了评估，使用ROC analysis.Measurements和主要结果：共进行了69个容量负荷步骤，其中48个表现出积极的容量反应。ROC分析显示以下曲线下面积（AUC）值：CVP，0.88; AUC，0.65; GEDI，0.75; SVV，0.78;和PPV，0.83。ROC曲线下面积的比较没有显示任何统计学显著差异（p > 0.05），除了与CVP相比的VEP（p = 0.005）。结论：在这些OLV实验条件下，前负荷的体积和动力学参数以及CVP在预测容量反应性方面似乎具有相似的价值。(C)2013 Elsevier Inc. All rights reserved.
Objectives: The aim of this study was to evaluate the ability of static, volumetric, and dynamic parameters of cardiac preload to predict volume responsiveness during one-lung ventilation (OLV).Design: Prospective experimental study.Setting: Laboratory of the animal facility of the University Medical Center Hamburg-Eppendorf.Participants: Twenty-three German domestic pigs.Interventions: Hypovolemia was induced by withdrawing 20 mL/kg body weight (BW) of blood. OLV was established, and the volume withdrawn was retransfused in 3 volume-loading steps, each consisting of 7 mL/kg BW. An ultrasonic flow probe around the pulmonary artery was used to measure the stroke-volume index (SVI) and to evaluate the volume response. An increase in the SVI of >= 15% was considered a positive response. For each measurement time point, central venous pressure (CVP), left atrial pressure (LAP), the global end-diastolic volume index (GEDI), stroke-volume variation (SVV), and pulse-pressure variation (PPV) were recorded. The ability to predict volume responsiveness was assessed using ROC analysis.Measurements and Main Results: A total of 69 volume loading steps were performed, 48 of which showed a positive volume response. ROC analysis revealed the following area under the curve (AUC) values: CVP, 0.88; LAP, 0.65; GEDI, 0.75; SVV, 0.78; and PPV, 0.83. A comparison of the areas under the ROC curves did not reveal any statistically significant differences (p > 0.05), with the exception of LAP compared with CVP (p = 0.005).Conclusions: Under these OLV experimental conditions, the volumetric and dynamic parameters of preload, as well as CVP, seemed to be of similar value in predicting volume responsiveness. (C) 2013 Elsevier Inc. All rights reserved.