The Use of Pulse Pressure Variation and Stroke Volume Variation in Spontaneously Breathing Patients to Assess Dynamic Arterial Elastance and to Predict Arterial Pressure Response to Fluid Administration
The Use of Pulse Pressure Variation and Stroke Volume Variation in Spontaneously Breathing Patients to Assess Dynamic Arterial Elastance and to Predict Arterial Pressure Response to Fluid Administration
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DOI：
10.1213/ane.0000000000000442
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发表时间：
2015-01-01
影响因子：
5.7
通讯作者：
Rhodes, Andrew
中科院分区：
文献类型：
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作者：
Cecconi, Maurizio;Monge Garcia, M. Ignacio;Rhodes, Andrew
背景：动态动脉弹性(EA(Dyn))，定义为脉压变化(PPV)与每搏输出量变化(SVV)的比率，已被认为是动脉压对液体注射的反应的预测指标。在这项研究中，我们评估了电针(Dyn)在预测液体挑战(FC)后动脉血压反应的有效性。方法：术后入院并接受Nexfin监护仪监测的患者(荷兰阿姆斯特丹BMEYE)。如果患者有自主呼吸，并且在FC期间心输出量增加了10%，则纳入分析。根据FC后平均动脉压(MAP)的增加将患者分为MAP有效组(MAP增加10%)和MAP无反应组(MAP增加10%)。从监护仪获得的PPV和SVV值连续计算Ea(Dyn)。结果：26例患者34个FCS。17个FCS(50%)可引起MAP阳性反应。MAP应答组输注前EA(Dyn)显著高于MAP应答组(1.39+/-0.41vs0.85+/-0.23，P=0.0001)。预输注电针对FC的MAP反应为阳性，受试者操作特征曲线下面积为0.92+/-0.04，标准差(95%可信区间为0.78-0.99；P<；0.0001)。输注前EA(Dyn)值>；=1.06(灰区：0.9-1.15)对MAP反应者的敏感度和特异度分别为88.2%和88.2%(约95%可信区间，%-99%)。结论：无创EA(Dyn)，定义为PPV/SVV比率，可预测自主呼吸、预负荷依赖患者补液后动脉血压的升高。
BACKGROUND: Dynamic arterial elastance (Ea(dyn)), defined as the pulse pressure variation (PPV) to stroke volume variation (SVV) ratio, has been suggested as a predictor of the arterial pressure response to fluid administration. In this study, we assessed the effectiveness of Ea(dyn) to predict the arterial blood pressure response to a fluid challenge (FC) in preload-dependent, spontaneously breathing patients.METHODS: Patients admitted postoperatively and monitored with the Nexfin monitor (BMEYE, Amsterdam, The Netherlands) were enrolled in the study. Patients were included in the analysis if they were spontaneously breathing and had an increase in cardiac output >= 10% during an FC. Patients were classified according to the increase in mean arterial blood pressure (MAP) after FC into MAP-responders (MAP increase >= 10%) and MAP-nonresponders (MAP increase < 10%). Ea(dyn) was continuously calculated from the PPV and SVV values obtained from the monitor.RESULTS: Thirty-four FCs from 26 patients were studied. Seventeen FCs (50%) induced a positive MAP response. Preinfusion Ea(dyn) was significantly higher in MAP-responders (1.39 +/- 0.41 vs 0.85 +/- 0.23; P = 0.0001). Preinfusion Ea(dyn) predicted a positive MAP response to FC with an area under the receiver-operating characteristic curve of 0.92 +/- 0.04 of standard error (95% confidence interval, 0.78-0.99; P < 0.0001). A preinfusion Ea(dyn) value >= 1.06 (gray zone: 0.9-1.15) discriminated MAP-responders with a sensitivity and specificity of 88.2% (approximate 95% confidence interval, 64%-99%), respectively.CONCLUSIONS: Noninvasive Ea(dyn), defined as the PPV to SVV ratio, predicted the arterial blood pressure increase to fluid administration in spontaneously breathing, preload-dependent patients.