New-Onset Atrial Fibrillation in Sepsis: So Common, but So Different.
New-Onset Atrial Fibrillation in Sepsis: So Common, but So Different.
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脓毒症中新发心房颤动：很常见，但又很不同。
DOI：
10.1097/ccm.0000000000001541
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发表时间：
2016
影响因子：
8.8
通讯作者：
J. Quenot
中科院分区：
文献类型：
--
作者：
C. Guenancia;G. Laurent;R. Bruyère;J. Quenot
e306 www.ccmjournal.org May 2016 • Volume 44 • Number 5 (ΔPpleural = Vt × Ecw). As further summarized by Lakhal et al, our study highlights “...the cause for false negativity of PPV (too low ΔPpleural because of too low Vt and/or too low Ecw), ...” Finally, they asked a clinically relevant question: “...could a high Ecw be source of high PPV, even in a patient not responding to volume expansion (false positive for PPV)?” Given the significant correlation of Ecw with ΔPpleural (R = 0.84; p < 0.001) (2), it is highly likely that, in ARDS patients with a “too high” Ecw, the cyclic swings in pleural pressure (ΔPpleural) should be excessive, causing high PPV values even in nonresponders. This assertion agrees with our results in that both the Ecw (13.4 [12.0–19.2] vs 9.02 [7.63–11.8] cm H 2 O/L; p = 0.004) and the ratio of Ecw to respiratory system elastance (0.48 [0.36–0.56] vs 0.32 [0.25–0.41]; p = 0.03) were significantly higher in 12 nonresponders with a PPV greater than or equal to 10% (false positive) than in 32 other nonresponders with a PPV less than 10% (true negative). Furthermore, normalization of PPV by Ecw could markedly decrease the false-positive rate, such that only three nonresponders had a PPV/Ecw higher than 0.996 (the best cutoff value). We agree that our study could suggest a cause for falsepositive results of PPV in ARDS: a “too high” Ecw. However, the normalization of PPV by Ecw could not exclude all PPV false positives, and some PPV false positives occur in the absence of a “too high Ecw,” suggesting that false-positive cases of PPV observed in ARDS patients should not be attributed solely to “too high Ecw.” Actually, some other factors have been proposed to explain the false-positive cases. For example, a number of studies (3, 4) have clearly indicated that the presence of right ventricular (RV) dysfunction or acute cor pulmonale (ACP) may also cause falsely high PPVs in nonresponders although it is still a matter of debate (5). As already discussed in our article (2), it cannot be excluded that the presence of RV dysfunction or ACP may be responsible for some false-positive cases of PPV in our study population since we did not perform echocardiography. Thus, which factor (a “too high Ecw” or the presence of ACP) plays a prominent role in generating high PPV values in nonresponders remains an unsettled question. The authors have disclosed that they do not have any potential conflicts of interest.
影响因子：
120.7
作者：
Walkey, Allan J.;Wiener, Renda Soylemez;Ghobrial, Joanna M.;Curtis, Lesley H.;Benjamin, Emelia J.
通讯作者：
Benjamin, Emelia J.
影响因子：
4.8
作者：
Walkey, Allan J.;Greiner, Melissa A.;Heckbert, Susan R.;Jensen, Paul N.;Piccini, Jonathan P.;Sinner, Moritz F.;Curtis, Lesley H.;Benjamin, Emelia J.
通讯作者：
Benjamin, Emelia J.