ALTERNATIVE METHODS TO CENTRAL VENOUS PRESSURE FOR ASSESSING VOLUME STATUS IN CRITICALLY ILL PATIENTS
ALTERNATIVE METHODS TO CENTRAL VENOUS PRESSURE FOR ASSESSING VOLUME STATUS IN CRITICALLY ILL PATIENTS
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DOI：
10.1016/j.jen.2012.04.018
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发表时间：
2014-03-01
影响因子：
1.7
通讯作者：
Denninghoff, Kurt R.
中科院分区：
文献类型：
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作者：
Stoneking, Lisa;DeLuca, Lawrence A., Jr.;Denninghoff, Kurt R.
早期目标导向治疗可提高脓毒症患者的生存率，但需要放置中心静脉导管。我们评估了测量中心静脉压（CVP）来评估容积状态的替代方法，包括外周静脉压（PVP）和卒中容积变化（SVV），这可能有助于护士驱动的复苏方案。方法：患者入组于某学术医疗中心急诊科或ICU。在1小时内测量并记录CVP、PVP、SVV、肩肘位置以及清醒、运动和通气的二分类变量7次。采用回归分析预测PVP和/或SVV、肩/肘位置和二分类变量的CVP。结果：20例患者入组，其中20例有PVP测量，11例有SVV测量。多元回归分析显示，PVP （CVP = 6.7701 + 0.2312 × PVP - 0.1288 ×肩部+ 12.127 ×运动- 4.4805 ×颈线）、SVV （CVP = 14.578 - 0.3951 × SVV + 18.113 ×运动）和SVV与PVP （CVP = 4.2997 - 1.1675 × SVV + 0.3866 × PVP + 18.246 × Awake + 0.1467 ×肩部= 0.4525 ×肘部+ 15.472 ×脚线+ 10.202 ×臂线）对CVP有显著的预测关系。讨论：PVP和SVV是CVP较好的预测指标。结合PVP和SVV，加入与体位、运动、通气、睡眠/清醒状态相关的变量，进一步提高了模型的预测价值。这些模型说明了标准化患者体位、减少运动和将静脉注射线放置在上肢或颈部近端的重要性。
Introduction: Early goal-directed therapy increases survival in persons with sepsis but requires placement of a central line. We evaluate alternative methods to measuring central venous pressure (CVP) to assess volume status, including peripheral venous pressure (PVP) and stroke volume variation (SVV), which may facilitate nurse-driven resuscitation protocols.Methods: Patients were enrolled in the emergency department or ICU of an academic medical center. Measurements of CVP, PVP, SVV, shoulder and elbow position, and dichotomous variables Awake, Movement, and Vented were measured and recorded 7 times during a 1-hour period. Regression analysis was used to predict CVP from PVP and/or SVV, shoulder/elbow position, and dichotomous variables.Results: Twenty patients were enrolled, of which 20 had PVP measurements and 11 also had SVV measurements. Multiple regression analysis demonstrated significant predictive relationships for CVP using PVP (CVP = 6.7701 + 0.2312 x PVP - 0.1288 x Shoulder + 12.127 x Movement - 4.4805 x Neck line), SVV (CVP = 14.578 - 0.3951 x SVV + 18.113 x Movement), and SVV and PVP (CVP = 4.2997 - 1.1675 x SVV + 0.3866 x PVP + 18.246 x Awake + 0.1467 x Shoulder = 0.4525 x Elbow + 15.472 x Foot line + 10.202 x Arm line).Discussion: PVP and SVV are moderately good predictors of CVP. Combining PVP and SVV and adding variables related to body position, movement, ventilation, and sleep/wake state further improves the predictive value of the model. The models illustrate the importance of standardizing patient position, minimizing movement, and placing intravenous lines proximally in the upper extremity or neck.