Brachial artery peak velocity variation to predict fluid responsiveness in mechanically ventilated patients.
Brachial artery peak velocity variation to predict fluid responsiveness in mechanically ventilated patients.
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DOI：
10.1186/cc8027
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发表时间：
2009
期刊：
影响因子：
--
通讯作者：
Díaz Monrové JC
中科院分区：
文献类型：
--
作者：
Monge García MI;Gil Cano A;Díaz Monrové JC
尽管已经提出了几个参数来预测危重患者对液体扩张的血流动力学反应，但大多数参数都是侵入性的或需要使用特殊的监测设备。本研究的目的是确定使用多普勒超声测量的肱动脉峰值速度流量的无创评估是否可以预测机械通气患者的液体反应性。我们在一个拥有 17 个床位的多学科 ICU 中进行了一项前瞻性临床研究，纳入了 38 名机械通气患者，这些患者因存在急性循环衰竭而计划输液。使用 500 mL 合成胶体进行体积膨胀 (VE)。如果 VE 后每搏输出量指数 (SVi) 增加≥ 15%，则患者被归类为有反应者。 Vpeakbrach 的呼吸变化 (ΔVpeakbrach) 计算为单个呼吸周期内 Vpeakbrach 的最大值和最小值之间的差值，除以两个值的平均值，并以百分比表示。还计算了使用 FloTrac/Vigileo 系统测量的桡动脉压变化 (ΔPPrad) 和每搏输出量变化 (ΔSVVigileo)。 VE 使 19 名患者（应答者）的 SVi 增加 ≥ 15%。在基线时，有反应者的 ΔVpeakbrach、ΔPPrad 和 ΔSVVigileo 显着高于无反应患者 [14% vs 8%； 18% vs. 5%； 13% vs 8%； P < 0.0001，分别）。 ΔVpeakbrach 值 >10% 预测液体反应性，敏感性为 74%，特异性为 95%。 ΔPPrad 值 >10% 和 ΔSVVigileo >11% 预测容量反应性，灵敏度分别为 95% 和 79%，特异性为 95% 和 89%。肱动脉峰值速度的呼吸变化可能是机械通气支持和急性循环衰竭患者液体反应性无创评估的可行工具。 ClinicalTrials.gov ID：NCT00890071
Although several parameters have been proposed to predict the hemodynamic response to fluid expansion in critically ill patients, most of them are invasive or require the use of special monitoring devices. The aim of this study is to determine whether noninvasive evaluation of respiratory variation of brachial artery peak velocity flow measured using Doppler ultrasound could predict fluid responsiveness in mechanically ventilated patients. We conducted a prospective clinical research in a 17-bed multidisciplinary ICU and included 38 mechanically ventilated patients for whom fluid administration was planned due to the presence of acute circulatory failure. Volume expansion (VE) was performed with 500 mL of a synthetic colloid. Patients were classified as responders if stroke volume index (SVi) increased ≥ 15% after VE. The respiratory variation in Vpeakbrach (ΔVpeakbrach) was calculated as the difference between maximum and minimum values of Vpeakbrach over a single respiratory cycle, divided by the mean of the two values and expressed as a percentage. Radial arterial pressure variation (ΔPPrad) and stroke volume variation measured using the FloTrac/Vigileo system (ΔSVVigileo), were also calculated. VE increased SVi by ≥ 15% in 19 patients (responders). At baseline, ΔVpeakbrach, ΔPPrad and ΔSVVigileo were significantly higher in responder than nonresponder patients [14 vs 8%; 18 vs. 5%; 13 vs 8%; P < 0.0001, respectively). A ΔVpeakbrach value >10% predicted fluid responsiveness with a sensitivity of 74% and a specificity of 95%. A ΔPPrad value >10% and a ΔSVVigileo >11% predicted volume responsiveness with a sensitivity of 95% and 79%, and a specificity of 95% and 89%, respectively. Respiratory variations in brachial artery peak velocity could be a feasible tool for the noninvasive assessment of fluid responsiveness in patients with mechanical ventilatory support and acute circulatory failure. ClinicalTrials.gov ID: NCT00890071
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影响因子：
15.1
作者：
Hofer, Christoph K.;Senn, Alban;Weibel, Luc;Zollinger, Andreas
通讯作者：
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3.1
作者：
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通讯作者：
Manecke, Gerard R.