The influence of venovenous renal replacement therapy on measurements by the transpulmonary thermodilution technique
The influence of venovenous renal replacement therapy on measurements by the transpulmonary thermodilution technique
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DOI：
10.1213/01.ane.0000280440.08530.fb
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发表时间：
2007-10-01
影响因子：
5.7
通讯作者：
Wegscheider, Karl
中科院分区：
文献类型：
--
作者：
Sakka, Samir G.;Hanusch, Tino;Wegscheider, Karl
背景：经肺热稀释技术已被建议用于危重患者的扩展血流动力学监测。然而，其中许多患者还需要肾脏替代治疗（RRT）。因此，我们分析了静脉-静脉RRT对心脏指数(0)、胸内血容量指数（ITBVI）和血管外肺水指数（EVLWI）测量的影响。方法：我们研究了连续24例危重患者（15例男性，9例女性，年龄39-81岁，平均62岁），他们接受了临床指状5F股动脉导管（PV2015L20，德国普勒斯医疗系统公司），并连接到监护仪（PiCCOplus，德国普勒斯医疗系统公司）。12F透析导管（Trilyse Expert, Vygon）从股静脉进入下腔静脉（n = 12）或置入上腔静脉（n = 12）。患者持续接受肝素抗凝治疗。血液动力学测量一式三份，分别在RRT期间、RRT短暂中断期间（断开连接，不重新输血）和重新连接后立即进行中心静脉注射生理盐水（15 mL, < 8℃）。呼吸机设置、液体状态和血管活性药物保持不变。结果：RRT与Cl（平均变化，-0.1 L/min/m(2), P = 0.003）和ITBVI（平均变化，-18 mL/m(2), P = 0.02）显著变化相关，而EVLWI不受影响（平均变化，+0.1 mL/kg, P = 0.42）。两亚组RRT对Cl、ITBVI、EVLWI的影响无统计学差异。结论：RRT对脓毒症和维持心排血量患者的Cl、ITBVI和EVLWI测量无临床相关影响。此外，透析导管尖端位置在这些条件下的影响没有显著差异。
BACKGROUND: Use of the transpulmonary thermodilution technique has been suggested for extended hemodynamic monitoring in critically ill patients. However, many of these patients also require renal replacement therapy (RRT). Therefore, we analyzed the influence of venovenous RRT on measurement of cardiac index (0), intrathoracic blood volume index (ITBVI), and extravascular lung water index (EVLWI).METHODS: We studied 24 consecutive critically ill patients (15 mates, 9 females; age 39-81, mean 62 yr) who had received a clinically indicated 5F femoral arterial, catheter (PV2015L20, Pulsion Medical Systems, Germany), which was connected to a monitor (PiCCOplus, Pulsion Medical Systems, Germany). A 12F dialysis catheter (Trilyse Expert, Vygon) was either advanced from the vena femoralis into the vena cava inferior (n = 12) or placed into the superior vena cava (n = 12). Patients continuously received heparin for anticoagulation. Hemodynamic measurements were performed in triplicate by central venous injection of, saline (15 mL, < 8 degrees C during RRT, during a brief interruption in RRT (by disconnection, without retransfusion), and immediately after reconnection. Ventilator settings, fluid status, and vasoactive drugs remained unchanged.RESULTS: RRT was associated with significant changes in Cl (mean change, -0.1 L/min/m(2), P = 0.003) and ITBVI (mean change, -18 mL/m(2), P = 0.02), whereas EVLWI was unaffected (mean change, +0.1 mL/kg, P = 0.42). The influence of RRT on Cl, ITBVI, and EVLWI was not statistically different in both subgroups.CONCLUSIONS: RRT had no clinically relevant effect on measurement of Cl, ITBVI, and EVLWI in patients with sepsis and maintained cardiac output. Furthermore, the dialysis catheter tip position had no significantly different influence under these conditions.