Dynamic arterial elastance to predict arterial pressure response to volume loading in preload-dependent patients.
Dynamic arterial elastance to predict arterial pressure response to volume loading in preload-dependent patients.
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DOI：
10.1186/cc9420
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发表时间：
2011
期刊：
影响因子：
--
通讯作者：
Gracia Romero M
中科院分区：
文献类型：
--
作者：
Monge García MI;Gil Cano A;Gracia Romero M
血流动力学复苏的目的不仅是要达到足够的心输出量，而且要达到足够的平均动脉压（MAP），以保证足够的组织灌注压。由于动脉压对容积扩张（VE）的反应取决于动脉张力，因此了解患者是否为前负荷依赖性仅提供了问题的部分解决方案。本研究的目的是评估通过动态动脉弹性（Eadyn）（定义为脉压变异（PPV）与每搏输出量变异（SVV）的比值）对动脉张力进行功能评价的能力，以预测急性循环衰竭的扩张性、前负荷依赖性患者MAP对液体给药的血流动力学反应。我们在三级护理教学医院的成人内科/外科重症监护室进行了一项前瞻性临床研究，包括25例使用Vigileo®监护仪进行监测的受控机械通气患者，由于存在急性循环衰竭而决定给予液体，包括动脉低血压（MAP ≤65 mmHg或收缩期动脉压<90 mmHg）和前负荷反应性保留条件，定义为SVV值≥ 10%。输液前，MAP应答者（VE后MAP升高≥15%）和MAP无应答者之间的Eadyn有显著差异。VE诱导的MAP升高与基线Eadyn密切相关（r2 = 0.83; P < 0.0001）。MAP升高的唯一预测因子是Eadyn（曲线下面积，0.986 ± 0.02; 95%置信区间（CI），0.84-1）。基线Eadyn值>0.89预测输液后MAP增加，灵敏度为93.75%（95%CI，69.8%-99.8%），特异性为100%（95%CI，66.4%-100%）。由Eadyn进行的动脉张力功能评估（PVV与SVV的比值）可预测控制机械通气下扩张性、前负荷依赖性患者容量负荷后的动脉压反应。
Hemodynamic resuscitation should be aimed at achieving not only adequate cardiac output but also sufficient mean arterial pressure (MAP) to guarantee adequate tissue perfusion pressure. Since the arterial pressure response to volume expansion (VE) depends on arterial tone, knowing whether a patient is preload-dependent provides only a partial solution to the problem. The objective of this study was to assess the ability of a functional evaluation of arterial tone by dynamic arterial elastance (Eadyn), defined as the pulse pressure variation (PPV) to stroke volume variation (SVV) ratio, to predict the hemodynamic response in MAP to fluid administration in hypotensive, preload-dependent patients with acute circulatory failure. We performed a prospective clinical study in an adult medical/surgical intensive care unit in a tertiary care teaching hospital, including 25 patients with controlled mechanical ventilation who were monitored with the Vigileo® monitor, for whom the decision to give fluids was made because of the presence of acute circulatory failure, including arterial hypotension (MAP ≤65 mmHg or systolic arterial pressure <90 mmHg) and preserved preload responsiveness condition, defined as a SVV value ≥10%. Before fluid infusion, Eadyn was significantly different between MAP responders (MAP increase ≥15% after VE) and MAP nonresponders. VE-induced increases in MAP were strongly correlated with baseline Eadyn (r2 = 0.83; P < 0.0001). The only predictor of MAP increase was Eadyn (area under the curve, 0.986 ± 0.02; 95% confidence interval (CI), 0.84-1). A baseline Eadyn value >0.89 predicted a MAP increase after fluid administration with a sensitivity of 93.75% (95% CI, 69.8%-99.8%) and a specificity of 100% (95% CI, 66.4%-100%). Functional assessment of arterial tone by Eadyn, measured as the PVV to SVV ratio, predicted arterial pressure response after volume loading in hypotensive, preload-dependent patients under controlled mechanical ventilation.
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DOI：
10.1186/cc8027
发表时间：
2009
期刊：
Critical care (London, England)
影响因子：
--
作者：
Monge García MI;Gil Cano A;Díaz Monrové JC
通讯作者：
Díaz Monrové JC
影响因子：
38.9
作者：
Antonelli, Massimo;Levy, Mitchell;Torres, Antoni
通讯作者：
Torres, Antoni
DOI：
10.1002/ccd.1810120604
发表时间：
1986-01-01
期刊：
CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS
影响因子：
--
作者：
FERGUSON, JJ;RANDALL, OS
通讯作者：
RANDALL, OS
影响因子：
4.9
作者：
Palmieri, V;Bella, JN;Devereux, RB
通讯作者：
Devereux, RB
影响因子：
8.3
作者：
Alfie, J;Waisman, GD;Cámera, MI
通讯作者：
Cámera, MI