High Central Venous Pressure and Right Ventricle Size Are Related to Non-decreased Left Ventricle Stroke Volume After Negative Fluid Balance in Critically Ill Patients: A Single Prospective Observational Study.
High Central Venous Pressure and Right Ventricle Size Are Related to Non-decreased Left Ventricle Stroke Volume After Negative Fluid Balance in Critically Ill Patients: A Single Prospective Observational Study.
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DOI：
10.3389/fmed.2021.715099
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发表时间：
2021
影响因子：
3.9
通讯作者：
Dawei L
中科院分区：
文献类型：
--
作者：
Hua Z;Xin D;Xiaoting W;Dawei L
背景：心脏前负荷的最佳调节对于改善左心室每搏输出量（LVSV）和组织灌注至关重要。中心静脉压（CVP）引起的LVSV变化是危重患者治疗中最重要的问题。目的：本研究旨在探讨CVP升高患者液体负平衡后LVSV的变化，以及右心室充盈状态参数与LVSV变化的关系。研究方法：本前瞻性队列研究纳入了北京协和医院重症医学科ICU入院24 h内中心静脉压（CVP）较高（≥8 mmHg）的患者。根据液体负平衡后LVSV的变化将患者分为两组。临界值为10%。记录两组患者术前及液体负平衡后的血流动力学及超声心动图参数。结果：共纳入71例患者。VI组（LVOT VTI增加≥10%）40例，VNI组（LVOT VTI增加<10%）31例。在所有患者中，56.3%的患者在液体负平衡后出现LVSV增加。在T0时的血流动力学参数方面，VI组患者的CVP较高（p < 0.001）和P（v-a）CO2（p < 0.001）和较低的ScVO 2（p < 0.001）相对于VNI组，关于T0时的回波参数，RVD/LVD比值VI组患者的DIVC（p <0.001）、DIVC呼气末（p < 0.001）和ΔLVOT VTI（p < 0.001）较高，而T0 LVOT VTI（p < 0.001）较低。多因素Logistic回归分析显示，CVP和RVD/LVD比值≥0.6与危重患者液体负平衡后LVSV增加显著相关。CVP的AUC为0.894。中心静脉压> 10.5mmHg的敏感性为87.5%，特异性为77.4%。CVP的AUC结合RVD/LVD比值≥0.6为0.926，其敏感性为92.6%，特异性为80.4%。结论：CVP和RVD/LVD比值≥0.6与危重患者RV应激显著相关。液体负平衡并不总是导致这些患者的LVSV降低，甚至增加。
Background: Optimal adjustment of cardiac preload is essential for improving left ventricle stroke volume (LVSV) and tissue perfusion. Changes in LVSV caused by central venous pressure (CVP) are the most important concerns in the treatment of critically ill patients. Objectives: This study aimed to clarify the changes in LVSV after negative fluid balance in patients with elevated CVP, and to elucidate the relationship between the parameters of right ventricle (RV) filling state and LVSV changes. Methods: This prospective cohort study included patients with high central venous pressure (CVP) (≥8 mmHg) within 24 h of ICU admission in the Critical Medicine Department of Peking Union Medical College Hospital. Patients were classified into two groups based on the LVSV changes after negative fluid balance. The cutoff value was 10%. The hemodynamic and echo parameters of the two groups were recorded at baseline and after negative fluid balance. Results: A total of 71 patients included in this study. Forty in VI Group (LVOT VTI increased ≥10%) and 31 in VNI Group (LVOT VTI increased <10%). Of all patients, 56.3% showed increased LVSV after negative fluid balance. In terms of hemodynamic parameters at T0, patients in VI Group had a higher CVP (p < 0.001) and P(v-a)CO2 (p < 0.001) and lower ScVO2 (p < 0.001) relative to VNI Group, regarding the echo parameters at T0, the RVD/LVD ratio (p < 0.001), DIVC end−expiratory (p < 0.001), and ΔLVOT VTI (p < 0.001) were higher, while T0 LVOT VTI (p < 0.001) was lower, in VI Group patients. The multifactor logistic regression analysis suggested that a high CVP and RVD/LVD ratio ≥0.6 were significant associated with LVSV increase after negative fluid balance in critically patients. The AUC of CVP was 0.894. A CVP >10.5 mmHg provided a sensitivity of 87.5% and a specificity of 77.4%. The AUC of CVP combined with the RVD/LVD ratio ≥0.6 was 0.926, which provided a sensitivity of 92.6% and a specificity of 80.4%. Conclusion: High CVP and RVD/LVD ratio ≥0.6 were significant associated with RV stressed in critically patients. Negative fluid balance will not always lead to a decrease, even an increase, in LVSV in these patients.
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影响因子：
8.1
作者：
Meyer G;Vieillard-Baron A;Planquette B
通讯作者：
Planquette B
影响因子：
158.5
作者：
Rivers, E;Nguyen, B;Tomlanovich, M
通讯作者：
Tomlanovich, M
DOI：
10.1186/s13054-015-0970-1
发表时间：
2015-06-15
期刊：
Critical care (London, England)
影响因子：
--
作者：
Acheampong A;Vincent JL
通讯作者：
Vincent JL
DOI：
10.1016/j.echo.2013.06.004
发表时间：
2013-09-01
影响因子：
6.5
作者：
Beigel, Roy;Cercek, Bojan;Siegel, Robert J.
通讯作者：
Siegel, Robert J.
DOI：
10.1186/s13054-016-1440-0
发表时间：
2016-09-10
期刊：
Critical care (London, England)
影响因子：
--
作者：
Pinsky MR
通讯作者：
Pinsky MR