Impact of deep breathing on predictability of stroke volume variation in spontaneous breathing patients
Impact of deep breathing on predictability of stroke volume variation in spontaneous breathing patients
复制标题
DOI：
10.1111/aas.13541
复制
发表时间：
2020-01-22
影响因子：
2.1
通讯作者：
Nishikawa, Kiyonobu
中科院分区：
文献类型：
--
作者：
Mukai, Akira;Suehiro, Koichi;Nishikawa, Kiyonobu
背景本研究调查了深呼吸期间每搏输出量变异度（SVV）在自主呼吸患者中鉴别液体反应的能力。方法选择30例全麻患者，在麻醉诱导前进行评估。在正常呼吸期间，使用ClearSight系统测量血液动力学变量，包括每搏输出量（SV）和SVV。在这些测量之后，要求每名患者保持深呼吸（6次呼吸min（-1）），并记录血液动力学变量。然后，将检查床调整至头低脚高位（15度）2分钟，并测量血液动力学变量。针对正常和深呼吸期间的SVV以及正常和深呼吸之间的SVV差异（Δ SVV）创建受试者操作特征曲线，以区分流体响应者（改变位置后SV增加>10%）。使用Pearson相关系数检查SV增加和Δ SVV之间的相关性。灰色区域法用于评估血流动力学变量的不确定范围。结果受试者工作特征曲线分析显示，Delta SVV预测液体反应性的可靠性较好（AUC：0.850; 95% CI：0.672-0.953;阈值：4%，敏感性：75.0%，特异性：88.9%），而正常呼吸时SVV预测液体反应性的可靠性较差（AUC：0.579; 95% CI：0.386-0.756）。尽管深呼吸期间的SVV表现出可接受的可预测性（AUC：0.778; 95% CI：0.589-0.908），但灵敏度不佳（58.3%）。采用灰色区域方法，Delta SVV的不确定范围较小，范围为1.4%-4.2%（23%的患者）。结论深呼吸可提高自主呼吸患者动态指标的可靠性。试验注册UMIN-CTR，标识符：UMIN 000027970。
Background This study investigated the ability of stroke volume variation (SVV) during deep breathing to discriminate fluid responders among spontaneously breathing patients. Methods Thirty patients undergoing general anaesthesia were enrolled and assessed before anaesthetic induction. Haemodynamic variables, including stroke volume (SV) and SVV, were measured using the ClearSight system during normal breathing. After these measurements, each patient was required to maintain deep breathing (6 breaths min(-1)) and haemodynamic variables were recorded. Then, the table was adjusted to the Trendelenburg position (15 degrees) for 2 minutes, and haemodynamic variables were measured. Receiver operating characteristic curves were created for SVV during normal and deep breathing, and the difference in SVV between normal and deep breathing (Delta SVV) to discriminate fluid responders (SV increase >10% after changing position). The correlation between SV increase and Delta SVV was examined using Pearson's correlation coefficient. The grey zone approach was used to assess the inconclusive range of the haemodynamic variables. Results Receiver operating characteristic curve analysis indicated that Delta SVV showed good reliability in predicting fluid responsiveness (AUC: 0.850; 95% CI: 0.672-0.953; threshold: 4%, sensitivity: 75.0%, specificity: 88.9%], while SVV during normal breathing did not (AUC: 0.579; 95% CI: 0.386-0.756)]. Although SVV during deep breathing exhibited acceptable predictability (AUC: 0.778; 95% CI: 0.589-0.908), the sensitivity was not good (58.3%). With the grey zone approach, the inconclusive range of Delta SVV was small with the range of 1.4%-4.2% (23% of patients). Conclusion Deep breathing could improve the reliability of dynamic indices in spontaneously breathing patients. Trial registration UMIN-CTR, identifer: UMIN000027970.