Radial artery pulse pressure variation correlates with brachial artery peak velocity variation in ventilated subjects when measured by internal medicine residents using hand-carried ultrasound devices
Radial artery pulse pressure variation correlates with brachial artery peak velocity variation in ventilated subjects when measured by internal medicine residents using hand-carried ultrasound devices
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DOI：
10.1378/chest.06-1768
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发表时间：
2007-05-01
期刊：
影响因子：
9.6
通讯作者：
Schmidt, Gregory A.
中科院分区：
文献类型：
--
作者：
Brennan, J. Matthew;Blair, John. E. A.;Schmidt, Gregory A.
背景：快速预测容量扩张对接受机械通气的不稳定患者至关重要。桡动脉脉压变化（Delta PP）和主动脉血流峰值速度的变化都是准确的预测指标，但可能不切实际的护理点工具。目的：我们试图确定内科住院医师使用带式超声（HCU）装置测量的肱动脉血流速度（Delta peak- ba）的呼吸变化是否可以为接受机械通气的患者提供Delta PP的准确推论。方法：选取30例经桡动脉导管被动接受容量控制通气的患者。肱动脉多普勒信号由盲法内科住院医师使用HCU装置记录和分析。同时桡动脉脉搏波和中心静脉压记录（如有）由一名盲法重症监护医师进行分析。结果：30例患者均获得多普勒信号。Delta peak- ba与Delta PP相关性良好（r = 0.84），具有极好的一致性（加权kappa为0.82）和有限的观察者内变异性（2.8 +/- 2.8%）[平均值：+/- SD]。δ峰值- ba截断值为16%，可高度预测δ PP >= 13%（敏感性91%，特异性95%）。CVP与Delta peak- ba （r = - 0.21）和Delta PP （r = - 0.16）之间存在较差的相关性。结论：内科住院医师使用HCU多普勒评估AVpeak-BA与Delta PP是一种快速、无创的床边相关性，AVpeak-BA截止值为16%可能被证明是一种预测接受机械通气患者容量反应性的护理点工具。
Background: Rapid prediction of the effect of volume expansion is crucial in unstable patients receiving mechanical ventilation. Both radial artery pulse pressure variation (Delta PP) and change of aortic blood flow peak velocity are accurate predictors but may be impractical point-of-care tools. Purpose: We sought to determine whether respiratory changes in the brachial artery blood flow velocity (Delta Vpeak-BA) as measured by internal medicine residents using a band-carried ultrasound (HCU) device could provide an accurate corollary to Delta PP in patients receiving mechanical ventilation.Methods: Thirty patients passively receiving volume-control ventilation with preexisting radial artery catheters were enrolled. The brachial artery Doppler signal was recorded and analyzed by blinded internal medicine residents using a HCU device. Simultaneous radial artery pulse wave and central venous pressure recordings (when available) were analyzed by a blinded critical care physician.Results: A Doppler signal was obtained in all 30 subjects. The Delta Vpeak-BA correlated well with Delta PP (r = 0.84) with excellent agreement (weighted kappa, 0.82) and limited intraobserver variability (2.8 +/- 2.8%) [mean: +/- SD]. A Delta Vpeak-BA cutoff of 16% was highly predictive of Delta PP >= 13% (sensitivity, 91%; specificity, 95%). A poor correlation existed between the CVP and both Delta Vpeak-BA (r = - 0.21) and Delta PP (r = - 0.16).Conclusions: The HCU Doppler assessment of the AVpeak-BA as performed by internal medicine residents is a rapid, noninvasive bedside correlate to Delta PP, and a AVpeak-BA cutoff of 16% may prove useful as a point-of-care tool for the prediction of volume responsiveness in patients receiving mechanical ventilation.