Uncalibrated pulse contour-derived stroke volume variation predicts fluid responsiveness in mechanically ventilated patients undergoing liver transplantation
Uncalibrated pulse contour-derived stroke volume variation predicts fluid responsiveness in mechanically ventilated patients undergoing liver transplantation
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DOI：
10.1093/bja/aen277
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发表时间：
2008-12-01
影响因子：
9.8
通讯作者：
Sztark, F.
中科院分区：
文献类型：
--
作者：
Biais, M.;Nouette-Gaulain, K.;Sztark, F.
每搏输出量变异度（SVV）能够充分预测个体对液体负荷的反应。我们的目的是评估一种新的算法（Vigileo（TM）; Flotrac（TM））测量的SVV是否可以预测液体反应性。在20 min内用白蛋白（4%）20 ml × BMI进行VE。在VE之前和之后立即测量SVV、脉压变异度（PPV）、中心静脉压（CVP）和肺动脉闭塞压（PAOP）。通过经胸超声心动图（CO-TTE）测量的心输出量（CO）用于定义VE后CO增加15%或更多的应答患者，或非应答患者。还记录了使用肺动脉导管（CO-PAC）和Vigileo（CO-Vigileo）获得的CO。排除了5名患者。17例患者为应答者（Rs），18例为无应答者（NR）。在VE之前，（i）RS的SVV和PPV较高，（ii）RS的CVP和PAOP较低。基线SVV和PPV与VE引起的CO变化相关（分别为r（2）=0.72，P < 0.0001; r（2）=0.84，P < 0.0001）。SVV阈值> 10%区分Rs的灵敏度为94%，特异性为94%。VE后SVV的降低与CO的升高呈显著正相关（r（2）=0.51; P < 0.0001）。SVV和PPV的ROC曲线下面积无差异。VE后CO-Vigileo变化与CO-TTE变化（r（2）=0.74，P < 0.0001）和CO-PAC变化（r（2）=0.77，P < 0.0001）密切相关，Vigileo系统测定的SVV可作为肝移植术后循环衰竭患者液体反应性的预测指标。CO-Vigileo能够跟踪VE诱导的CO变化。
Stroke volume variation (SVV) is able to predict adequately the individual response to fluid loading. Our objective was to assess whether the SVV measured by a new algorithm (Vigileo (TM); Flotrac (TM)) can predict fluid responsiveness.Forty mechanically ventilated patients undergoing liver transplantation, who needed volume expansion (VE), were included. VE was done with albumin (4%) 20 mlxBMI over 20 min. SVV, pulse pressure variation (PPV), central venous pressure (CVP), and pulmonary artery occlusion pressure (PAOP) were measured immediately before and after VE. Cardiac output (CO) measured by transthoracic echocardiography (CO-TTE) was used to define responder patients if CO increased by 15% or more after VE, or non-responder otherwise. CO obtained with the pulmonary artery catheter (CO-PAC) and with Vigileo (CO-Vigileo) were also recorded.Five patients were excluded. Seventeen patients were responders (Rs) and 18 were non-responders (NRs). Before VE (i) SVV and PPV were higher in Rs and (ii) CVP and PAOP were lower in Rs. Baseline SVV and PPV correlated with change in CO induced by VE (respectively, r(2)=0.72, P < 0.0001; r(2)=0.84, P < 0.0001). An SVV threshold of > 10% discriminated Rs with a sensitivity of 94% and a specificity of 94%. After VE, the decrease in SVV was significantly correlated with the increase in CO (r(2)=0.51; P < 0.0001). There was no difference between the area under the ROC curves of SVV and PPV. After VE, the change in CO-Vigileo was closely correlated with change in CO-TTE (r(2)=0.74, P < 0.0001) and with change in CO-PAC (r(2)=0.77, P < 0.0001).The SVV obtained by the Vigileo system may be used as a predictor of fluid responsiveness in patients with circulatory failure after liver transplantation. CO-Vigileo is able to track the change in CO induced by VE.