PDF(Pubmed)
Abstract：
UNASSIGNED: The prediction of fluid responsiveness is crucial for the fluid management of septic shock patients. This prospective, observational study was conducted to compare end-tidal carbon dioxide (ETCO2) change due to fluid challenge (FC-induced ΔETCO2) versus internal jugular vein distensibility index (IJVDI) as predictors of fluid responsiveness in such patients.
UNASSIGNED: Septic hypoperfused mechanically ventilated patients were classified as fluid responders (Rs) and non-responders (NRs) according to the improvement of left ventricular outflow tract-velocity time integral (ΔLVOT-VTI) after fluid challenge (FC). The receiver operating characteristic (ROC) curves of FC-induced ΔETCO2, pre-(FC) IJVDI and their combination for prediction of fluid responsiveness were compared to that of ΔLVOT-VTI% as a gold standard.
UNASSIGNED: Of 140 patients who completed the study, 51 (36.4%) patients were classified as Rs and 89 (63.6%) patients as NRs. With regard to the prediction of fluid responsiveness, no significant difference (P. 0. 384) was found between the diagnostic accuracy of FC-induced ΔETCO2 >2 mmHg (area under the ROC curve [AUC] 0.908, P < 0.001) and that of pre-(FC) IJVDI >18% (AUC 0.938, P < 0.001), but a prediction model combining both markers, ΔETCO2 ≥3 mmHg and IJVDI ≥16%, achieved significantly higher accuracy (AUC 0.982, P < 0.001) than each independent one (P < 0.05).
UNASSIGNED: Under stable ventilatory and metabolic conditions, the predictivity of FC-induced ΔETCO2 >2 mmHg can be comparable to that of pre-(FC) IJVDI >18%. A predictive model combining both FC-induced ΔETCO2 ≥3 mmHg and IJVDI ≥16% can provide higher accuracy than that recorded for each one independently.
UNASSIGNED: Septic hypoperfused mechanically ventilated patients were classified as fluid responders (Rs) and non-responders (NRs) according to the improvement of left ventricular outflow tract-velocity time integral (ΔLVOT-VTI) after fluid challenge (FC). The receiver operating characteristic (ROC) curves of FC-induced ΔETCO2, pre-(FC) IJVDI and their combination for prediction of fluid responsiveness were compared to that of ΔLVOT-VTI% as a gold standard.
UNASSIGNED: Of 140 patients who completed the study, 51 (36.4%) patients were classified as Rs and 89 (63.6%) patients as NRs. With regard to the prediction of fluid responsiveness, no significant difference (P. 0. 384) was found between the diagnostic accuracy of FC-induced ΔETCO2 >2 mmHg (area under the ROC curve [AUC] 0.908, P < 0.001) and that of pre-(FC) IJVDI >18% (AUC 0.938, P < 0.001), but a prediction model combining both markers, ΔETCO2 ≥3 mmHg and IJVDI ≥16%, achieved significantly higher accuracy (AUC 0.982, P < 0.001) than each independent one (P < 0.05).
UNASSIGNED: Under stable ventilatory and metabolic conditions, the predictivity of FC-induced ΔETCO2 >2 mmHg can be comparable to that of pre-(FC) IJVDI >18%. A predictive model combining both FC-induced ΔETCO2 ≥3 mmHg and IJVDI ≥16% can provide higher accuracy than that recorded for each one independently.
摘要：
■液体反应性的预测对于感染性休克患者的液体管理至关重要。这个未来,进行了观察性研究，以比较潮气末二氧化碳（ETCO2）由于液体挑战（FC诱导的ΔETCO2）和颈内静脉扩张指数（IJVDI）引起的变化，作为此类患者液体反应性的预测因子。
■根据液体攻击（FC）后左心室流出道速度时间积分（ΔLVOT-VTI）的改善，将脓毒症低灌注机械通气患者分为液体反应者（Rs）和无反应者（NRs）。将FC诱导的ΔETCO2，pre（FC）IJVDI及其组合用于预测流体响应性的受试者工作特性（ROC）曲线与作为金标准的ΔLVOT-VTI％进行了比较。
■在完成研究的140名患者中，51例（36.4%）患者被归类为Rs，89例（63.6%）患者被归类为NRs。关于流体响应性的预测，无显著差异(P.0.384）在FC诱导的ΔETCO2>2mmHg（ROC曲线下面积[AUC]0.908，P<0.001）和前（FC）IJVDI>18％（AUC0.938，P<0.001）的诊断准确性之间发现，但是结合了两个标记的预测模型，ΔETCO2≥3mmHg,IJVDI≥16%,取得了显着更高的准确性（AUC0.982，P<0.001）比每个独立的（P<0.05）。
■在稳定的通气和代谢条件下，FC诱导的ΔETCO2>2mmHg的预测值可与（FC）IJVDI>18％的预测值相当。结合FC诱导的ΔETCO2≥3mmHg和IJVDI≥16％的预测模型可以提供比每个独立记录的更高的准确性。
■根据液体攻击（FC）后左心室流出道速度时间积分（ΔLVOT-VTI）的改善，将脓毒症低灌注机械通气患者分为液体反应者（Rs）和无反应者（NRs）。将FC诱导的ΔETCO2，pre（FC）IJVDI及其组合用于预测流体响应性的受试者工作特性（ROC）曲线与作为金标准的ΔLVOT-VTI％进行了比较。
■在完成研究的140名患者中，51例（36.4%）患者被归类为Rs，89例（63.6%）患者被归类为NRs。关于流体响应性的预测，无显著差异(P.0.384）在FC诱导的ΔETCO2>2mmHg（ROC曲线下面积[AUC]0.908，P<0.001）和前（FC）IJVDI>18％（AUC0.938，P<0.001）的诊断准确性之间发现，但是结合了两个标记的预测模型，ΔETCO2≥3mmHg,IJVDI≥16%,取得了显着更高的准确性（AUC0.982，P<0.001）比每个独立的（P<0.05）。
■在稳定的通气和代谢条件下，FC诱导的ΔETCO2>2mmHg的预测值可与（FC）IJVDI>18％的预测值相当。结合FC诱导的ΔETCO2≥3mmHg和IJVDI≥16％的预测模型可以提供比每个独立记录的更高的准确性。
