PDF(Pubmed)
Abstract：
Evaluating fluid responsiveness with dynamic parameters is recommended for fluid management. However, in hemodynamically stable patients who are breathing spontaneously, accurately measuring stroke volume variation via echocardiography and passive leg raising is challenging due to subtle SV changes. This study aimed to identify normal SV changes in healthy volunteers and evaluate the precision of hemodynamic parameters in screening mild hypovolemia in patients. This prospective, repeated-measures, cross-sectional study screened 269 subjects via echocardiography. Initially, 45 healthy volunteers underwent a fluid challenge test, the outcomes of which served as criteria to screen 215 ICU patients. Among these patients, 53 underwent additional fluid challenge testing. Hemodynamic parameters, including medians of maximum velocity time integrals (VTImaxs), peak velocity of VTImax (PV), internal jugular vein diameters (IJVD), and area (IJVA) were repeatedly measured first at a 60° upper body elevation (UBE), second in a supine position, third at UBE, fourth in a supine position, and lastly in a supine position after fluid loading. The hemodynamic responses to the position changes were compared between 83 fluid non-responders and 15 fluid responders. Fluid responsiveness was defined as fluid-induced medians\' change of VTImaxs (fluid-induced median VTImax change) ≥ 10%. None of the healthy volunteers showed the mean value of repeatedly measured medians of VTImaxs ≥ 7%, following either UBE position (UBE-induced median VTImax change) or fluid loading (fluid-induced median VTImax change). UBE-induced median VTImax and PV changes were significantly correlated with fluid responsiveness (p < 0.001, AUC 0.959; p < 0.001, AUC 0.804). The significant correlations were demonstrated via multivariable analysis using binary logistic regression (p = 0.001, OR 90.1) and the correlation coefficient (R2 = 0.793) using linear regression analysis. UBE-induced median VTImax changes (≥ 11.8% and 7.98%) predicted fluid-induced median VTImax changes ≥ 10% and 7% (AUC 0.959 and 0.939). The collapsibility and variation of IJVD and IJVA showed no significant correlation. An increase in the mean value of medians of repeatedly measured VTImaxs transitioning from an UBE to a supine position, effectively screened mild hypovolemia and demonstrated a significant correlation with fluid responsiveness in spontaneously breathing patients maintaining hemodynamic stability.
摘要：
对于流体管理，建议使用动态参数评估流体响应性。然而,血流动力学稳定的患者自主呼吸，通过超声心动图和被动抬腿精确测量每搏量的变化是具有挑战性的，由于细微的SV变化。本研究旨在确定健康志愿者的正常SV变化，并评估血液动力学参数在筛查轻度低血容量患者中的准确性。这个未来,重复措施，横断面研究通过超声心动图筛选了269名受试者。最初，45名健康志愿者接受了液体挑战测试，其结局作为筛查215例ICU患者的标准.在这些患者中,53人接受了额外的流体挑战测试。血流动力学参数,包括最大速度时间积分(VTImaxs)的中位数，VTImax(PV)的峰值速度，颈内静脉直径（IJVD），首先在60°的上身高度（UBE）下重复测量面积（IJVA），第二个仰卧位，第三在UBE，第四个仰卧位，最后在液体加载后处于仰卧位。比较了83名液体无反应者和15名液体反应者对位置变化的血液动力学反应。流体反应性定义为流体诱导的VTImax中位数变化(流体诱导的VTImax中位数变化)≥10%。没有健康志愿者显示重复测量的VTImaxs中位数的平均值≥7%，在UBE位置（UBE引起的VTImax中位数变化）或流体负荷（流体引起的VTImax中位数变化）之后。UBE诱导的中位VTImax和PV变化与液体反应性显着相关（p<0.001，AUC0.959；p<0.001，AUC0.804）。通过使用二元逻辑回归（p=0.001，OR90.1）的多变量分析和使用线性回归分析的相关系数（R2=0.793）证明了显着的相关性。UBE诱导的VTImax中位数变化（≥11.8％和7.98％）预测液体诱导的VTImax中位数变化≥10％和7％（AUC0.959和0.939）。IJVD与IJVA的塌陷性和变异无显著相干性。重复测量的VTImaxs从UBE过渡到仰卧位的中位数增加，在维持血流动力学稳定的自主呼吸患者中，有效筛查轻度低血容量，并证明与液体反应性显着相关。
