PDF(Pubmed)
Abstract：
BACKGROUND: The prediction of fluid responsiveness in critical patients helps clinicians in decision making to avoid either under- or overloading of fluid. This study was designed to determine whether lung recruitment maneuver (LRM) would have an effect on the predictability of fluid responsiveness by the changes of hemodynamic parameters in pediatric patients who were receiving lung-protective ventilation and one-lung ventilation (OLV).
METHODS: A total of 34 children, aged 1-6 years old, scheduled for heart surgeries via right thoracotomy were enrolled. Patients were anesthetized and OLV with lung-protection ventilation settings was established, and then, positioned on left lateral decubitus. LRM and volume expansion (VE) were performed in sequence. Heart rate (HR), systolic arterial pressure (SAP), mean arterial pressure (MAP) diastolic arterial pressure (DAP), stroke volume (SV), stroke volume variation (SVV), and pulse pressure variation (PPV) were recorded via an A-line based monitor system at the following time points: before and after LRM (T1 and T2) and before and after VE (T3 and T4). An increase in stroke volume (SV) or mean arterial pressure (MAP) of ≥10% following fluid loading identified fluid responders. The predictability of fluid responsiveness by the changes of SV (ΔSVLRM) and MAP (ΔMAPLRM) after LRM and VE were statistically evaluated by receiver operating characteristic curves [area under the curves (AUC)].
RESULTS: SVs in all patients were significantly decreased after LRM (p < 0.01) and then, increased and returned to baseline after VE (p < 0.01). In total, 16 out of 34 patients who were fluid responders had significantly lower SV after LRM compared to that in fluid non-responders. The area under the receiver operating characteristic curves for ΔSVLRM was 0.828 (95% confidence interval [CI], 0.660 to 0.935; p < 0.001) and it indicated that ΔSVLRM was able to predict the fluid responsiveness of pediatric patients. MAPs in all patients were also decreased significantly after LRM, and 12 of them fell into the category of fluid responders after VE. Statistically, ΔMAPLRM did not predict fluid responsiveness when LRM was considered as an influential factor (p = 0.07).
CONCLUSIONS: ΔSVLRM, but not ΔMAPLRM, showed great reliability in the prediction of the fluid responsiveness following VE in children during one-lung ventilation with lung-protective settings.
BACKGROUND: ChiCTR2300070690.
METHODS: A total of 34 children, aged 1-6 years old, scheduled for heart surgeries via right thoracotomy were enrolled. Patients were anesthetized and OLV with lung-protection ventilation settings was established, and then, positioned on left lateral decubitus. LRM and volume expansion (VE) were performed in sequence. Heart rate (HR), systolic arterial pressure (SAP), mean arterial pressure (MAP) diastolic arterial pressure (DAP), stroke volume (SV), stroke volume variation (SVV), and pulse pressure variation (PPV) were recorded via an A-line based monitor system at the following time points: before and after LRM (T1 and T2) and before and after VE (T3 and T4). An increase in stroke volume (SV) or mean arterial pressure (MAP) of ≥10% following fluid loading identified fluid responders. The predictability of fluid responsiveness by the changes of SV (ΔSVLRM) and MAP (ΔMAPLRM) after LRM and VE were statistically evaluated by receiver operating characteristic curves [area under the curves (AUC)].
RESULTS: SVs in all patients were significantly decreased after LRM (p < 0.01) and then, increased and returned to baseline after VE (p < 0.01). In total, 16 out of 34 patients who were fluid responders had significantly lower SV after LRM compared to that in fluid non-responders. The area under the receiver operating characteristic curves for ΔSVLRM was 0.828 (95% confidence interval [CI], 0.660 to 0.935; p < 0.001) and it indicated that ΔSVLRM was able to predict the fluid responsiveness of pediatric patients. MAPs in all patients were also decreased significantly after LRM, and 12 of them fell into the category of fluid responders after VE. Statistically, ΔMAPLRM did not predict fluid responsiveness when LRM was considered as an influential factor (p = 0.07).
CONCLUSIONS: ΔSVLRM, but not ΔMAPLRM, showed great reliability in the prediction of the fluid responsiveness following VE in children during one-lung ventilation with lung-protective settings.
BACKGROUND: ChiCTR2300070690.
摘要：
背景：预测危重患者的液体反应性有助于临床医生做出决策，以避免液体负荷不足或超负荷。这项研究旨在通过接受肺保护性通气和单肺通气（OLV）的儿科患者的血流动力学参数的变化来确定肺募集操作（LRM）是否会对液体反应性的可预测性产生影响。
方法：共有34名儿童，1-6岁,计划通过右胸切开术进行心脏手术。对患者进行麻醉，并建立具有肺保护通气设置的OLV，然后,位于左侧卧位。依次进行LRM和体积膨胀(VE)。心率(HR)收缩压（SAP），平均动脉压（MAP）舒张压（DAP），每搏输出量(SV),每搏输出量变化(SVV),通过基于A线的监测系统在以下时间点记录和脉压变化（PPV）：LRM之前和之后（T1和T2）以及VE之前和之后（T3和T4）。流体负荷确定的流体响应者后，每搏输出量（SV）或平均动脉压（MAP）增加≥10％。通过受试者工作特征曲线[曲线下面积（AUC）]对LRM和VE后SV（ΔSVLRM）和MAP（ΔMAPLRM）变化的液体反应性的可预测性进行了统计评估。
结果：所有患者的SVs在LRM后显著下降(p<0.01),VE后升高并恢复至基线(p<0.01)。总的来说,与液体无反应者相比，LRM后34例液体反应者中有16例的SV显着降低。ΔSVLRM的接收器工作特征曲线下面积为0.828(95%置信区间[CI],0.660至0.935；p<0.001），表明ΔSVLRM能够预测儿科患者的液体反应性。所有患者的MAP在LRM后也显著下降，其中12人属于VE后的液体反应者类别。统计上,当LRM被认为是影响因素时，ΔMAPLRM不能预测液体反应性（p=0.07）。
结论：ΔSVLRM，但不是ΔMAPLRM，在具有肺保护设置的单肺通气期间，对VE后儿童的液体反应性的预测显示出极大的可靠性。
背景：ChiCTR2300070690。
方法：共有34名儿童，1-6岁,计划通过右胸切开术进行心脏手术。对患者进行麻醉，并建立具有肺保护通气设置的OLV，然后,位于左侧卧位。依次进行LRM和体积膨胀(VE)。心率(HR)收缩压（SAP），平均动脉压（MAP）舒张压（DAP），每搏输出量(SV),每搏输出量变化(SVV),通过基于A线的监测系统在以下时间点记录和脉压变化（PPV）：LRM之前和之后（T1和T2）以及VE之前和之后（T3和T4）。流体负荷确定的流体响应者后，每搏输出量（SV）或平均动脉压（MAP）增加≥10％。通过受试者工作特征曲线[曲线下面积（AUC）]对LRM和VE后SV（ΔSVLRM）和MAP（ΔMAPLRM）变化的液体反应性的可预测性进行了统计评估。
结果：所有患者的SVs在LRM后显著下降(p<0.01),VE后升高并恢复至基线(p<0.01)。总的来说,与液体无反应者相比，LRM后34例液体反应者中有16例的SV显着降低。ΔSVLRM的接收器工作特征曲线下面积为0.828(95%置信区间[CI],0.660至0.935；p<0.001），表明ΔSVLRM能够预测儿科患者的液体反应性。所有患者的MAP在LRM后也显著下降，其中12人属于VE后的液体反应者类别。统计上,当LRM被认为是影响因素时，ΔMAPLRM不能预测液体反应性（p=0.07）。
结论：ΔSVLRM，但不是ΔMAPLRM，在具有肺保护设置的单肺通气期间，对VE后儿童的液体反应性的预测显示出极大的可靠性。
背景：ChiCTR2300070690。
