登革热休克综合征(DSS)是严重登革热的主要临床表型之一。它被定义为显著的等离子体泄漏,导致血管内容量减少并最终导致心血管衰竭。代偿储备指数(CRI)是一种新的生理参数,从跟踪中心容积实时变化的脉搏动脉波形的特征分析中得出。我们调查了CRI预测ICU重症登革热患者复发性休克的实用性。
我们在热带病医院的儿科和成人重症监护病房进行了一项前瞻性观察研究,胡志明市,越南。每小时监测患者的临床参数和生命体征,除了使用脉搏血氧饱和度连续记录动脉波形。波形数据以无线方式传输到笔记本电脑,并与患者的临床数据同步。
本研究招募了一百三名疑似严重登革热的患者。63例患者具有分析所需的最低数据集。中位年龄为11岁(IQR8-14岁)。CRI与心率呈负相关,与血压呈中度负相关。发现CRI可以预测12小时内的反复休克(OR2.24,95%CI1.54-3.26),P<0.001)。从CRI测量到第一次复发性休克的中位持续时间为5.4h(IQR2.9-6.8)。CRI临界值0.4提供了预测复发性休克的敏感性和特异性的最佳组合(分别为0.66[95%CI0.47-0.85]和0.86[95%CI0.80-0.92])。
CRI是监测重症登革热患者血管内容量状态的一种有用的非侵入性方法。
Dengue shock syndrome (DSS) is one of the major clinical phenotypes of severe dengue. It is defined by significant plasma leak, leading to intravascular volume depletion and eventually cardiovascular collapse. The compensatory reserve Index (CRI) is a new physiological parameter, derived from feature analysis of the pulse arterial waveform that tracks real-time changes in central volume. We investigated the utility of CRI to predict recurrent shock in severe dengue patients admitted to the ICU.
We performed a prospective observational study in the pediatric and adult intensive care units at the Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam. Patients were monitored with hourly clinical parameters and vital signs, in addition to continuous recording of the arterial waveform using pulse oximetry. The waveform data was wirelessly transmitted to a laptop where it was synchronized with the patient\'s clinical data.
One hundred three patients with suspected severe dengue were recruited to this study. Sixty-three patients had the minimum required dataset for analysis. Median age was 11 years (IQR 8-14 years). CRI had a negative correlation with heart rate and moderate negative association with blood pressure. CRI was found to predict recurrent shock within 12 h of being measured (OR 2.24, 95% CI 1.54-3.26), P < 0.001). The median duration from CRI measurement to the first recurrent shock was 5.4 h (IQR 2.9-6.8). A CRI cutoff of 0.4 provided the best combination of sensitivity and specificity for predicting recurrent shock (0.66 [95% CI 0.47-0.85] and 0.86 [95% CI 0.80-0.92] respectively).
CRI is a useful non-invasive method for monitoring intravascular volume status in patients with severe dengue.