当前位置: X-MOL 学术Br. J. Anaesth. › 论文详情
Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)
Passive leg raising-induced changes in pulse pressure variation to assess fluid responsiveness in mechanically ventilated patients: a multicentre prospective observational study
British Journal of Anaesthesia ( IF 9.8 ) Pub Date : 2022-07-14 , DOI: 10.1016/j.bja.2022.04.031
Jihad Mallat 1 , Marc-Olivier Fischer 2 , Maxime Granier 3 , Christophe Vinsonneau 4 , Marie Jonard 5 , Yazine Mahjoub 6 , Fawzi Ali Baghdadi 7 , Sébastien Préau 8 , Fabien Poher 9 , Olivier Rebet 10 , Belaid Bouhemad 11 , Malcolm Lemyze 3 , Mehdi Marzouk 4 , Emmanuel Besnier 12 , Fadi Hamed 13 , Nadeem Rahman 13 , Osama Abou-Arab 14 , Pierre-Grégoire Guinot 15
Affiliation  

Background

Passive leg raising-induced changes in cardiac index can be used to predict fluid responsiveness. We investigated whether passive leg raising-induced changes in pulse pressure variation (ΔPPVPLR) can also predict fluid responsiveness in mechanically ventilated patients.

Methods

In this multicentre prospective observational study, we included 270 critically ill patients on mechanical ventilation in whom volume expansion was indicated because of acute circulatory failure. We did not include patients with cardiac arrythmias. Cardiac index and PPV were measured before/during a passive leg raising test and before/after volume expansion. A volume expansion-induced increase in cardiac index of >15% defined fluid responsiveness. To investigate whether ΔPPVPLR can predict fluid responsiveness, we determined areas under the receiver operating characteristic curves (AUROCs) and grey zones for relative and absolute ΔPPVPLR.

Results

Of the 270 patients, 238 (88%) were on controlled mechanical ventilation with no spontaneous breathing activity and 32 (12%) were on pressure support ventilation. The median tidal volume was 7.1 (inter-quartile range [IQR], 6.6–7.6) ml kg−1 ideal body weight. One hundred sixty-four patients (61%) were fluid responders. Relative and absolute ΔPPVPLR predicted fluid responsiveness with an AUROC of 0.92 (95% confidence interval [95% CI], 0.88–0.95; P<0.001) each. The grey zone for relative and absolute ΔPPVPLR included 4.8% and 22.6% of patients, respectively. These results were not affected by ventilatory mode and baseline characteristics (type of shock, centre, vasoactive treatment).

Conclusions

Passive leg raising-induced changes in pulse pressure variation accurately predict fluid responsiveness with a small grey zone in critically ill patients on mechanical ventilation.

Clinical trial registration

NCT 03225378.



中文翻译:

被动抬腿引起的脉压变化变化以评估机械通气患者的液体反应性:一项多中心前瞻性观察研究

背景

被动抬腿引起的心脏指数变化可用于预测液体反应性。我们研究了被动抬腿引起的脉压变化(ΔPPV PLR)是否也可以预测机械通气患者的液体反应性。

方法

在这项多中心前瞻性观察研究中,我们纳入了 270 名因急性循环衰竭而需要扩容的机械通气危重患者。我们不包括心律失常患者。在被动抬腿测试之前/期间以及扩容之前/之后测量心脏指数和 PPV。容量扩张引起的心脏指数增加 > 15% 定义为液体反应性。为了研究 ΔPPV PLR是否可以预测液体反应性,我们确定了受试者工作特征曲线 (AUROC) 下的区域以及相对和绝对 ΔPPV PLR的灰色区域。

结果

在 270 名患者中,238 名 (88%) 接受控制机械通气,没有自主呼吸活动,32 名 (12%) 接受压力支持通气。潮气量中位数为 7.1(四分位间距 [IQR],6.6-7.6)ml kg -1理想体重。164 名患者 (61%) 是液体反应者。相对和绝对 ΔPPV PLR预测液体反应性,AUROC 均为 0.92(95% 置信区间 [95% CI],0.88-0.95;P <0.001)。相对和绝对 ΔPPV PLR的灰色区域分别包括 4.8% 和 22.6% 的患者。这些结果不受通气模式和基线特征(休克类型、中心、血管活性治疗)的影响。

结论

被动抬腿引起的脉压变化变化准确地预测了机械通气危重患者的液体反应性,具有一个小的灰色区域。

临床试验注册

NCT 03225378。

更新日期:2022-07-14
down
wechat
bug