Mandatory criteria for the application of variability-based parameters of fluid responsiveness: a prospective study in different groups of ICU patients
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Background and objective
Stroke volume variation (SVV) has high sensitivity and specificity in predicting fluid responsiveness. However, sinus rhythm (SR) and controlled mechanical ventilation (CV) are mandatory for their application. Several studies suggest a limited applicability of SVV in intensive care unit (ICU) patients. We hypothesized that the applicability of SVV might be different over time and within certain subgroups of ICU patients. Therefore, we analysed the prevalence of SR and CV in ICU patients during the first 24 h of PiCCO-monitoring (primary endpoint) and during the total ICU stay. We also investigated the applicability of SVV in the subgroups of patients with sepsis, cirrhosis, and acute pancreatitis.
The prevalence of SR and CV was documented immediately before 1241 thermodilution measurements in 88 patients. Results: In all measurements, SVV was applicable in about 24%. However, the applicability of SVV was time-dependent: the prevalence of both SR and CV was higher during the first 24 h compared to measurements thereafter (36.1% vs. 21.9%; P<0.001). Within different subgroups, the applicability during the first 24 h of monitoring ranged between 0% in acute pancreatitis, 25.5% in liver failure, and 48.9% in patients without pancreatitis, liver failure, pneumonia or sepsis.
The applicability of SVV in a predominantly medical ICU is only about 25%–35%. The prevalence of both mandatory criteria decreases over time during the ICU stay. Furthermore, the applicability is particularly low in patients with acute pancreatitis and liver failure.
Key wordsHemodynamic monitoring Preload Fluid responsiveness Stroke volume variation Pulse pressure variation
通过对危重病人在入院后24 小时内和整个重症 监护过程中窦性心律和控制呼吸情况的调查,分 析每搏量变异在评估危重病人容量反应的适用 性,并探究每搏量变异度在败血症、肝硬化和胰 腺炎病人中的适用性。
通过探究窦性节律和控制呼吸情况评估每搏量变 异度在重症监护病人临床上的适用性,弥补重症 监护病人窦性节律和控制呼吸情况数据的空白。
在进行1241 次热稀释法血流量测量前,对88 位 病人的窦性节律和控制呼吸情况进行调查。
每搏量变异度在主要的医疗重症监护病房中的适 用性只约为25%~35%。两项强制性指标的流行 性在重症监护病房的情况随时间的延长而降低。 此外,每搏量变异度在胰腺炎和肝功能衰竭患者 中的适用性尤其低。
关键词前负荷 容量反应性 每搏量变异度 脉压变异
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