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Mandatory criteria for the application of variability-based parameters of fluid responsiveness: a prospective study in different groups of ICU patients

不同患者群体容量反应性变量参数应用的强制性标准:重症监护病人窦性节律和控制呼吸流行情况的前瞻性研究

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Abstract

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.

Methods

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.

Conclusions

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.

中文概要

目的

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。

创新点

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。

方法

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。

结论

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。

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Authors and Affiliations

  1. II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, D-81675, München, Germany

    Wolfgang Huber, Uli Mayr, Andreas Umgelter & Roland M. Schmid

  2. Universitätsklinik für Innere Medizin I, Salzburger Landeskliniken, Universitätsklinikum Salzburg, Müllner Hauptstraße 48, A-5020, Salzburg, Austria

    Michael Franzen

  3. II. Medizinische Klinik, Universitätsklinikum Mannheim, Theodor-Kutzer-Ufer 1-3, D-68167, Mannheim, Germany

    Wolfgang Reindl

  4. Klinik für Innere Medizin, RoMed Klinik Bad Aibling, Harthauser Straße 16, D-83043, Bad Aibling, Germany

    Florian Eckel

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  1. Wolfgang Huber
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  2. Uli Mayr
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  3. Andreas Umgelter
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  4. Michael Franzen
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  6. Roland M. Schmid
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  7. Florian Eckel
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Correspondence to Wolfgang Huber.

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Huber, W., Mayr, U., Umgelter, A. et al. Mandatory criteria for the application of variability-based parameters of fluid responsiveness: a prospective study in different groups of ICU patients. J. Zhejiang Univ. Sci. B 19, 515–524 (2018). https://doi.org/10.1631/jzus.B1700243

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