流体挑战期间中央静脉压的变化对于指导流体治疗的价值有限
Priscilla Souza de Oliveira1, Fernando José da Silva Ramos1, Daniere Yurie Vieira Tomotani1
1Department of Anesthesiology, Pain and Intensive Care Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo - São Paulo (SP), Brazil.
Critical care science
|December 4, 2024
概括
中枢静脉压力变化和基线呼吸变化不能可靠地预测重症患者的液体反应. 这些血液动力学参数在指导流体治疗决策时具有有限的价值.
科学领域:
- 关键护理医学 关键护理医学
- 血液动力学 血液动力学
- 流体响应性监测 监测 流体响应性监测
背景情况:
- 液体复苏对于管理重症患者至关重要.
- 精确预测液体反应是优化血液动力学状态和患者结果的必要条件.
- 中枢静脉压力 (CVP) 是一个常见的监测参数,但其在预测流体响应的实用性是有争议的.
研究的目的:
- 评估流体膨胀期间中央静脉压力 (CVP) 变化的疗效.
- 为了确定CVP振幅 (RespCVP) 的基线循环呼吸变化是否可以预测流体响应.
- 评估这些参数在流体响应者和不响应者之间进行歧视的能力.
主要方法:
- 一项前性观察性研究,涉及30名机械通风的成年患者接受液体挑战.
- 在基线 (CVPT0) 和在5分钟,10分钟和15分钟后测量的CVP (ΔCVPT5, ΔCVPT10, ΔCVPT15).
- 记录了基线RespCVP,并将流体反应率定义为心脏指数增加≥15%.
主要成果:
- 无论是基线CVP还是液体挑战后的变化都不能充分预测液体反应能力 (AUC值在0.63到0.78之间).
- 基线 RespCVP 在预测流体响应性方面表现不佳 (AUC:0.70).
- 这项研究包括11名流体反应者和19名不反应者.
结论:
- 流体膨胀期间中央静脉压力的变化为流体响应提供了有限的预测值.
- 基线CVP振幅的循环呼吸变化也是一个不可靠的预测指标.
- 这些发现表明,在指导重症患者的流体治疗时,应谨慎使用CVP衍生参数.
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