使用输液指数识别预负载响应的被动腿抬高测试的准确性 - - 在资源有限的环境中进行单中心研究
Marialessia Casazzo1, Luigi Pisani1,2,3, Rabiul Alam Md Erfan Uddin4
1Department of Anesthesia and Intensive Care, University of Bari, 70124 Bari, Italy.
Diagnostics (Basel, Switzerland)
|January 11, 2025
概括
使用输液指数 (PI) 的被动腿部升高测试 (PLR) 准确预测了严重病情的低输液患者的液体反应. 在基线测量PI变化时,诊断准确度最高.
科学领域:
- 关键护理医学 关键护理医学
- 心血管生理学心血管生理学
- 临床诊断 临床诊断 临床诊断 临床诊断
背景情况:
- 低输液是重症患者的关键状况,通常需要输液.
- 精确评估液体反应对于优化血液动力学管理至关重要.
- 资源有限的环境为先进的血液动力学监测带来了独特的挑战.
研究的目的:
- 为了评估被动腿抬高测试 (PLR) 的准确性,使用 perfusion index (PI) 来预测预加载响应.
- 在资源有限的环境中,评估PLR与PI在临重病患者的诊断性能.
- 为了比较PLR与PI在不同时间点 (基线和长达72小时) 的准确性.
主要方法:
- 孟加拉国Chattogram的一个前性观察单中心研究.
- 包括患有败血症或严重疟疾的重症患者和低输液迹象.
- 基线和6,24,48,72小时后的PLR测试的性能,测量PI.
- 将PI评估的预负载响应与心脏指数 (CI) 变化 (≥5%) 作为参考标准进行比较.
- 构建接收器操作特征 (ROC) 曲线以确定精度.
主要成果:
- 该研究包括34名败血症和10名严重疟疾患者.
- 一个PI变化切线为9.7%,对非响应者进行了最好的歧视.
- 使用PI的PLR在基线表现出很好的准确性 (ROC曲线下的面积 [AUROC] 0.87).
- 该测试表现出高灵敏度和负预测值,具有较低的特异性和正预测值.
- 与基线相比,诊断准确性 (AUROC) 在较晚的时间点 (6-72小时) 降低.
结论:
- 在PLR测试后PI的变化有效地检测了败血症或严重疟疾和低输液患者的预加载响应.
- 使用PI的PLR的诊断准确性在基线测量时优越.
- 这种方法为资源有限的重症监护机构的流体管理提供了有价值的工具.
相关概念视频
01:27Assessment of the Cardiovascular System III: Palpation
189
Palpation involves feeling the body to evaluate texture, size, consistency, and tenderness for assessing cardiovascular health. The following steps are organized in a head-to-toe order:
Jugular Venous Pressure (JVP) Measurement
Position the patient at a thirty- to forty-five-degree angle or in a semi-fowler's position. Look for the highest point of pulsation in the internal jugular vein and measure the vertical distance to the angle of Loius or sternal angle. A normal JVP is 3-4 cm above...
Jugular Venous Pressure (JVP) Measurement
Position the patient at a thirty- to forty-five-degree angle or in a semi-fowler's position. Look for the highest point of pulsation in the internal jugular vein and measure the vertical distance to the angle of Loius or sternal angle. A normal JVP is 3-4 cm above...
189
01:11Assessing Blood pressure in the Leg
1.9K
Proper measurement of leg blood pressure is a critical skill for healthcare providers, ensuring precise and reliable readings. When performed correctly, this procedure informs patient care and enhances the efficacy of interventions. The following text outlines step-by-step guidelines to measure blood pressure in the leg, providing clarity and ease of understanding for practitioners.
Preparation:
Preparation:
1.9K
01:10Pre-Procedural Guidelines for Assessing Blood Pressure
520
Accurate blood pressure assessment is crucial for diagnosing and managing various health conditions. To ensure the reliability of these measurements, healthcare professionals must adhere to standardized pre-procedural guidelines. These guidelines enhance patient safety and improve the overall quality of healthcare. The following steps are essential for obtaining accurate and consistent blood pressure readings, from using the appropriate tools to ensuring effective communication with the...
520