SIGH35和终端呼气阻塞测试用于评估重症患者接受压力支通风的流体反应
Antonio Messina1,2, Lorenzo Calabrò3, Francesco Benedetto4,5
1IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy. antonio.messina@humanitas.it.
Critical care (London, England)
|May 2, 2025
概括
SIGH35机动可靠地预测了重症患者在压力支通风 (PSV) 上的流体反应,优于终端呼气阻塞试验 (EEOT). 对于具有最小启发力度的患者来说,EEOT仍然是有用的.
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
- 呼吸机械学 呼吸机械
背景情况:
- 在重症患者中,在压力支通风 (PSV) 期间自发呼吸活动时,评估液体反应是具有挑战性的.
- 自发呼吸会影响心肺相互作用,使血液动力学评估复杂化.
- 这项研究比较了预测流体响应的两种方法:SIGH35和终端呼气阻塞试验 (EEOT).
研究的目的:
- 为了比较SIGH35和EEOT在预测PSV的ICU患者的流体反应的可靠性.
- 为了评估这些血液动力学测试在临床环境中的有效性,自发呼吸.
- 为了确定哪个测试在这个患者群体中对指导液体的管理是优越的.
主要方法:
- 一项前性研究招募了60名在PSV治疗的ICU患者,具有不同启发力 (P0.1).
- 使用MOSTCARE®系统监测血液动力学变量.
- 在4毫升/公斤晶体体体积膨胀后,评估了流体反应,响应者被定义为心脏输出量 (CO) 的≥10%增加.
- 使用ROC曲线和AUC分析评估了SIGH35 (测量脉冲压变化) 和EEOT (测量CO变化) 的可靠性.
主要成果:
- SIGH35测试显示了0.93的高曲线下面积 (AUC) 预测流体响应,具有93.1%的灵敏度和91.6%的特异性.
- EEOT显示较低的AUC为0.67,敏感度为72.4%,特异性为70.3%.
- 在低吸入力 (P0.1 <1.5 cmH2O) 的患者中,SIGH35 (AUC 0.98) 和EEOT (AUC 0.89) 均可靠,两者之间没有显著差异.
结论:
- 在接受PSV的ICU患者中,SIGH35是液体反应的可靠预测指标.
- 在整个研究群体中,SIGH35的表现优于EEOT.
- EEOT仍然是一个可靠的选择,用于在患者中评估液体响应能力,以最小的自发启发力.
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