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在10秒末尾呼气阻塞试验期间脉冲压的实时变化可靠地检测预加载响应能力
Francesco Gavelli1,2,3, Nello De Vita4,5, Christopher Lai4
1Service de médecine intensive-réanimation, Hôpital de Bicêtre, DMU CORREVE, Université Paris-Saclay, AP-HP, Inserm UMR S_999, FHU SEPSIS, CARMAS, Le Kremlin-Bicêtre, France. francesco.gavelli@uniupo.it.
Critical care (London, England)
|June 13, 2025
概括
终端呼气阻塞 (EEO) 测试可靠地检测通风患者在10秒内动脉脉冲压 (PP) 变化的预负载响应. 较短的EEO持续时间或添加终端启发性阻塞 (EIO) 并没有提高准确性.
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
- 机械通风机械通风机械通风机
背景情况:
- 终端呼气阻塞 (EEO) 测试通过测量心脏指数 (ΔCI) 的变化来评估预负载响应.
- 调查更短的EEO持续时间和添加终端启发性阻塞 (EIO) 可以优化这种诊断工具.
研究的目的:
- 评估EEO诱导的动脉脉冲压变化 (∆PP) 的诊断准确性,并减少阻塞持续时间 (10s和5s).
- 为了确定是否添加EIO可以提高EEO测试的准确性,用于预加载响应检测.
主要方法:
- 在143名机械呼吸的鼻节律患者中,进行了EO和EOO测试.
- 预负载响应被定义为液体玻尿酸或被动腿部提升诱导的ΔCI.
- 脉冲压力 (∆PP) 和心脏指数 (ΔCI) 的变化在各种闭塞持续时间 (15s,10s,5s) 中被分析.
主要成果:
- 与非响应者相比,15s和10s EEO 显著增加了预加载响应者的 ΔCI.
- ∆PP在5s,10s和15s期间的EEO在响应者中显著更高.
- ∆PP的诊断准确性 (AUROC) 在10s和15s EEO时很高,在添加EIO时没有显著差异.
结论:
- 一个10秒的EO可靠地检测了在有鼻节律的通风患者的预负载响应.
- 在EEO期间动脉脉冲压的实时变化对于评估流体响应性是有效的.
- 将EEO持续时间缩短到10秒,可以保持诊断准确度,而不会影响结果.
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