Extrasystoles for fluid responsiveness prediction in critically ill patients
| Autor: | Thomas Scheeren, Simon T. Vistisen, Christoffer Sølling, Thomas Elkmann, Martin Buhl Krog, Mikael Fink Vallentin |
|---|---|
| Přispěvatelé: | Critical care, Anesthesiology, Peri-operative and Emergency medicine (CAPE) |
| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
Cardiac output
medicine.medical_specialty Ectopic beat Fluid responsiveness Critical Care and Intensive Care Medicine 03 medical and health sciences 0302 clinical medicine 030202 anesthesiology Hemodynamic monitoring Internal medicine medicine Receiver operating characteristic business.industry Research lcsh:Medical emergencies. Critical care. Intensive care. First aid 030208 emergency & critical care medicine Stroke volume lcsh:RC86-88.9 medicine.disease Preload Blood pressure Extrasystole Cardiology business Beat (music) |
| Zdroj: | Journal of Intensive Care Vistisen, S T, Krog, M B, Elkmann, T, Vallentin, M F, Scheeren, T W L & Sølling, C 2018, ' Extrasystoles for fluid responsiveness prediction in critically ill patients ', Journal of Intensive Care, vol. 6, 52 . https://doi.org/10.1186/s40560-018-0324-6 Journal of Intensive Care, 6(52):52. BMC Journal of Intensive Care, Vol 6, Iss 1, Pp 1-8 (2018) |
| ISSN: | 2052-0492 |
| Popis: | Background Fluid responsiveness prediction with continuously available monitoring is an unsettled matter for the vast majority of critically ill patients, and development of new and reliable methods is desired. We hypothesized that the post-ectopic beat, which is associated with increased preload, could be analyzed in relation to preceding sinus beats and that the change in cardiac performance (e.g., systolic blood pressure) at the post-ectopic beat could predict fluid responsiveness. Methods Critically ill patients were observed when scheduled for a 500-ml volume expansion. The 30-min ECG prior to volume expansion was analyzed for the occurrence of extrasystoles. Classification variables were defined as the change in a variable (e.g., systolic blood pressure or pre-ejection period) from the median of ten preceding sinus beats to extrasystolic post-ectopic beat. A stroke volume increase > 10% following volume expansion defined fluid responsiveness. Results Twenty-six patients were included. The change in systolic blood pressure predicted fluid responsiveness with receiver operating characteristic (ROC) area 0.79 (CI [0.52:1.00]), specificity 100%, sensitivity 67%, positive predictive value 100%, and negative predictive value 91% (threshold: 5%). The change in pre-ejection period predicted fluid responsiveness with ROC area 0.74 (CI [0.53:0.94]), specificity 78%, sensitivity 67%, positive predictive value 50%, and negative predictive value 88% (threshold 7.5 ms). Conclusions Based on standard critical care monitoring, analysis of the extrasystolic post-ectopic beat predicts fluid responsiveness in critical care patients with good accuracy. The presented results are considered preliminary proof-of-concept results, and further validation is needed to confirm these preliminary findings. Electronic supplementary material The online version of this article (10.1186/s40560-018-0324-6) contains supplementary material, which is available to authorized users. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full text from SpringerLink