Ultrasound assessment of volume responsiveness in critically ill surgical patients: Two measurements are better than one
| Autor: | Raymond Fang, Ashely R. Menne, Syeda Fatima, Stephen Biederman, Sarah B. Murthi, Hegang Chen, Thomas M. Scalea, Jacob J. Glaser, Samuel M. Galvagno |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
Adult
Male medicine.medical_specialty Critical Illness Population Hemodynamics 030204 cardiovascular system & hematology Critical Care and Intensive Care Medicine Inferior vena cava 03 medical and health sciences 0302 clinical medicine Internal medicine medicine Humans Colloids Prospective Studies education Prospective cohort study education.field_of_study Receiver operating characteristic business.industry 030208 emergency & critical care medicine Stroke Volume Stroke volume Crystalloid Solutions Middle Aged Confidence interval Intensive Care Units Treatment Outcome medicine.vein Echocardiography Anesthesia Cardiology Fluid Therapy Surgery Female Transthoracic echocardiogram Isotonic Solutions business |
| Zdroj: | The journal of trauma and acute care surgery. 82(3) |
| ISSN: | 2163-0763 |
| Popis: | BACKGROUND The intended physiologic response to a fluid bolus is an increase in stroke volume (SV). Several ultrasound (US) measures have been shown to be predictive. The best measure(s) in critically ill surgical patients remains unclear. METHODS This is a prospective observational study in critically ill surgical patients receiving a bolus of crystalloid, colloid or blood. A transthoracic echocardiogram was performed before (pre-transthoracic echocardiogram) and after. A positive volume response (+VR) was defined as a ≥15% increase in SV. Predictive measures were: left ventricular velocity time integral (VTI), respiratory SV variation (rSVV), passive leg raise SVV (plr SVV), positional internal jugular (IJ) vein change (0-90 degrees) and respiratory variation in the IJ sitting upright (90 degrees IJ). For each measure the area under the receiver operating curve (AUROC) was assessed and the best measure(s) determined. RESULTS Between November 2013 and November 2015, 199 patients completed the study. After the pilot analyses, plr SVV was abandoned because it could not be reliably assessed. VTI, rv 90 degrees IJ, 0 degree to 90 degrees IJ, were all significantly associated with VR (p < 0.05), rSVV and rv inferior vena cava were not. For VTI AUROC was 0.71 (95% confidence interval [CI], 0.64-0.77). For rv 90 degrees, it was 0.65 (95% CI, 0.57-0.71), and 0.61 (95% CI, 0.54-0.69) for 0 degrees to 90 degrees IJ. When VTI and rv 90 degrees were considered together, the AUROC rose to 0.76 (95% CI, 0.69-0.82) for the population as a whole and 0.78 (95% CI, 0.69-0.85) in mechanically ventilated patients. The positive predictive value for combined assessment was 80% and the negative 70%. CONCLUSION In a clinically relevant heterogeneous population, US is moderately predictive of VR. Inferior vena cava diameter change is not predictive. IJ change and VTI are the best measures, especially when used together. Future work should focus on combination metrics and the IJ. LEVEL OF EVIDENCE Diagnostic test, level II. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|