Predicting volume responsiveness in spontaneously breathing patients still a challenging problem 英文参考文献.docVIP

Available online /content/10/5/165 Commentary Predicting volume responsiveness in spontaneously breathing patients: still a challenging problem S Magder Division of Critical Care, Royal Victoria Hospital, 687 Pine Avenue West, Montreal, Quebec, Canada H3A 1A1 Corresponding author: S Magder, Sheldon.magder@muhc.mcgill.ca Published: 11 September 2006 Critical Care 2006, 10:165 (doi:10.1186/cc5029) This article is online at /content/10/5/165 ? 2006 BioMed Central Ltd See related commentary by Heenen et al., /content/10/4/R102 Abstract [7]. The authors presented a number of possible reasons for the difference from our previous studies [8,9]. The prediction of which patients respond to fluid infusion and which patients do not is an important issue in the intensive care setting. Assessment of this response by monitoring changes in some hemodynamic characteristics in relation to spontaneous breathing efforts would be very helpful for the management of the critically ill. This unfortunately remains a difficult clinical problem, as discussed in the previous issue of the journal. Technical factors and physiological factors limit the usefulness of current techniques. First, their study included patients who did not have adequate inspiratory efforts, whereas we only included patients with adequate efforts. I can understand how one would include these patients when examining overall usefulness of a test for the whole population, but this test is based on the response of Pra when pleural pressure falls, and if it does not fall then the test cannot be used. In their discussion Heenen and colleagues argued that a difference in the findings may also be because we had disconnected patients from the ventilator. We only did this on a few occasions, however, to ensure that we did not miss an inspiratory effort – and thus this should also have had a minimal effect on our results. It