Pulse pressure variation and stroke volume variation during increased intra-abdominal pressure an experimental study 英文参考文献.docVIP

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Pulse pressure variation and stroke volume variation during increased intra-abdominal pressure an experimental study 英文参考文献.doc

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Pulse pressure variation and stroke volume variation during increased intra-abdominal pressure an experimental study 英文参考文献

Jacquesetal.CriticalCare2011,15:R33 /content/15/1/R33 RESEARCH OpenAccess Pulsepressurevariationandstrokevolume variationduringincreasedintra-abdominal pressure:anexperimentalstudy DidierJacques1*,KarimBendjelid2,SergeDuperret3,Jo?lleColling3,VincentPiriou4,Jean-PaulViale5 Abstract Introduction:Theaimofthisstudywastoevaluatedynamicindicesoffluidresponsivenessinamodelofintra- abdominalhypertension. Methods:Ninemechanically-ventilatedpigsunderwentincreasedintra-abdominalpressure(IAP)byabdominal bandingupto30mmHgandthenfluidloading(FL)atthisIAP.Thesameprotocolwascarriedoutinthesame animalsmadehypovolemicbybloodwithdrawal.Inbothvolemicconditions,dynamicindicesofpreload dependenceweremeasuredatbaselineIAP,at30mmHgofIAP,andafterFL.Dynamicindicesinvolvedrespiratory variationsinstrokevolume(SVV),pulsepressure(PPV),andsystolicpressure(SPV,%SPVandΔdown).Strokevolume (SV)wasmeasuredusinganultrasoundtransit-timeflowprobeplacedaroundtheaorticroot.Pigswere consideredtobefluidrespondersiftheirSVincreasedby15%ormorewithFL.Indicesoffluidresponsiveness werecomparedwithaMann-WhitneyUtest.Then,receiveroperatingcharacteristic(ROC)curvesweregenerated fortheseparameters,allowingdeterminationofthecut-offvaluesbyusingYouden’ smethod. Results:Fiveanimalsbeforebloodwithdrawalandallanimalsafterbloodwithdrawalwerefluidresponders.Before FL,SVV(78±19vs42±17%),PPV(64±18vs37±15%),SPV(24±5vs18±3mmHg),%SPV(24±4vs17± 3%)andΔdown(13±5vs6±4mmHg)werehigherinrespondersthaninnon-responders(P0.05).Areas underROCcurveswere0.93(95%confidenceinterval:0.80to1.06),0.89(0.70to1.07),0.90(0.74to1.05),0.92(0.78 to1.06),and0.86(0.67to1.06),respectively.Thresholdvaluesdiscriminatingrespondersandnon-responderswere 67%forSVVand41%forPPV. Conclusions:Inintra-abdominalhypertension,respiratoryvariationsinstrokevolumeandarterialpressureremain indicativeoffluidresponsiveness,evenifthresholdvaluesidentifyingrespondersandnon-respondersmightbe higherthanduringnormalintra-abdominalpressure.Furtherstudiesarerequiredinhumanstode