Respiratory variations of inferior vena cava diameter to predict fluid responsiveness in spontaneously breathing patients with acute circulatory failure need for a cautious use 英文参考文献.docVIP

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Respiratory variations of inferior vena cava diameter to predict fluid responsiveness in spontaneously breathing patients with acute circulatory failure need for a cautious use 英文参考文献.doc

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Respiratory variations of inferior vena cava diameter to predict fluid responsiveness in spontaneously breathing patients with acute circulatory failure need for a cautious use 英文参考文献

Mulleretal.CriticalCare2012,16:R188 /content/16/5/R188 RESEARCH OpenAccess Respiratoryvariationsofinferiorvenacava diametertopredictfluidresponsivenessin spontaneouslybreathingpatientswithacute circulatoryfailure:needforacautioususe LaurentMuller1*,XavierBobbia1,MehdiToumi1,GuillaumeLouart1,NicolasMolinari2,BenoitRagonnet3, HervéQuintard4,MarcLeone3,LanaZoric1,JeanYvesLefrant1andtheAzuReagroup Abstract Introduction:Toinvestigatewhetherrespiratoryvariationofinferiorvenacavadiameter(cIVC)predictfluid responsivenessinspontaneouslybreathingpatientswithacutecirculatoryfailure(ACF). Methods:FortypatientswithACFandspontaneousbreathingwereincluded.Responsetofluidchallengewas definedasa15%increaseofsubaorticvelocitytimeindex(VTI)measuredbytransthoracicechocardiography. InferiorvenacavadiameterswererecordedbyasubcostalviewusingMMode.ThecIVCwascalculatedasfollows: (Dmax-Dmin/Dmax)×100andthenreceiveroperatingcharacteristic(ROC)curvesweregeneratedforcIVC, baselineVTI,Ewavevelocity,E/AandE/Earatios. Results:Among40includedpatients,20(50%)wereresponders(R).ThecausesofACFweresepsis(n=24), haemorrhage(n=11),anddehydration(n=5).TheareaundertheROCcurveforcIVCwas0.77(95%CI:0.60- 0.88).Thebestcutoffvaluewas40%(Se=70%,Sp=80%).TheAUCoftheROCcurvesforbaselineEwave velocity,VTI,E/Aratio,E/Earatiowere0.83(95%CI:0.68-0.93),0.78(95%CI:0.61-0.88),0.76(95%CI:0.59-0.89),0.58 (95%CI:0.41-0.75),respectively.ThedifferencesbetweenAUCtheROCcurvesforcIVCandbaselineEwave velocity,baselineVTI,baselineE/Aratio,andbaselineE/Earatiowerenotstatisticallydifferent(p=0.46,p=0.99, p=1.00,p=0.26,respectively). Conclusion:InspontaneouslybreathingpatientswithACF,highcIVCvalues(40%)areusuallyassociatedwith fluidresponsivenesswhilelowvalues(40%)donotexcludefluidresponsiveness. Introduction preload indices like central venous pressure (CVP) do Assessmentoffluidresponsivenessremainsadailythera- notrepresentareasonablealternativefortwomainrea- peuticchallengeinspontaneouslybreathingcriticallyill sons.First,c