Use of near-infrared spectroscopy during a vascular occlusion test to assess the microcirculatory response during fluid challenge 英文参考文献.docVIP

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Use of near-infrared spectroscopy during a vascular occlusion test to assess the microcirculatory response during fluid challenge 英文参考文献.doc

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Use of near-infrared spectroscopy during a vascular occlusion test to assess the microcirculatory response during fluid challenge 英文参考文献

Futieretal.CriticalCare2011,15:R214 /content/15/5/R214 RESEARCH OpenAccess Useofnear-infraredspectroscopyduringa vascularocclusiontesttoassessthe microcirculatoryresponseduringfluidchallenge EmmanuelFutier1*,SebastienChristophe1,EmmanuelRobin2,AntoinePetit1,BrunoPereira3,JacquesDesbordes2, Jean-EtienneBazin1andBenoitVallet4 Abstract Introduction:Adequatevolumeexpansion(VE)inpatientswithevidenceofhypoperfusionshouldbeaimednot onlyatachievinganincreaseinstrokevolume(SV)andcardiacindex(CI)butalsoatimprovedtissueperfusion andoxygenation.Ouraiminthisstudywastoassessthedynamicchangesinmuscletissueoxygensaturation (StO2)duringhypovolaemiaandinresponsetoVE. Methods:Weconductedaprospectivestudyof42fluidchallengesinpatientsundergoingmajorabdominal surgerywithevidenceofhypovolaemia,definedaspulsepressurevariation(PPV)13%andSVvariation(SVV) 12%.CI,SV,SVV(FloTrac/Vigileo)andPPVweremeasuredbeforeandafterVE.Fluidresponsivenesswasdefined asanincreaseofSV15%aftera500-mLcolloidinfusionover15minutes.Inallpatients,themuscleStO2andits changesduringastandardisedvascularocclusiontestwereanalysedusinganear-infraredspectroscopydevice afteranaesthesiainduction(whichdefinedthebaselinestate)andbeforeandaftereachVE. Results:Nopatientswerepreload-responsiveafteranaesthesiainduction.Twenty-nineofforty-twofluidchallenges (69%)werepositiveforVE,withastatisticallysignificant(P0.001)differenceinSVchangesbetweenpositiveand negativeresponsestoVE.TherewasastatisticallysignificantdifferenceinPPVandSVVvaluesbeforeVEinthepositive andnegativefluidresponses[PPV:16%(15%to18%)vs.14%(13%to15%),P=0.001;andSVV:14%(13%to16%)vs.16% (15%to16%),P=0.03orpositiveandnegativefluidresponses,respectively].Dataarepresentedasmediansand25thand 75thpercentilesBeforeVEtherewasnosignificantdifferenceinStO2valuesrelativetobaseline[86%(78%to88%)vs. 84%(77%to91%),P=0.83],withoutasignificantdifference(P=0.36)betweenpositiveandnegativefluidchallenges. Hypovolaemiawasassociatedwithasignificantreduction(P=0.004)inStO2recoveryslope,wi