The Role of Ultrasonic Cardiac Output Monitor in Evaluating Stroke Volume Variation to Determine Fluid Responsiveness in Patients with Shock.

IF 2.7 3区医学 Q2 CRITICAL CARE MEDICINE

SHOCK Pub Date : 2025-03-25 DOI:10.1097/SHK.0000000000002584

Seval Orman, Pervin Hancı, Serdar Efe, Volkan İnal

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引用次数: 0

Abstract

Background: Dynamic assessment of cardiac output (CO) with passive leg raise (PLR), stroke volume variation (SVV), and pulse pressure variation (PPV) offer effective and safe methods to predict fluid responsiveness in patients with shock. The primary aim of this study was to evaluate the reliability of CO and SVV readings with the Ultrasonic Cardiac Output Monitor (USCOM) 1A device compared to PPV measurements in determining fluid responsiveness of patients in shock.

Materials and method: Intubated and mechanically ventilated patients aged 18-95 with shock admitted to the medical intensive care unit from June 2019 to December 2020 were included in the study. Fluid responsiveness was assessed using PPV from arterial monitoring and CO/SVV using the USCOM 1A device. CO, PPV, and SVV data were recorded before and after PLR.

Results: Out of 145 shock patients, 92 were included. Before the PLR maneuver, 67 patients had PPV values above 12% and were stated as fluid responsive. The SVV index measured by the USCOM device demonstrated good sensitivity (85%) and specificity (96%) in identifying fluid responsiveness. The agreement with PPV was substantial [Cronbach's alpha reliability: 0.718 (p < 0.001)], and the index was internally consistent [kappa agreement: 0.707 (p < 0.001)]. The SVV index moderately correlated with PPV [R: 0.588 (p: 0.001). Regarding fluid responsiveness determined by PPV, the AUC value of SVV was 0.797 (0.701-0.894) (p: 0.001).

Conclusion: SVV measured by the USCOM device is a reliable and practical tool for hemodynamic assessment in clinical practice, particularly when invasive methods are unsuitable.

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超声心输出量监测仪在评估卒中容量变化以确定休克患者液体反应性中的作用。

背景：动态评估被动抬腿（PLR）时的心输出量（CO）、卒中容积变化（SVV）和脉压变化（PPV）为预测休克患者的液体反应性提供了有效和安全的方法。本研究的主要目的是评估超声心输出量监测仪（USCOM） 1A装置测量CO和SVV读数与PPV测量在确定休克患者液体反应性方面的可靠性。材料与方法：选取2019年6月至2020年12月在重症监护病房住院的18-95岁插管机械通气休克患者为研究对象。通过动脉监测的PPV和USCOM 1A装置的CO/SVV来评估流体反应性。记录PLR前后CO、PPV、SVV数据。结果：145例休克患者纳入92例。在PLR操作之前，67例患者的PPV值高于12%，并被认为是液体反应。USCOM装置测量的SVV指数在识别流体反应性方面具有良好的灵敏度（85%）和特异性（96%）。与PPV的一致性是显著的[Cronbach's alpha信度：0.718 (p < 0.001)]，该指数内部一致[kappa信度：0.707 (p < 0.001)]。SVV指数与PPV中度相关[R: 0.588 (p: 0.001)]。对于由PPV测定的液体反应性，SVV的AUC值为0.797 (0.701-0.894)（p: 0.001）。结论：USCOM装置测量SVV在临床实践中是一种可靠实用的血流动力学评估工具，特别是在有创方法不适合的情况下。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

SHOCK 医学-外科

CiteScore

6.20

自引率

3.20%

发文量

199

审稿时长

1 months

期刊介绍： SHOCK®: Injury, Inflammation, and Sepsis: Laboratory and Clinical Approaches includes studies of novel therapeutic approaches, such as immunomodulation, gene therapy, nutrition, and others. The mission of the Journal is to foster and promote multidisciplinary studies, both experimental and clinical in nature, that critically examine the etiology, mechanisms and novel therapeutics of shock-related pathophysiological conditions. Its purpose is to excel as a vehicle for timely publication in the areas of basic and clinical studies of shock, trauma, sepsis, inflammation, ischemia, and related pathobiological states, with particular emphasis on the biologic mechanisms that determine the response to such injury. Making such information available will ultimately facilitate improved care of the traumatized or septic individual.