Tissue perfusion and fluid responsiveness assessment in critically ill patients. A feasibility pilot study using the IKORUS urothelial plethysmography device.
Adrian Wong, Rory McDonald, Nurul Liana Roslan, Kate Bramham, Sam Hutchings
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引用次数: 0
Abstract
Background: Accurate assessment of tissue perfusion is challenging. Commonly used markers like lactate levels and central venous oxygen saturation are indirect, intermittent, and provide a global picture of circulatory status which may not reflect perfusion at the organ level. The urethral perfusion index (UPi), measured through a specialized urinary catheter, is a novel technique that offers continuous, real-time monitoring of perfusion in a central tissue bed, potentially providing more immediate and targeted clinical information.
Objectives: 1. To assess the correlation between changes to left ventricular outflow tract velocity time integral (LVOT VTi) and UPi following a fluid challenge.2. To assess the relationship between UPi and other markers of tissue perfusion.
Design: Interventional, feasibility pilot study.
Setting: Single-centre, study conducted at a tertiary-level institution in the United Kingdom. All patients were mechanically ventilated adults, whom the primary clinical team thought would benefit from a fluid challenge.
Intervention: A fluid challenge (FC) was defined as a 250 ml bolus of crystalloid solution.
Main outcome measures: Focused transthoracic echocardiogram measured LVOT VTi and UPi, measured pre- and post-FC.
Results: There were no reported complications associated with device use or insertion. Mean duration of data recorded was 19 hours and the Signal Quality Index of the UPi trace was high (93%). There was a moderate positive correlation between the time matched values of UPi and LVOT VTi (Spearman r = 0.55, p < 0.0001), R2 value of 0.272. However, there was no discernible correlation seen between change in UPi and VTi following fluid (Spearman r = 0.24, p = 0.14). Patients with below-average UPi at baseline had evidence of poorer systemic tissue perfusion, as measured by lactate concentration and capillary refill time, and received more vasoactive drugs.ConclusionUPi may be a marker of tissue perfusion in a diverse group of critically ill patients. With further evaluation it may, therefore, present a future therapeutic target. Although there is some relationship between LVOT VTi and UPi, it is not precise enough to be used as a marker of fluid responsiveness.Trial registration: London Southeast Research and Ethics Committee (22/LO/0911).
背景：准确评估组织灌注是具有挑战性的。常用的指标如乳酸水平和中心静脉氧饱和度是间接的，间歇性的，提供了循环状态的全局图像，可能不能反映器官水平的灌注。尿道灌注指数（UPi），通过专门的导尿管测量，是一种新的技术，提供连续，实时监测灌注在中央组织床，潜在地提供更直接和有针对性的临床信息。目的:1。评估液体挑战后左心室流出道速度时间积分（LVOT VTi）与UPi变化的相关性。探讨UPi与其他组织灌注指标的关系。设计：干预性、可行性试点研究。环境：在英国的一所高等院校进行的单中心研究。所有患者都是机械通气的成年人，主要临床团队认为他们会从液体挑战中受益。干预措施：液体刺激（FC）定义为250 ml晶体溶液。主要观察指标：经胸超声心动图测量LVOT、VTi和UPi， fc前后测量。结果：无与器械使用或插入相关的并发症报道。记录数据的平均持续时间为19小时，UPi轨迹的信号质量指数高（93%）。UPi与LVOT VTi的时间匹配值呈正相关（Spearman r = 0.55, p < 0.0001）， R2值为0.272。然而，输液后UPi和VTi的变化之间没有明显的相关性（Spearman r = 0.24, p = 0.14）。基线时UPi低于平均水平的患者有较差的全身组织灌注的证据，通过乳酸浓度和毛细血管再充血时间来测量，并且接受更多的血管活性药物。结论upi可能是多种危重患者组织灌注的标志。因此，通过进一步的评估，它可能会成为未来的治疗靶点。虽然LVOT VTi和UPi之间有一定的关系，但它不够精确，不能作为液体反应的标志。试验注册：伦敦东南研究与伦理委员会（22/LO/0911）。
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.
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