以中心静脉-动脉 PCO2 差值和中心静脉血氧饱和度的变化为标志，确定重症患者的输液反应性：对一项多中心前瞻性研究的临时分析

IF 8.8 1区医学 Q1 CRITICAL CARE MEDICINE

Critical Care Pub Date : 2024-11-08 DOI:10.1186/s13054-024-05156-y

Jihad Mallat, Osama Abou-Arab, Malcolm Lemyze, Dahlia Saleh, Pierre-Grégoire Guinot, Marc-Olivier Fischer

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引用次数: 0

摘要

这项研究的主要目的是，在镇静和机械通气的脓毒症患者中，容量扩张（VE）引起的中心静脉与动脉二氧化碳差（ΔP(v-a)CO2）和中心静脉血氧饱和度（ΔScvO2）的变化是否是确定液体反应性（FR）的可靠参数。我们还试图确定 FR 的程度是否与基线 ScvO2 和 P(v-a)CO2 水平有关。这是一项多中心前瞻性研究的事后分析。我们纳入了 205 名急性循环衰竭的机械通气患者。在机械通气前后测量了心脏指数（CI）、P（v-a）CO2、ScvO2 和其他血流动力学变量。VE 引起的 CI 升高 > 15%，即为体液反应者。测定了 ΔP(v-a)CO2 和 ΔScvO2 的接收者操作特征曲线下面积（AUC）和灰区。115 名患者（56.1%）被归类为体液反应者。确定 FR 的 ΔP(v-a)CO2 和 ΔScvO2 的 AUC 分别为 0.831 (95% CI 0.772-0.880) (p < 0.001) 和 0.801 (95% CI 0.739-0.853) (p < 0.001)。VE 后，ΔP(v-a)CO2 ≤ 2.1 mmHg 和 ΔScvO2 ≥ 3.4% 可将患者分为有反应者和无反应者，阳性预测值分别为 90% 和 86%，阴性预测值分别为 58% 和 64%。ΔP（v-a）CO2（- 2 至 0 mmHg）和ΔScvO2（- 1 至 5%）的灰色区域分别包括 22% 和 40.5% 的患者。在多变量分析中，ΔP(v-a)CO2 和 ΔScvO2 与 FR 独立相关。灌注前 ScvO2 和 P(v-a)CO2 水平与 FR 之间没有明显关系。在机械性重症患者中，ΔP(v-a)CO2 和 ΔScvO2 是确定 FR 的可靠参数，可在没有 CI 测量的情况下使用。对 VE 的反应与基线 ScvO2 和 P(v-a)CO2 水平无关。临床试验注册该研究已在 ClinicalTrials.gov 注册：NCT03225378，日期：2017年7月20日。

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Changes in central venous-to-arterial PCO2 difference and central venous oxygen saturation as markers to define fluid responsiveness in critically ill patients: a pot-hoc analysis of a multi-center prospective study

The main aim of the study whether changes in central venous-to-arterial CO2 difference (ΔP(v–a)CO2) and central venous oxygen saturation (ΔScvO2) induced by volume expansion (VE) are reliable parameters to define fluid responsiveness (FR) in sedated and mechanically ventilated septic patients. We also sought to determine whether the degree of FR was related to baseline ScvO2 and P(v–a)CO2 levels. This was a post-hoc analysis of a multicenter prospective study. We included 205 mechanically ventilated patients with acute circulatory failure. Cardiac index (CI), P(v–a)CO2, ScvO2, and other hemodynamic variables were measured before and after VE. A VE-induced increase in CI > 15% defined fluid responders. Areas under the receiver operating characteristic curves (AUCs) and the gray zones were determined for ΔP(v–a)CO2 and ΔScvO2. One hundred fifteen patients (56.1%) were classified as fluid responders. The AUCs for ΔP(v–a)CO2 and ΔScvO2 to define FR were 0.831 (95% CI 0.772–0.880) (p < 0.001) and 0.801 (95% CI 0.739–0.853) (p < 0.001), respectively. ΔP(v–a)CO2 ≤ 2.1 mmHg and ΔScvO2 ≥ 3.4% after VE allowed the categorization between responders and non-responders with positive predictive values of 90% and 86% and negative predictive values of 58% and 64%, respectively. The gray zones for ΔP(v–a)CO2 (− 2 to 0 mmHg) and ΔScvO2 (− 1 to 5%) included 22% and 40.5% of patients, respectively. ΔP(v–a)CO2 and ΔScvO2 were independently associated with FR in multivariable analysis. No significant relationships were found between pre-infusion ScvO2 and P(v–a)CO2 levels and FR. In mechanically critically ill patients, ΔP(v–a)CO2 and ΔScvO2 are reliable parameters to define FR and can be used in the absence of CI measurement. The response to VE was independent of baseline ScvO2 and P(v–a)CO2 levels. Clinical trial registration The study was registered in the ClinicalTrials.gov registry: NCT03225378, date: July 20, 2017.

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来源期刊

Critical Care 医学-危重病医学

CiteScore

20.60

自引率

3.30%

发文量

348

审稿时长

1.5 months

期刊介绍： Critical Care is an esteemed international medical journal that undergoes a rigorous peer-review process to maintain its high quality standards. Its primary objective is to enhance the healthcare services offered to critically ill patients. To achieve this, the journal focuses on gathering, exchanging, disseminating, and endorsing evidence-based information that is highly relevant to intensivists. By doing so, Critical Care seeks to provide a thorough and inclusive examination of the intensive care field.