Priscilla Souza de Oliveira, Fernando José da Silva Ramos, Daniere Yurie Vieira Tomotani, Flávia Ribeiro Machado, Flávio Geraldo Rezende de Freitas
{"title":"在液体刺激期间中心静脉压的变化对指导液体治疗的价值有限。","authors":"Priscilla Souza de Oliveira, Fernando José da Silva Ramos, Daniere Yurie Vieira Tomotani, Flávia Ribeiro Machado, Flávio Geraldo Rezende de Freitas","doi":"10.62675/2965-2774.20240073-en","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>To evaluate whether changes in central venous pressure during fluid expansion and baseline cyclic respiratory variation in the central venous pressure amplitude (RespCVP) curve could be used to discriminate between fluid responders and nonresponders.</p><p><strong>Methods: </strong>This prospective observational study included critically ill adult patients who underwent fluid expansion in the form of a fluid bolus or fluid challenge with crystalloids. All patients were under mechanical ventilation and adequately sedated. We determined the central venous pressure at baseline (CVPT0) and the changes at 5 (ΔCVPT5), 10 (ΔCVPT10) and 15 (ΔCVPT15) minutes during fluid infusion. We also measured the RespCVP at baseline. Fluid responsiveness was defined as a cardiac index increase of ≥ 15%.</p><p><strong>Results: </strong>The study included 30 patients (11 responders and 19 nonresponders). The CVPT0 and the changes after a fluid challenge at all three time points did not adequately predict fluid responsiveness, as determined by their area under the curve values (CVPT0: 0.70, (95%CI: 0.49 - 0.90; ΔCVPT5: 0.78, (95%CI: 0.57 - 0.99; ΔCVPT10: 0.63, (95%CI: 0.39 - 0.88; ΔCVPT15: 0.68, ((95%CI: 0.45 - 0.92). The RespCVP at baseline also had a poor performance (area under the curve: 0.70; 95%CI: 0.50 - 0.91).</p><p><strong>Conclusion: </strong>Changes in central venous pressure have limited value in predicting fluid responsiveness.</p>","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":"36 ","pages":"e20240073en"},"PeriodicalIF":0.0000,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11634234/pdf/","citationCount":"0","resultStr":"{\"title\":\"Changes in central venous pressure during a fluid challenge have limited value for guiding fluid therapy.\",\"authors\":\"Priscilla Souza de Oliveira, Fernando José da Silva Ramos, Daniere Yurie Vieira Tomotani, Flávia Ribeiro Machado, Flávio Geraldo Rezende de Freitas\",\"doi\":\"10.62675/2965-2774.20240073-en\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>To evaluate whether changes in central venous pressure during fluid expansion and baseline cyclic respiratory variation in the central venous pressure amplitude (RespCVP) curve could be used to discriminate between fluid responders and nonresponders.</p><p><strong>Methods: </strong>This prospective observational study included critically ill adult patients who underwent fluid expansion in the form of a fluid bolus or fluid challenge with crystalloids. All patients were under mechanical ventilation and adequately sedated. We determined the central venous pressure at baseline (CVPT0) and the changes at 5 (ΔCVPT5), 10 (ΔCVPT10) and 15 (ΔCVPT15) minutes during fluid infusion. We also measured the RespCVP at baseline. Fluid responsiveness was defined as a cardiac index increase of ≥ 15%.</p><p><strong>Results: </strong>The study included 30 patients (11 responders and 19 nonresponders). The CVPT0 and the changes after a fluid challenge at all three time points did not adequately predict fluid responsiveness, as determined by their area under the curve values (CVPT0: 0.70, (95%CI: 0.49 - 0.90; ΔCVPT5: 0.78, (95%CI: 0.57 - 0.99; ΔCVPT10: 0.63, (95%CI: 0.39 - 0.88; ΔCVPT15: 0.68, ((95%CI: 0.45 - 0.92). The RespCVP at baseline also had a poor performance (area under the curve: 0.70; 95%CI: 0.50 - 0.91).</p><p><strong>Conclusion: </strong>Changes in central venous pressure have limited value in predicting fluid responsiveness.</p>\",\"PeriodicalId\":72721,\"journal\":{\"name\":\"Critical care science\",\"volume\":\"36 \",\"pages\":\"e20240073en\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2024-12-02\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11634234/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Critical care science\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.62675/2965-2774.20240073-en\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Critical care science","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.62675/2965-2774.20240073-en","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/1/1 0:00:00","PubModel":"eCollection","JCR":"","JCRName":"","Score":null,"Total":0}
Changes in central venous pressure during a fluid challenge have limited value for guiding fluid therapy.
Objective: To evaluate whether changes in central venous pressure during fluid expansion and baseline cyclic respiratory variation in the central venous pressure amplitude (RespCVP) curve could be used to discriminate between fluid responders and nonresponders.
Methods: This prospective observational study included critically ill adult patients who underwent fluid expansion in the form of a fluid bolus or fluid challenge with crystalloids. All patients were under mechanical ventilation and adequately sedated. We determined the central venous pressure at baseline (CVPT0) and the changes at 5 (ΔCVPT5), 10 (ΔCVPT10) and 15 (ΔCVPT15) minutes during fluid infusion. We also measured the RespCVP at baseline. Fluid responsiveness was defined as a cardiac index increase of ≥ 15%.
Results: The study included 30 patients (11 responders and 19 nonresponders). The CVPT0 and the changes after a fluid challenge at all three time points did not adequately predict fluid responsiveness, as determined by their area under the curve values (CVPT0: 0.70, (95%CI: 0.49 - 0.90; ΔCVPT5: 0.78, (95%CI: 0.57 - 0.99; ΔCVPT10: 0.63, (95%CI: 0.39 - 0.88; ΔCVPT15: 0.68, ((95%CI: 0.45 - 0.92). The RespCVP at baseline also had a poor performance (area under the curve: 0.70; 95%CI: 0.50 - 0.91).
Conclusion: Changes in central venous pressure have limited value in predicting fluid responsiveness.
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