Carlos Ocaña-Alcober, Ignacio Oulego-Erroz, Daniel Palanca-Arias, Almudena Alonso-Ojembarrena, Juan José Menéndez-Suso, José Luis Vázquez-Martínez
{"title":"身体大小对自主呼吸儿童被动抬腿时脑容量反应的影响。","authors":"Carlos Ocaña-Alcober, Ignacio Oulego-Erroz, Daniel Palanca-Arias, Almudena Alonso-Ojembarrena, Juan José Menéndez-Suso, José Luis Vázquez-Martínez","doi":"10.1097/PCC.0000000000003828","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>To test whether indexing stroke volume change (ΔSV%) to body size during the passive leg raising (PLR) test in spontanoeusly breathing children improves accuracy to detect fluid responsiveness (FR).</p><p><strong>Design: </strong>Observational study.</p><p><strong>Setting: </strong>Two pediatric hospitals.</p><p><strong>Patients: </strong>Children 2-16 years old.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>In study phase 1, we measured ΔSV% by echocardiography during PLR in healthy children. A positive PLR test was defined as a mean ΔSV% greater than or equal to 10%. The correlation between ΔSV% with body size parameters was assessed, and optimal body size indexation was generated. In study phase 2, the PLR was performed in acutely ill children before a fluid challenge of 20 mL/kg of normal saline. ΔSV% was measured at 10 and 20 mL/kg and FR was defined as ΔSV% greater than or equal to 10% or greater than or equal to 15% (four possible definitions of FR). The diagnostic performance of the PLR using nonindexed and indexed ΔSV% to identify FR was assessed using the area under the receiver operating characteristic curve (AUC) analyses. We recruited 133 and 87 children in phase 1 and 2, respectively. Mean ΔSV% and the proportion of positive PLR test increased with age tertiles both in healthy children and children receiving a fluid challenge (p ≤ 0.01). ΔSV% positively correlated with body size. Indexing by height (i.e., [ΔSV%/0.0006] × height2.493) removed the effect of body size. The AUC of the PLR for FR ranged from 0.745 to 0.802, depending on the FR definition applied. The use of height-indexed ΔSV% improved diagnostic performance (AUC range, 0.852-0.894) compared to non-indexed ΔSV%, although the result was significant only when FR was defined as ΔSV% greater than 15% after 20 mL/kg (DeLong test < 0.05).</p><p><strong>Conclusions: </strong>The response in ΔSV% to a PLR is greatly influenced by body size. Indexing the value by height may improve the diagnostic performance of the PLR in children.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.5000,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Impact of Body Size on Stroke Volume Response to Passive Leg Raising in Spontaneously Breathing Children.\",\"authors\":\"Carlos Ocaña-Alcober, Ignacio Oulego-Erroz, Daniel Palanca-Arias, Almudena Alonso-Ojembarrena, Juan José Menéndez-Suso, José Luis Vázquez-Martínez\",\"doi\":\"10.1097/PCC.0000000000003828\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>To test whether indexing stroke volume change (ΔSV%) to body size during the passive leg raising (PLR) test in spontanoeusly breathing children improves accuracy to detect fluid responsiveness (FR).</p><p><strong>Design: </strong>Observational study.</p><p><strong>Setting: </strong>Two pediatric hospitals.</p><p><strong>Patients: </strong>Children 2-16 years old.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>In study phase 1, we measured ΔSV% by echocardiography during PLR in healthy children. A positive PLR test was defined as a mean ΔSV% greater than or equal to 10%. The correlation between ΔSV% with body size parameters was assessed, and optimal body size indexation was generated. In study phase 2, the PLR was performed in acutely ill children before a fluid challenge of 20 mL/kg of normal saline. ΔSV% was measured at 10 and 20 mL/kg and FR was defined as ΔSV% greater than or equal to 10% or greater than or equal to 15% (four possible definitions of FR). The diagnostic performance of the PLR using nonindexed and indexed ΔSV% to identify FR was assessed using the area under the receiver operating characteristic curve (AUC) analyses. We recruited 133 and 87 children in phase 1 and 2, respectively. Mean ΔSV% and the proportion of positive PLR test increased with age tertiles both in healthy children and children receiving a fluid challenge (p ≤ 0.01). ΔSV% positively correlated with body size. Indexing by height (i.e., [ΔSV%/0.0006] × height2.493) removed the effect of body size. The AUC of the PLR for FR ranged from 0.745 to 0.802, depending on the FR definition applied. The use of height-indexed ΔSV% improved diagnostic performance (AUC range, 0.852-0.894) compared to non-indexed ΔSV%, although the result was significant only when FR was defined as ΔSV% greater than 15% after 20 mL/kg (DeLong test < 0.05).</p><p><strong>Conclusions: </strong>The response in ΔSV% to a PLR is greatly influenced by body size. Indexing the value by height may improve the diagnostic performance of the PLR in children.</p>\",\"PeriodicalId\":19760,\"journal\":{\"name\":\"Pediatric Critical Care Medicine\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":4.5000,\"publicationDate\":\"2025-09-12\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Pediatric Critical Care Medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/PCC.0000000000003828\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CRITICAL CARE MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Pediatric Critical Care Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/PCC.0000000000003828","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
Impact of Body Size on Stroke Volume Response to Passive Leg Raising in Spontaneously Breathing Children.
Objectives: To test whether indexing stroke volume change (ΔSV%) to body size during the passive leg raising (PLR) test in spontanoeusly breathing children improves accuracy to detect fluid responsiveness (FR).
Design: Observational study.
Setting: Two pediatric hospitals.
Patients: Children 2-16 years old.
Interventions: None.
Measurements and main results: In study phase 1, we measured ΔSV% by echocardiography during PLR in healthy children. A positive PLR test was defined as a mean ΔSV% greater than or equal to 10%. The correlation between ΔSV% with body size parameters was assessed, and optimal body size indexation was generated. In study phase 2, the PLR was performed in acutely ill children before a fluid challenge of 20 mL/kg of normal saline. ΔSV% was measured at 10 and 20 mL/kg and FR was defined as ΔSV% greater than or equal to 10% or greater than or equal to 15% (four possible definitions of FR). The diagnostic performance of the PLR using nonindexed and indexed ΔSV% to identify FR was assessed using the area under the receiver operating characteristic curve (AUC) analyses. We recruited 133 and 87 children in phase 1 and 2, respectively. Mean ΔSV% and the proportion of positive PLR test increased with age tertiles both in healthy children and children receiving a fluid challenge (p ≤ 0.01). ΔSV% positively correlated with body size. Indexing by height (i.e., [ΔSV%/0.0006] × height2.493) removed the effect of body size. The AUC of the PLR for FR ranged from 0.745 to 0.802, depending on the FR definition applied. The use of height-indexed ΔSV% improved diagnostic performance (AUC range, 0.852-0.894) compared to non-indexed ΔSV%, although the result was significant only when FR was defined as ΔSV% greater than 15% after 20 mL/kg (DeLong test < 0.05).
Conclusions: The response in ΔSV% to a PLR is greatly influenced by body size. Indexing the value by height may improve the diagnostic performance of the PLR in children.
期刊介绍：
Pediatric Critical Care Medicine is written for the entire critical care team: pediatricians, neonatologists, respiratory therapists, nurses, and others who deal with pediatric patients who are critically ill or injured. International in scope, with editorial board members and contributors from around the world, the Journal includes a full range of scientific content, including clinical articles, scientific investigations, solicited reviews, and abstracts from pediatric critical care meetings. Additionally, the Journal includes abstracts of selected articles published in Chinese, French, Italian, Japanese, Portuguese, and Spanish translations - making news of advances in the field available to pediatric and neonatal intensive care practitioners worldwide.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
