利用脉压变化预测低潮气量通气患者的输液反应性:系统回顾与元分析》。

IF 16.4 1区 化学 Q1 CHEMISTRY, MULTIDISCIPLINARY
Accounts of Chemical Research Pub Date : 2020-01-24 eCollection Date: 2020-01-01 DOI:10.1177/1179548420901518
Jorge Iván Alvarado Sánchez, Juan Daniel Caicedo Ruiz, Juan José Diaztagle Fernández, Gustavo Adolfo Ospina-Tascón, Luis Eduardo Cruz Martínez
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引用次数: 0

摘要

简介:脉压变化(PPV)已被证明可用于预测潮气量(Vt)大于 8 毫升/千克的通气患者对液体的反应性。然而,重症监护中的大多数情况下都不得不使用较低的 Vt。因此,我们试图评估在机械通气支持期间使用 Vt ⩽8 mL kg-1 时 PPV 的操作性能:我们在 PubMed 和 Embase 数据库中检索了 1990 年 1 月至 2019 年 1 月间评估 PPV 作为重症监护和围手术期成人患者液体反应性预测指标的文章,通气潮气量⩽8 mL kg-1 且无呼吸努力和心律失常。我们纳入了队列研究和横断面研究。两位作者使用预定义的检索词进行了独立筛选。通过双变量分析和层次分析评估了灵敏度、特异性和曲线下面积(AUC)的拟合数据:结果:我们检索到 19 项试验,共有 777 名患者和 935 次液体挑战。在 Vt ⩽8 mL kg-1 时,PPV 预测机械通气期间液体反应性的拟合灵敏度为 0.65(95% 置信区间 [CI]:0.57-0.73),特异性为 0.79(95% CI:0.73-0.84),AUC 为 0.75。诊断几率比为 5.5(95% CI:3.08-10.01,P 结论:对于潮气量⩽8 mL kg-1 且无呼吸困难和心律失常的重症监护和围手术期患者,脉压变化作为输液反应性的预测指标显示出良好的操作性能。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Use of Pulse Pressure Variation as Predictor of Fluid Responsiveness in Patients Ventilated With Low Tidal Volume: A Systematic Review and Meta-Analysis.

Use of Pulse Pressure Variation as Predictor of Fluid Responsiveness in Patients Ventilated With Low Tidal Volume: A Systematic Review and Meta-Analysis.

Use of Pulse Pressure Variation as Predictor of Fluid Responsiveness in Patients Ventilated With Low Tidal Volume: A Systematic Review and Meta-Analysis.

Use of Pulse Pressure Variation as Predictor of Fluid Responsiveness in Patients Ventilated With Low Tidal Volume: A Systematic Review and Meta-Analysis.

Introduction: Pulse pressure variation (PPV) has been shown to be useful to predict fluid responsiveness in patients ventilated at tidal volume (Vt) >8 mL kg-1. Nevertheless, most conditions in critical care force to use lower Vt. Thus, we sought to evaluate the operative performance of PPV when a Vt ⩽8 mL kg-1 is used during mechanical ventilation support.

Methods: We searched PubMed and Embase databases for articles evaluating the operative performance of PPV as a predictor of fluid responsiveness in critical care and perioperative adult patients ventilated with tidal volume ⩽8 mL kg-1 without respiratory effort and arrhythmias, between January 1990 and January 2019. We included cohort and cross-sectional studies. Two authors performed an Independently selection using predefined terms of search. The fitted data of sensitivity, specificity, and area under the curve (AUC) were assessed by bivariate and hierarchical analyses.

Results: We retrieved 19 trials with a total of 777 patients and a total of 935 fluid challenges. The fitted sensitivity of PPV to predict fluid responsiveness during mechanical ventilation at Vt ⩽8 mL kg-1 was 0.65 (95% confidence interval [CI]: 0.57-0.73), the specificity was 0.79 (95% CI: 0.73-0.84), and the AUC was 0.75. The diagnostic odds ratio was 5.5 (95% CI: 3.08-10.01, P < .001) by the random-effects model.

Conclusions: Pulse pressure variation shows a fair operative performance as a predictor of fluid responsiveness in critical care and perioperative patients ventilated with a tidal volume ⩽8 mL kg-1 without respiratory effort and arrhythmias.

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来源期刊
Accounts of Chemical Research
Accounts of Chemical Research 化学-化学综合
CiteScore
31.40
自引率
1.10%
发文量
312
审稿时长
2 months
期刊介绍: Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.
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