经胸壁床旁超声预测机械通气患者急性循环衰竭容量反应性的临床研究

doi:10.3969/j.issn.1002-1949.2017.12.014

Chinese Journal of Critical Care Medicine

2017, Vol. 37

Issue (12): 1134-1138 DOI: 10.3969/j.issn.1002-1949.2017.12.014

A clinical investigation about using bedside ultrasound via chest wall to predict fluid responsiveness in acute circulatory failure patients with mechanical ventilation

ang Run-ze, Zhou Shu-sheng, Liu Bao, Zha Yu, Huang Yu, Wang Chun-yan, Cao Xiao-guang

Department of Critical Care Medicine, the Affiliated Provincial Hospital of Anhui Medical University, Hefei 230001, China

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Abstract Objective: To This study would evaluate the value of measurement of internal jugular vein (IJVR) collapsibility and inferior vena cava(IVCR) in fluid responsiveness. Methods: This study was a prospective clinical analysis and 56 mechanically ventilated patients were assessed. Ultrasound of IJVR dimensions was performed before and after fluid challenge (500 mL colloid fluid bolus). IJVR collapsibility was calculated as (IJVmax-IJVmin)/IJVmax and expressed as a percentage. Central venous pressure (CVP) and IVCR collapsibility were also collected. We would evaluate the value of IJVR collapsibility, CVP and IVCR collapsibility by the sensitivity, specificity and likelihood ratios of receiver operating characteristic (ROC) curves in predicting volume responsiveness. Results: We enrolled 56 patients, 32 were responsiveness (57%) and 24(43%) were no responsiveness. IJVR and ΔSV were correlated (r=0.809, P＜0.05). Fluid responsiveness was defined when collapsibility value for IJVR was ≥13%. The area under the ROC curve was 0.735 (95%CI 0.603～0.866), with a sensitivity of 85.7% and specificity of 70.3%. Fluid responsiveness was defined when collapsibility value for IVCR was≥18.7%. The area under the ROC curve was 0.853 (95%CI 0.696～0.956 ), with a sensitivity of 86.7% and specificity of 83%. Interestingly, combining IJVR collapsibility more than 13% and IVCR collapsibility more than 18% predicted fluid responsiveness with a sensitivity of 90.9% and specificity of 89.3%. But fluid responsiveness was defined when CVP was ≤10 cm H2O. The area under the ROC curve was 0.653 (95%CI 0.441～0.828), with a sensitivity of 56.7% and specificity of 50.8%. Conclusion: IJVR collapsibility may be an accurate, easily acquired non-invasive parameter of fluid responsiveness in acute circulatory failure. The combined use of IJVR and IVCR can improve the sensitivity and specificity. 

Received: 28 July 2017

Corresponding Authors: Zhou Shu-sheng, E-mail:zhouss108@163.com

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	ang Run-ze
	Zhou Shu-sheng
	Liu Bao
	Zha Yu
	Huang Yu
	Wang Chun-yan
	Cao Xiao-guang

Cite this article:

ang Run-ze,Zhou Shu-sheng,Liu Bao, et al. A clinical investigation about using bedside ultrasound via chest wall to predict fluid responsiveness in acute circulatory failure patients with mechanical ventilation[J]. Chinese Journal of Critical Care Medicine, 2017, 37(12): 1134-1138.

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http://www.cnemergency.org.cn/EN/10.3969/j.issn.1002-1949.2017.12.014 OR http://www.cnemergency.org.cn/EN/Y2017/V37/I12/1134

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