Fluid responsiveness prediction using Vigileo FloTrac measured cardiac output changes during passive leg raise test

被引：15
作者：
Krige A. [1 ]
Bland M. [1 ]
Fanshawe T. [2 ]
机构：
[1] Royal Blackburn Hospital, Department of Anaesthesia and Critical Care, Haslingden Road, Blackburn
[2] University of Oxford, Nuffield Department of Primary Care Health Sciences, Oxford
来源：
Journal of Intensive Care | / 4卷 / 1期
关键词：
Cardiac output monitoring; Edwards Vigileo FloTrac monitoring; Fluid responsiveness; Passive leg raising; Septic shock; Vasoplegic shock;
D O I：
10.1186/s40560-016-0188-6
中图分类号：
学科分类号：
摘要：
Background: Passive leg raising (PLR) is a so called self-volume challenge used to test for fluid responsiveness. Changes in cardiac output (CO) or stroke volume (SV) measured during PLR are used to predict the need for subsequent fluid loading. This requires a device that can measure CO changes rapidly. The Vigileo™ monitor, using third-generation software, allows continuous CO monitoring. The aim of this study was to compare changes in CO (measured with the Vigileo device) during a PLR manoeuvre to calculate the accuracy for predicting fluid responsiveness. Methods: This is a prospective study in a 20-bedded mixed general critical care unit in a large non-university regional referral hospital. Fluid responders were defined as having an increase in CO of greater than 15 % following a fluid challenge. Patients meeting the criteria for circulatory shock with a Vigileo™ monitor (Vigileo™; FloTrac; Edwards™; Lifesciences, Irvine, CA, USA) already in situ, and assessed as requiring volume expansion by the clinical team based on clinical criteria, were included. All patients underwent a PLR manoeuvre followed by a fluid challenge. Results: Data was collected and analysed on stroke volume variation (SVV) at baseline and CO and SVV changes during the PLR manoeuvre and following a subsequent fluid challenge in 33 patients. The majority had septic shock. Patient characteristics, baseline haemodynamic variables and baseline vasoactive infusion requirements were similar between fluid responders (10 patients) and non-responders (23 patients). Peak increase in CO occurred within 120 s during the PLR in all cases. Using an optimal cut point of 9 % increase in CO during the PLR produced an area under the receiver operating characteristic curve of 0.85 (95 % CI 0.63 to 1.00) with a sensitivity of 80 % (95 % CI 44 to 96 %) and a specificity of 91 % (95 % CI 70 to 98 %). Conclusions: CO changes measured by the Vigileo™ monitor using third-generation software during a PLR test predict fluid responsiveness in mixed medical and surgical patients with vasopressor-dependent circulatory shock. © 2016 The Author(s).
引用
收藏
相关论文
共 54 条
[11]  
Weidemann H.P., Wheeler A.P., Bernard G.R., Thompson B.T., Hayden D., deBoisblanc B., Connors A.F., Hite R.D., Harabin A.L., Comparison of two fluid management strategies in acute lung injury, N Engl J Med, 354, pp. 2564-2575, (2006)
[12]  
Cavallaro F., Sandroni C., Antonelli M., Functional hemodynamic monitoring and dynamic indices of fluid responsiveness, Minerva Anestesiol, 74, pp. 137-143, (2008)
[13]  
Marik P.E., Cavallazzi R., Vasu T., Hirani A., Dynamic changes in arterial waveform derived variables and fluid responsiveness in mechanically ventilated patients: a systematic review of the literature, Crit Care Med, 37, pp. 2642-2647, (2009)
[14]  
Michard F., Teboul J.L., Using heart-lung interactions to assess fluid responsiveness during mechanical ventilation, Crit Care, 4, pp. 282-289, (2000)
[15]  
Perner A., Faber T., Stroke volume variation does not predict fluid responsiveness in patients with septic shock on pressure support ventilation, Acta Anaesthesiol Scand, 50, pp. 1068-1073, (2006)
[16]  
Hofer C.K., Senn A., Weibel L., Zollinger A., Assessment of stroke volume variation for prediction of fluid responsiveness using the modified FloTrac and PiCCOplus system, Crit Care, 12, (2008)
[17]  
Soubrier S., Saulnier F., Hubert H., Delour P., Lenci H., Onimus T., Nseir S., Durocher A., Can dynamic indicators help the prediction of fluid responsiveness in spontaneously breathing critically ill patients?, Intensive Care Med, 33, pp. 1117-1124, (2007)
[18]  
Rutlen D.L., Wackers F.J., Zaret B.L., Radionuclide assessment of peripheral intravascular capacity: a technique to measure intravascular volume changes in the capacitance circulation in man, Circulation, 64, pp. 146-152, (1981)
[19]  
Gaffney F.A., Bastian B.C., Thal E.R., Et al., Passive leg raising does not produce a significant or sustained autotransfusion effect, J Trauma, 22, pp. 190-193, (1982)
[20]  
Wong D.H., O'Connor D., Tremper K.K., Et al., Changes in cardiac output after acute blood loss and position change in man, Crit Care Med, 17, pp. 979-983, (1989)
123456