ABSTRACT
Objective:To explore the value of severe ultrasound measurement of internal jugular vein dilation index (ΔIJV) combined with passive leg raising (PLR) in predicting the volume responsiveness of septic shock.Methods:Patients diagnosed with septic shock under complete mechanical ventilation in the ICU of Jinshan Hospital Affiliated to Fudan University from January 2020 to March 2021 were prospectively selected as the research objects. After 500 mL crystals were injected within 30 min, the patients having the "gold standard" left stroke volume (SV) increased by 15% were allocated to the volume response positive group, and patient having an SV increased by less than 15% to the volume response negative group. First, the maximum anterior posterior diameter (IJV max) and the minimum anterior posterior diameter (IJV min) in the respiratory cycle of internal jugular vein were measured by ultrasound, then SV before and after PLR was measured, and finally SV, IJV max and IJV min were measured again after rapid infusion of 500 mL crystals, and ΔIJV=(IJV max-IJV min)/(IJV mean)×100%. The Wilcoxon rank-sum test was used to compare the hemodynamic indexes before and after capacity expansion and PLR. Spearman rank method was used to analyze the change rate of SV (ΔSV) after PLR and the correlation between ΔIJV and ΔSV of the "gold standard". The sensitivity, specificity and relevant cut-off values were obtained by drawing the subject function curve to evaluate the value of ΔIJV and PLR in predicting the volume responsiveness of patients with sepsis. Results:A total of 56 patients were enrolled in the study, and they were divided into two groups: 32 patients in the volume response positive group and 24 patients in the volume response negative group. There was a positive correlation between ΔIJV and ΔSV after capacity expansion ( r=0.778, P<0.01). Taking ΔIJV>17.3% as the threshold, the area under the curve (AUC) was 0.846 (95% CI: 0.716~0.977), the sensitivity was 84.4% and the specificity was 83.3%. PLR was also positively correlated with ΔSV ( r=0.698, P<0.01). Taking ΔSV>15.5% after PLR as the threshold, the AUC was 0.895 (95% CI: 0.796~0.993), the sensitivity was 96.9%, and the specificity was 79.2%. When ΔIJV combined with PLR predicted volume reactivity, the AUC was 0.944 (95% CI: 0.862~1.000), the sensitivity was 99.8% and the specificity was 87.5%. Conclusions:The measurement of internal jugular vein respiratory dilation index by bedside ultrasound is a reliable index to predict volume responsiveness in patients with sepsis. When combined with PLR, the sensitivity and specificity of prediction can be improved.
ABSTRACT
Objective To evaluate the cardiac function in patients with chronic obstructive pulmonary disease ( COPD) by using echocardiography.Methods Three hundred and twenty eight COPD patients and 60 age and gender-matched healthy subjects ( control group ) were enrolled in the study. According to Global Initiative for Chronic Obstructive Lung Disease ( GOLD ) criteria, patients were as classified as mild (n=102), moderate (n=85), severe (n=80) and very severe (61).All participants underwent conventional echocardiography and two dimensional-speckle tracking echocardiography (2D-STE) to assess cardiac function.Results The LVEF was reduced significantly, while the PASP was increased in severe and very severe COPD patients [(60.9 ±2.0)% and (59.4 ±2.8)%, t value:3.358, 4.859 to normal controls, 5.247, 6.641 to mild, 3.280, 4.863 to moderate, respectively, all P<0.001].The LA size was dilated in very severe COPD patients [(3.9 ±0.5) cm, t value: -2.407, -2.625, -2.071,-2.186, P<0.05 ] , and the RVEF was significantly less than those of the other patients [ ( 42.8 ± 7.3)%,t value: 6.357, 6.832, 5.581, 4.639, P<0.05 ] .The right ventricular FAC of moderate or severe COPD patients and the segmental and global LS of left and right ventricular in COPD patients were significantly lower than those in the normal controls, and which were gradually decreased as GOLD classification rising [ RVFAC, moderate: ( 37.7 ±2.0 )%, severe: ( 35.5 ±3.2 ) %, very severe:(34.0 ±3.1) %, t value: -4.616, -5.982, -7.195, respectively; LSLVg, moderate: ( -18.62 ± 1.76) %, severe: ( -17.15 ±0.73 ) %, very severe: ( -16.51 ±0.89 ) %, t value: -9.389,-15.494, -16.873, respectively;LSRVg, moderate:(-20.52 ±2.27) %, severe:(-18.84 ±1.38)%, very severe:(-16.82 ±1.10) %, t value:-8.555, -13.595, -18.499, respectively, all P<0.001].Besides, the FAC of COPD patients was positively correlated with the RVEF (r =0.676,P <0.05), while the RVLSg was negatively correlated with the FAC and RVEF (r=-0.677, -0.591,all P<0.05) .Conclusions There were left and right ventricular dysfunction in COPD patients, which decreased as GOLD classification upgraded. The FAC and 2D-STE can effectively detect the subtle abnormalities of regional and global ventricular function.