ABSTRACT
Objective:To identify the feasibility of inferior vena cava variability (ΔDIVC) combined with rectus femoris atrophy fraction in predicting the outcome of weaning from invasive mechanical ventilation (IMV).Methods:From January to December 2021, the patients with the need for IMV admitted to the Affiliated Yixing Hospital of Jiangsu University were recruited into prospective case-control study. The patients who met the withdrawal criteria were treated with a 2-h spontaneous breathing trial (SBT) and then extubated immediately. Patients with stable spontaneous breathing after extubation for more than 48 h were classified as successful weaning group, and on the contrary, the other patients were classified as failed weaning group. The clinical data and withdrawal indexes of the two groups were evaluated. The correlation between ΔD IVC and rectus femoris atrophy fraction was assessed. The influencing factors of weaning outcome were observed. The diagnostic value of ΔD IVC, rectus femoris atrophy fraction and the combination of two indexes in predicting weaning success were calculated by a plotting receiver operating characteristic (ROC) curve. Results:Sixty IMV patients were included in this study, including 38 cases of successful weaning and 22 cases of failed weaning. The two groups were comparable with regard to clinical data (all P>0.05). The rectus femoris cross-sectional area in the two groups diminished gradually with the length of ICU stay ( F=3.266, 3.625, both P<0.05). The rectus femoris cross-sectional area at the first SBT was significantly lower than that on the first day of admission in both groups [the successful weaning group: (2.54±0.88) cm 2vs. (3.08±0.98) cm 2; the failed weaning group: (2.22±0.87) cm 2vs. (3.02±1.10) cm 2, both P<0.05], but there was no significant difference between the two groups (all P>0.05). Patients in the successful weaning group had higher ΔD IVC and higher rectus femoris atrophy fraction than those in the weaning failure group [ΔD IVC: (25.02±4.65)% vs. (20.30±3.16)%; rectus femoris atrophy fraction: (81.89±5.09)% vs. (72.68±8.98)%, both P<0.05]. There was a positive correlation between ΔD IVC and rectus femoris atrophy fraction ( r=0.346, P=0.007). Both ΔD IVC and rectus femoris atrophy fraction played an important role in affecting weaning success (all P<0.05). The area under the curve (AUC) of ΔD IVC combined with rectus femoris atrophy fraction for predicting the weaning success was 0.880, which was significantly higher than that of ΔD IVC (AUC=0.791) or rectus femoris atrophy fraction (AUC=0.826). Conclusions:The predictive value of ΔD IVC combined with rectus femoris atrophy fraction for successful weaning of patients undergoing IMV is relatively accurate, which can be used to guide weaning.
ABSTRACT
Objective:To investigate the effect of inferior vena cava variability (IVCV) combined with difference of central venous-to-arterial partial pressure of carbon dioxide (Pcv-aCO 2) on guiding fluid resuscitation in septic shock. Methods:Patients with septic shock admitted to the department of critical care medicine of Jiangxi Provincial People's Hospital from January 1, 2018 to December 31, 2020 were enrolled, and they were divided into control group and observation group according to random number table method. Patients in both groups were given fluid resuscitation according to septic shock fluid resuscitation guidelines. The patients in the control group received fluid resuscitation strictly according to the early goal-directed therapy (EGDT) strategy. Resuscitation target: central venous pressure (CVP) 12-15 cmH 2O (1 cmH 2O≈0.098 kPa), mean arterial pressure (MAP) > 65 mmHg (1 mmHg≈0.133 kPa), mean urine volume (UO) > 0.5 mL·kg -1·h -1, central venous oxygen saturation (ScvO 2) > 0.70. In the observation group, the endpoint of resuscitation was evaluated by IVCV dynamically monitored by bedside ultrasound and Pcv-aCO 2. Resuscitation target: fixed filling of inferior vena cava with diameter > 2 cm, IVCV < 18%, and Pcv-aCO 2 < 6 mmHg. The changes in recovery indexes before and 6 hours and 24 hours of resuscitation of the two groups were recorded, and the 6-hour efficiency of fluid resuscitation, 6-hour lactate clearance rate (LCR) and 6-hour and 24-hour total volume of resuscitation were also recorded; at the same time, the duration of mechanical ventilation, length of intensive care unit (ICU) stay, 28-day mortality and the incidence of acute renal failure and acute pulmonary edema between the two groups were compared. Results:A total of 80 patients were enrolled in the analysis, with 40 in the control group and 40 in the observation group. The MAP, CVP and ScvO 2 at 6 hours and 24 hours of resuscitation in the two groups were significantly higher than those before resuscitation, while Pcv-aCO 2 and blood lactic acid (Lac) were significantly decreased, and UO was increased gradually with the extension of resuscitation time, indicating that both resuscitation endpoint evaluation schemes could alleviate the shock state of patients. Compared with before resuscitation, IVCV at 6 hours and 24 hours of resuscitation in the observation group were decreased significantly [(17.54±4.52)%, (18.32±3.64)% vs. (27.49±10.56)%, both P < 0.05]. Compared with the control group, MAP and ScvO 2 at 6 hours of resuscitation in the observation group were significantly increased [MAP (mmHg): 69.09±4.64 vs. 66.37±4.32, ScvO 2: 0.666±0.033 vs. 0.645±0.035, both P < 0.05], 24-hour MAP was increased significantly (mmHg: 75.16±3.28 vs. 70.12±2.18, P < 0.05), but CVP was relatively lowered (cmH 2O: 9.25±1.49 vs. 10.25±1.05, P < 0.05), indicating that the fluid resuscitation efficiency was higher in the observation group. Compared with the control group, 6-hour LCR in the observation group was significantly increased [(55.64±6.23)% vs. (52.45±4.52)%, P < 0.05], 6-hour and 24-hour total volume of resuscitation was significantly decreased (mL: 2 860.73±658.32 vs. 3 568.54±856.43, 4 768.65±1 085.65 vs. 5 385.34±1 354.83, both P < 0.05), the duration of mechanical ventilation was significantly shortened (days: 6.78±3.45 vs. 8.45±2.85, P < 0.05), while the incidence of acute pulmonary edema was significantly decreased [2.5% (1/40) vs. 20.0% (8/40), P < 0.05]. There was no significant difference in the length of ICU stay, 28-day mortality or incidence of acute renal failure between the two groups. Conclusions:Dynamic monitoring of IVCV and Pcv-aCO 2 can effectively guide the early fluid resuscitation of patients with septic shock, and compared with EGDT, it can significantly shorten the duration of mechanical ventilation, reduce the amount of fluid resuscitation, and reduce the incidence of acute pulmonary edema. Combined with its non-invasive characteristics, it has certain clinical advantages.