The assessment of ultrasonic measurement of superior vena cava blood flow for the volume responsiveness of patients with mechanical ventilation / 中华危重病急救医学

ABSTRACT

Objective To approach the evaluative effect of respiratory variation of superior vena cava peak flow velocity measured using transthoracic echocardiography (TTE) on fluid responsiveness in patients with mechanical ventilation.Methods A prospective cohort study was conducted.All mechanical ventilated critically ill patients whose fluid therapy was planned due to hypovolemia in Department of Critical Care Medicine of Beijing Tongren Hospital of Capital Medical University from April 2011 to April 2013 were enrolled.Volume expansion was performed with 500 mL Linger solution within 30 minutes.Patients were classified as responders if pulse pressure variation (PPV) increased ≥ 13％ before volume expansion.The respiratory variation in superior vena cava peak velocity was calculated as the difference between maximum and minimum values of velocity in peak A,peak S and peak D over a single respiratory circle,and their variations (ΔA,ΔS,ΔD) were also calculated.The receiver operating characteristic curve (ROC curve) was plotted to assess the evaluative effect of respiratory variation of superior vena cava peak velocity on fluid responsiveness.Results Twenty-seven patients were enrolled in this study.Volume expansion increased PPV ≥ 13％ happened in 14 patients (responders).The velocity of superior vena cava in peak A,peak S,peak D was significantly increased after volume expansion compared with that before volume expansion in responders [peak A (cm/s)34.6 ± 2.2 vs.31.3 ±2.1,t=-2.493,P=0.027; peak S (cm/s)39.1 ± 1.3 vs.35.3 ±2.1,t=-2.564,P=0.024; peak D (cm/s)28.1 ± 1.2 vs.23.3 ± 1.4,t=-4.995,P=0.000],but there was no significant difference in ΔA,ΔS and ΔD between before and after volume expansion.The ΔA,ΔS and ΔD were positively correlated with PPV (r＝0.040,P=0.854; r=0.350,P=0.074; r=0.749,P=0.000).The area under ROC curve (AUC) of peak S was 0.36 [95％ confidence interval (95％CI)0.11-0.52],but the AUC of ΔS was 0.68 (95％CI 0.47-0.89),the AUC of peak D was 0.41 (95％CI 0.19-0.63),but the AUC of ΔD was 0.95 (95％CI 0.86-1.00),so the aberration rate of superior vena cava in respiration was better than the flow rate in superior vena cava.When the cut-off value of ΔS was 20.7％ for predicting fluid responsiveness,the sensitivity was 78.6％ and the specificity was 61.5％.When the cut-off value of ΔD was 12.7％ for predicting fluid responsiveness,the sensitivity was 92.0％ and the specificity was 92.3％.Conclusion Respiratory variations in superior vena cava peak velocity measured by TTE could assess fluid responsiveness in patients with mechanical ventilation.