应用颈总动脉血流速度时间积分的被动抬腿试验预测液体反应性。
Passive leg raising test using the carotid flow velocity-time integral to predict fluid responsiveness.
机构信息
Department of Critical Care Medicine, Sanatorio de Los Arcos, Juan B. Justo 909, CABA, Buenos Aires, Argentina.
Argentinian Critical Care Ultrasonography Association (ASARUC), Buenos Aires, Argentina.
出版信息
J Ultrasound. 2024 Mar;27(1):97-104. doi: 10.1007/s40477-023-00824-1. Epub 2023 Sep 5.
PURPOSE
The passive leg raising test (PLR) is a noninvasive method widely adopted to assess fluid responsiveness. We propose to explore if changes in the carotid flow assessed by echo-Doppler can predict fluid responsiveness after a PLR.
METHODS
We conducted a performance diagnostic study in two intensive care units from Argentina between February and April 2022. We included patients with signs of tissular hypoperfusion that required fluid resuscitation. We labeled the patients as fluid responders when we measured, after a fluid bolus, an increase greater than 15% in the left ventricle outflow tract (LVOT) VTI in an apical 5-chamber view and we compared those results with the carotid flow (CF) velocity-time integral (VTI) from the left supraclavicular region in a semi-recumbent position and during the PLR.
RESULTS
Of the 62 eligible patients, 50 patients (80.6%) were included. The area under the ROC curve for a change in CF VTI during the PLR test was 0.869 (95% CI 0.743-0.947). An increase of at least of 11% in the CF VTI with the PLR predicted fluid-responsiveness with a sensitivity of 77.3% (95% CI 54.6-92.2%) and specificity of 78.6% (95% CI 59-91.7%). The positive predictive value was 73.9% (95% CI 57.4-85.6%) and the negative predictive value was 81.5% (95% CI 66.5-90.7%). The positive likelihood ratio was 3.61 and the negative likelihood ratio was 0.29.
CONCLUSION
An increase greater than 11% in CF VTI after a PLR may be useful to predict fluid responsiveness among critically ill patients.
目的
被动抬腿试验（PLR）是一种广泛采用的非侵入性方法，用于评估液体反应性。我们提出探讨在 PLR 后，通过超声心动图评估颈动脉血流变化是否可以预测液体反应性。
方法
我们在阿根廷的两个重症监护病房进行了一项性能诊断研究，时间为 2022 年 2 月至 4 月。我们纳入了有组织灌注不足迹象、需要液体复苏的患者。我们在液体冲击后测量左心室流出道（LVOT）VTI 的增加大于 15%，将患者标记为液体反应者，并将这些结果与半卧位和 PLR 期间左锁骨上区域的颈动脉血流（CF）速度时间积分（VTI）进行比较。
结果
在 62 名符合条件的患者中，有 50 名患者（80.6%）入选。PLR 试验中 CF VTI 变化的 ROC 曲线下面积为 0.869（95%CI 0.743-0.947）。PLR 时 CF VTI 至少增加 11%预测液体反应性，敏感性为 77.3%（95%CI 54.6-92.2%），特异性为 78.6%（95%CI 59-91.7%）。阳性预测值为 73.9%（95%CI 57.4-85.6%），阴性预测值为 81.5%（95%CI 66.5-90.7%）。阳性似然比为 3.61，阴性似然比为 0.29。
结论
PLR 后 CF VTI 增加大于 11%可能有助于预测重症患者的液体反应性。
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