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CLC number: R44

On-line Access: 2018-07-04

Received: 2017-05-07

Revision Accepted: 2017-11-20

Crosschecked: 2018-06-06

Cited: 0

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Citations:  Bibtex RefMan EndNote GB/T7714

 ORCID:

Wolfgang Huber

https://orcid.org/0000-0001-9086-7908

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Journal of Zhejiang University SCIENCE B 2018 Vol.19 No.7 P.515-524

http://doi.org/10.1631/jzus.B1700243


Mandatory criteria for the application of variability-based parameters of fluid responsiveness: a prospective study in different groups of ICU patients


Author(s):  Wolfgang Huber, Uli Mayr, Andreas Umgelter, Michael Franzen, Wolfgang Reindl, Roland M. Schmid, Florian Eckel

Affiliation(s):  II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, D-81675 München, Germany; more

Corresponding email(s):   Wolfgang.Huber@tum.de

Key Words:  Hemodynamic monitoring, Preload, Fluid responsiveness, Stroke volume variation, Pulse pressure variation


Wolfgang Huber, Uli Mayr, Andreas Umgelter, Michael Franzen, Wolfgang Reindl, Roland M. Schmid, Florian Eckel. Mandatory criteria for the application of variability-based parameters of fluid responsiveness: a prospective study in different groups of ICU patients[J]. Journal of Zhejiang University Science B, 2018, 19(7): 515-524.

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author="Wolfgang Huber, Uli Mayr, Andreas Umgelter, Michael Franzen, Wolfgang Reindl, Roland M. Schmid, Florian Eckel",
journal="Journal of Zhejiang University Science B",
volume="19",
number="7",
pages="515-524",
year="2018",
publisher="Zhejiang University Press & Springer",
doi="10.1631/jzus.B1700243"
}

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%T Mandatory criteria for the application of variability-based parameters of fluid responsiveness: a prospective study in different groups of ICU patients
%A Wolfgang Huber
%A Uli Mayr
%A Andreas Umgelter
%A Michael Franzen
%A Wolfgang Reindl
%A Roland M. Schmid
%A Florian Eckel
%J Journal of Zhejiang University SCIENCE B
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A1 - Wolfgang Huber
A1 - Uli Mayr
A1 - Andreas Umgelter
A1 - Michael Franzen
A1 - Wolfgang Reindl
A1 - Roland M. Schmid
A1 - Florian Eckel
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PB - Zhejiang University Press & Springer
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DOI - 10.1631/jzus.B1700243


Abstract: 
Background and objective: stroke volume variation (SVV) has high sensitivity and specificity in predicting fluid responsiveness. However, sinus rhythm (SR) and controlled mechanical ventilation (CV) are mandatory for their application. Several studies suggest a limited applicability of SVV in intensive care unit (ICU) patients. We hypothesized that the applicability of SVV might be different over time and within certain subgroups of ICU patients. Therefore, we analysed the prevalence of SR and CV in ICU patients during the first 24 h of PiCCO-monitoring (primary endpoint) and during the total ICU stay. We also investigated the applicability of SVV in the subgroups of patients with sepsis, cirrhosis, and acute pancreatitis. Methods: The prevalence of SR and CV was documented immediately before 1241 thermodilution measurements in 88 patients. Results: In all measurements, SVV was applicable in about 24%. However, the applicability of SVV was time-dependent: the prevalence of both SR and CV was higher during the first 24 h compared to measurements thereafter (36.1% vs. 21.9%; P<0.001). Within different subgroups, the applicability during the first 24 h of monitoring ranged between 0% in acute pancreatitis, 25.5% in liver failure, and 48.9% in patients without pancreatitis, liver failure, pneumonia or sepsis. Conclusions: The applicability of SVV in a predominantly medical ICU is only about 25%–35%. The prevalence of both mandatory criteria decreases over time during the ICU stay. Furthermore, the applicability is particularly low in patients with acute pancreatitis and liver failure.

不同患者群体容量反应性变量参数应用的强制性标准:重症监护病人窦性节律和控制呼吸流行情况的前瞻性研究

目的:通过对危重病人在入院后24小时内和整个重症监护过程中窦性心律和控制呼吸情况的调查,分析每搏量变异在评估危重病人容量反应的适用性,并探究每搏量变异度在败血症、肝硬化和胰腺炎病人中的适用性.
创新点:通过探究窦性节律和控制呼吸情况评估每搏量变异度在重症监护病人临床上的适用性,弥补重症监护病人窦性节律和控制呼吸情况数据的空白.
方法:在进行1241次热稀释法血流量测量前,对88位病人的窦性节律和控制呼吸情况进行调查.
结论:每搏量变异度在主要的医疗重症监护病房中的适用性只约为25%~35%.两项强制性指标的流行性在重症监护病房的情况随时间的延长而降低.此外,每搏量变异度在胰腺炎和肝功能衰竭患者中的适用性尤其低.

关键词:血液动力学检测;前负荷;容量反应性;每搏量变异度;脉压变异

Darkslateblue:Affiliate; Royal Blue:Author; Turquoise:Article

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