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Báo cáo y học: "Dynamic arterial elastance to predict arterial pressure response to volume loading in preload-dependent patients"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Dynamic arterial elastance to predict arterial pressure response to volume loading in preload-dependent patients. | Monge García et al. Critical Care 2011 15 R15 http ccforum.eom content 15 1 R15 cs CRITICAL CARE RESEARCH Open Access Dynamic arterial elastance to predict arterial pressure response to volume loading in preload-dependent patients Manuel Ignacio Monge García Anselmo Gil Cano Manuel Gracia Romero Abstract Introduction Hemodynamic resuscitation should be aimed at achieving not only adequate cardiac output but also sufficient mean arterial pressure MAP to guarantee adequate tissue perfusion pressure. Since the arterial pressure response to volume expansion VE depends on arterial tone knowing whether a patient is preloaddependent provides only a partial solution to the problem. The objective of this study was to assess the ability of a functional evaluation of arterial tone by dynamic arterial elastance Eadyn defined as the pulse pressure variation PPV to stroke volume variation SVV ratio to predict the hemodynamic response in MAP to fluid administration in hypotensive preload-dependent patients with acute circulatory failure. Methods We performed a prospective clinical study in an adult medical surgical intensive care unit in a tertiary care teaching hospital including 25 patients with controlled mechanical ventilation who were monitored with the Vigileo monitor for whom the decision to give fluids was made because of the presence of acute circulatory failure including arterial hypotension MAP 65 mmHg or systolic arterial pressure 90 mmHg and preserved preload responsiveness condition defined as a SVV value 10 . Results Before fluid infusion Eadyn was significantly different between MAP responders MAP increase 15 after VE and MAP nonresponders. VE-induced increases in MAP were strongly correlated with baseline Eadyn r2 0.83 P 0.0001 . The only predictor of MAP increase was Eadyn area under the curve 0.986 0.02 95 confidence interval CI 0.84-1 . A baseline Eadyn value 0.89 predicted a MAP increase after fluid administration with a sensitivity of 93.75 95 CI 69.8 -99.8