Value of end-expiratory occlusion tests combined with brachial artery peak velocity in predicting volume responsiveness of mechanically ventilated patients with shock

doi:10.3877/cma.j.issn.1674-6880.2020.05.005

Abstract

Abstract:

Objective

To evaluate whether the brachial artery peak velocity (Vpeak-BA) induced by end-expiratory occlusion (EEO) tests can predict volume responsiveness of mechanically ventilated patients with shock.

Methods

From April 2018 to November 2019, 40 patients with shock undergoing mechanical ventilation were selected from the Department of Critical Care Medicine, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital). The sequential EEO and rehydration tests were performed on all enrolled patients. Their general data were recorded, as well as their left ventricle outflow tract velocity-time integral (VTI) and Vpeak-BA before and after the EEO and rehydration tests. The Vpeak-BA change (△VBA-EEO) and VTI change (△VTI-EEO) before and after the EEO test were calculated. Patients with a VTI increase of ≥ 15% after the rehydration test were included in the response group (23 patients), otherwise they were included in the non-response group (17 patients). The receiver operating characteristic (ROC) curve was used to evaluate the value of △VBA-EEO in predicting volume responsiveness.

Results

Before the EEO test, the Vpeak-BA [(48 ± 4) cm/s vs. (55 ± 5) cm/s] and VTI [(19.1 ± 4.7) cm vs. (23.0 ± 4.8) cm] between the response group and non-response group were statistically significantly different (t = 5.715, 3.010; both P < 0.05). The Vpeak-BA [(56 ± 6) cm/s vs. (48 ± 4) cm/s] and VTI [(22.8 ± 5.2) cm vs. (19.1 ± 4.7) cm] in the response group were significantly higher after the EEO test than before the EEO test (t = 5.324, 2.495; both P < 0.05). Before the rehydration test, the Vpeak-BA [(48 ± 4) cm/s vs. (54 ± 5) cm/s] and VTI [(19.0 ± 4.7) cm vs. (23.0 ± 4.4) cm] between the response group and non-response group were statistically significantly different (t = 5.222, 3.155; both P < 0.05). The Vpeak-BA [(58 ± 6) cm/s vs. (48 ± 4) cm/s] and VTI [(23.5 ± 5.0) cm vs. (19.0 ± 4.7) cm] in the response group were significantly higher after the rehydration test than before the rehydration test (t = 6.800, 3.133; both P < 0.05). The area under the ROC curve (AUC) of △VBA-EEO for predicting volume responsiveness was 0.830 [95% confidence interval (CI) (0.718, 0.941), P < 0.001], while the AUC of △VTI-EEO was 0.887 [95%CI (0.772, 1.003), P < 0.001]. Based on △VBA-EEO ≥ 12.5%, its sensitivity and specificity of predicting volume responsiveness were 82.6% and 70.6% respectively. Furthermore, its sensitivity and specificity of predicting volume responsiveness were 87.0% and 88.2% respectively, using △VTI-EEO ≥ 9.9% as the boundary point.

Conclusion

△VBA-EEO can relatively accurately predict the volume responsiveness of mechanically ventilated patients with shock and guide their fluid resuscitation therapy.

Key words: Shock, End-expiratory occlusion test, Volume responsiveness, Brachial artery peak velocity

Jue Shen, Wensheng Liu, Jiangfeng Tang, Lihong Shan, Kaizhong Liu. Value of end-expiratory occlusion tests combined with brachial artery peak velocity in predicting volume responsiveness of mechanically ventilated patients with shock[J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2020, 13(05): 345-350.

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组别	例数	年龄（岁）	性别（例，男/女）	体质量指数（kg/m²）	脓毒症（例）	潮气量（mL/kg）	总PEEP（mmHg）	应用血管活性药物（例）	去甲肾上腺素用量（μg·kg^-1·min^-1）	APACHEⅡ评分（分）
有反应组	23	59 ± 9	15/8	22.2 ± 4.0	21	7.2 ± 0.9	5.9 ± 1.8	16	0.9 ± 0.3	16.3 ± 5.0
无反应组	17	57 ± 12	12/5	22.1 ± 3.5	16	7.5 ± 0.9	6.1 ± 1.4	11	1.0 ± 0.3	16.4 ± 6.4
χ²/t值		0.468	0.129	0.084	0.112	1.122	0.358	0.105	1.086	0.027
P值		0.642	0.720	0.934	0.738	0.269	0.722	0.746	0.288	0.979

组别	例数	年龄（岁）	性别（例，男/女）	体质量指数（kg/m²）	脓毒症（例）	潮气量（mL/kg）	总PEEP（mmHg）	应用血管活性药物（例）	去甲肾上腺素用量（μg·kg^-1·min^-1）	APACHEⅡ评分（分）
有反应组	23	59 ± 9	15/8	22.2 ± 4.0	21	7.2 ± 0.9	5.9 ± 1.8	16	0.9 ± 0.3	16.3 ± 5.0
无反应组	17	57 ± 12	12/5	22.1 ± 3.5	16	7.5 ± 0.9	6.1 ± 1.4	11	1.0 ± 0.3	16.4 ± 6.4
χ²/t值		0.468	0.129	0.084	0.112	1.122	0.358	0.105	1.086	0.027
P值		0.642	0.720	0.934	0.738	0.269	0.722	0.746	0.288	0.979

组别		例数	Vpeak-BA（cm/s）	VTI（cm）
有反应组
	EEO试验前	23	48 ± 4	19.1 ± 4.7
	EEO试验后	23	56 ± 6^a	22.8 ± 5.2^a
无反应组
	EEO试验前	17	55 ± 5^b	23.0 ± 4.8^b
	EEO试验后	17	58 ± 4	24.4 ± 4.9

组别		例数	Vpeak-BA（cm/s）	VTI（cm）
有反应组
	EEO试验前	23	48 ± 4	19.1 ± 4.7
	EEO试验后	23	56 ± 6^a	22.8 ± 5.2^a
无反应组
	EEO试验前	17	55 ± 5^b	23.0 ± 4.8^b
	EEO试验后	17	58 ± 4	24.4 ± 4.9

组别		例数	Vpeak-BA（cm/s）	VTI（cm）
有反应组
	补液试验前	23	48 ± 4	19.0 ± 4.7
	补液试验后	23	58 ± 6^a	23.5 ± 5.0^a
无反应组
	补液试验前	17	54 ± 5^b	23.0 ± 4.4^b
	补液试验后	17	58 ± 5	24.3 ± 4.8

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