Changes in portal pulsatility index induced by a fluid challenge in patients with haemodynamic instability and systemic venous congestion: a prospective cohort study.

IF 5.7 1区 医学 Q1 CRITICAL CARE MEDICINE Annals of Intensive Care Pub Date : 2024-11-01 DOI:10.1186/s13613-024-01391-2
Martin Ruste, Rehane Reskot, Rémi Schweizer, Valentin Mayet, Jean-Luc Fellahi, Matthias Jacquet-Lagrèze
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Abstract

Background: It is uncertain whether fluid administration can improve patients with systemic venous congestion and haemodynamic instability. This study aimed to describe the changes in systemic venous congestion and peripheral perfusion parameters induced by a fluid challenge in these patients, and to analyse the influence of the fluid responsiveness status on these changes.

Methods: The study is a single-centre prospective cohort study of 36 critically ill ICU patients with haemodynamic instability and a maximum vena cava diameter ≥ 20 mm. Changes in cardiac index during a fluid challenge (4 mL/kg of lactated Ringer's solution during 5 min) assessed by pulse contour analysis, central venous pressure, ultrasound systemic congestion parameters (portal venous flow pulsatility index, supra hepatic and intrarenal venous Doppler), and peripheral perfusion parameters (capillary refill time and peripheral perfusion index) were assessed in the overall population. All these data were compared between patients presenting a cardiac index increase > 10% during the fluid challenge (fluid responders) and the others (fluid non-responders).

Results: Twenty-eight (78%) patients were admitted for postoperative care following cardiac surgery; their mean ± SD left ventricular ejection fraction was 42 ± 9% and right ventricular dysfunction was found in at least 61% of the patients. The mean ± SD SOFA score was 9 ± 3. Thirteen (36%) patients were fluid responders. The fluid challenge administration induced a significant increase in portal pulsatility index, VExUS score, and central venous pressure without significant difference of these changes between fluid responders and non-responders. No significant change in perfusion parameters was observed.

Conclusion: Fluid administration in patients with haemodynamic instability and systemic venous congestion worsens venous congestion regardless of the fluid responsiveness status, without improving perfusion parameters.

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前瞻性队列研究:血流动力学不稳定和全身静脉充血患者在液体挑战下的门静脉搏动指数变化。
背景:目前尚不确定输液能否改善全身静脉充血和血流动力学不稳定的患者。本研究旨在描述液体挑战对这些患者全身静脉充血和外周灌注参数的影响,并分析液体反应性状态对这些变化的影响:该研究是一项单中心前瞻性队列研究,对象是 36 名血流动力学不稳定、腔静脉最大直径≥ 20 毫米的重症 ICU 患者。通过脉搏轮廓分析、中心静脉压、超声系统充血参数(门静脉血流搏动指数、肝上静脉和肾内静脉多普勒)和外周灌注参数(毛细血管再充盈时间和外周灌注指数)评估了所有患者在液体挑战(5 分钟内每公斤 4 毫升乳酸林格氏液)期间的心脏指数变化。将所有这些数据在液体挑战期间心脏指数增加大于 10% 的患者(液体反应者)和其他患者(液体无反应者)之间进行比较:28名(78%)患者在心脏手术后接受了术后护理;他们的平均(± SD)左心室射血分数为42±9%,至少61%的患者存在右心室功能障碍。平均(± SD)SOFA 评分为 9 ± 3。13名患者(36%)对液体有反应。输液挑战引起门静脉搏动指数、VExUS 评分和中心静脉压显著增加,但输液应答者和非应答者之间的这些变化无明显差异。灌注参数无明显变化:结论:对血流动力学不稳定和全身静脉充血的患者输液会加重静脉充血,而与输液反应状态无关,同时不会改善灌注参数。
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来源期刊
Annals of Intensive Care
Annals of Intensive Care CRITICAL CARE MEDICINE-
CiteScore
14.20
自引率
3.70%
发文量
107
审稿时长
13 weeks
期刊介绍: Annals of Intensive Care is an online peer-reviewed journal that publishes high-quality review articles and original research papers in the field of intensive care medicine. It targets critical care providers including attending physicians, fellows, residents, nurses, and physiotherapists, who aim to enhance their knowledge and provide optimal care for their patients. The journal's articles are included in various prestigious databases such as CAS, Current contents, DOAJ, Embase, Journal Citation Reports/Science Edition, OCLC, PubMed, PubMed Central, Science Citation Index Expanded, SCOPUS, and Summon by Serial Solutions.
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