J Clin Monit Comput - Respiratory induced dynamic variations of stroke volume and its surrogates as predictors of fluid responsiveness: applicability in the early stages of specific critical states.

Tópicos

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Resumo

Respiratory induced dynamic variations of stroke volume and its surrogates are very sensitive and specific predictors of fluid responsiveness, but their use as targets for volume management can be limited. In a recent study, limiting factors were present in 53 % of surgical patients with inserted arterial line. In the intensive care unit (ICU) population the frequency is presumably higher, but the real prevalence is unknown. Our goal was to study the feasibility of dynamic variations guided initial volume resuscitation in specific critical states. We have performed a 5 year retrospective evaluation of patients admitted with diagnosis sepsis, polytrauma, after high risk surgery or cardiac arrest. Occurrence of major (sedation, mandatory ventilation and tidal volume, open chest and arrhythmias) and minor limiting factors (PEEP level, use of vasopressors and presence of arterial catheter) was screened within the first 24 h after admission. In the study period 1296 patients were hospitalized in our ICU with severe sepsis (n = 242), polytrauma (n = 561), after high risk surgery (n = 351) or cardiac arrest (n = 141). From these patients 549 (42.4 %) fulfilled all major criteria for applicability of dynamic variations. In our evaluation only limited number of patients admitted for polytrauma (51 %), sepsis (37 %), after cardiac arrest (39 %) or surgical procedure (33 %) fulfil all the major criteria for use of dynamic variations at the ICU admission. The prevalence was similar in patients with shock. Occurrence of minor factors can pose further bias in evaluation of these patients. General use of dynamic variations guided protocols for initial resuscitations seems not universally applicable.

Resumo Limpo

respiratori induc dynam variat stroke volum surrog sensit specif predictor fluid respons use target volum manag can limit recent studi limit factor present surgic patient insert arteri line intens care unit icu popul frequenc presum higher real preval unknown goal studi feasibl dynam variat guid initi volum resuscit specif critic state perform year retrospect evalu patient admit diagnosi sepsi polytrauma high risk surgeri cardiac arrest occurr major sedat mandatori ventil tidal volum open chest arrhythmia minor limit factor peep level use vasopressor presenc arteri cathet screen within first h admiss studi period patient hospit icu sever sepsi n polytrauma n high risk surgeri n cardiac arrest n patient fulfil major criteria applic dynam variat evalu limit number patient admit polytrauma sepsi cardiac arrest surgic procedur fulfil major criteria use dynam variat icu admiss preval similar patient shock occurr minor factor can pose bias evalu patient general use dynam variat guid protocol initi resuscit seem univers applic

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