关键词：
hand-carried ultrasound
mechanical veutilation
pulse pressure variation
摘要：
Background: Rapid prediction of the effect of volume expansion is crucial in unstable patients receiving mechanical ventilation. Both radial artery pulse pressure variation (Delta PP) and change of aortic blood flow peak velocity are accurate predictors but may be impractical point-of-care tools. Purpose: We sought to determine whether respiratory changes in the brachial artery blood flow velocity (Delta Vpeak-BA) as measured by internal medicine residents using a band-carried ultrasound (HCU) device could provide an accurate corollary to Delta PP in patients receiving mechanical ventilation. Methods: Thirty patients passively receiving volume-control ventilation with preexisting radial artery catheters were enrolled. The brachial artery Doppler signal was recorded and analyzed by blinded internal medicine residents using a HCU device. Simultaneous radial artery pulse wave and central venous pressure recordings (when available) were analyzed by a blinded critical care physician. Results: A Doppler signal was obtained in all 30 subjects. The Delta Vpeak-BA correlated well with Delta PP (r = 0.84) with excellent agreement (weighted kappa, 0.82) and limited intraobserver variability (2.8 +/- 2.8%) [mean: +/- SD]. A Delta Vpeak-BA cutoff of 16% was highly predictive of Delta PP >= 13% (sensitivity, 91%;specificity, 95%). A poor correlation existed between the CVP and both Delta Vpeak-BA (r = - 0.21) and Delta PP (r = - 0.16). Conclusions: The HCU Doppler assessment of the AVpeak-BA as performed by internal medicine residents is a rapid, noninvasive bedside correlate to Delta PP, and a AVpeak-BA cutoff of 16% may prove useful as a point-of-care tool for the prediction of volume responsiveness in patients receiving mechanical ventilation.
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中文科技期刊
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