Page 16 - 麻醉与监护论坛2015年第4期

Cover Thesis
not measure the inspiratory and plateau pressure, so could
not conclude that the increase in SVV was due partially
to the reduced chest wall compliance from body position
changes.
Our study had some limitations. First, SVV reflected
by GEDVI were assessed by PiCCOplus device and were
not compared with another technique, for instance left
ventricular or right ventricular end-diastolic volume
from transoesophageal echocardiography. However,
the changes in CI, SV, GEF and GEDVI related to body
position changes identified in this study were identical
to a previous investigation using echocardiography[19].
Second, the validity of SVV to predict fluid responsiveness
is usually proven by showing that baseline SVV correlated
well with volume expansion-induced changes in CO. In
this study, fluid volume needed to be stable to investigate
the influence of body position changes on the SVV, so no
volume expansion alterations were performed in this study.
Consequently, this study design did not allow for the use of
common methods to validate the SVV measurements in a
specific position. However, the SVV results showed strong
correlation with hemodynamic variables measured in five
different body positions. Thirdly, we studied sedated and
ventilated patients with a left ventricle ejection fraction
of 40% or greater and a tidal volume of 8 ml/kg. SVV is
affected by the depth of tidal volume under mechanical
ventilation. Therefore, our results could not be extrapolated
to ventilated patients with heart failure and low tidal
volume.
In conclusion, Dynamic SVV is reliable for functional
hemodynamic monitoring in ventilated and septic patients.
Tabel 4.The r, r2 and P value obtained with Pearson
Correlation Analysis between SVV in the supine position and
the CI changes induced by the 30° head-up or prone positions
SVV in supine position
30°head-up position induced r r2 P [12] Perel A. Assessing Fluid Responsiveness by the Systolic Pressure Variation in Mechanically Ventilated Patients:
change in CI -0.119 0.014 0.388
-0.130 0.017 0.313
Prone position induced
change in CI
SVV, stroke volume variation; CI, cardiac index
Laboratory and ClinicalCIonverstTighaetsiiosn
SVV correlated well with hemodynamic variables regardless
of patient position. The body position changes did not
affect the correlation of SVV and hemodynamic variables in
patients with sepsis. The 30° head-up and prone positions
increased SVV and decreased CI, SVI, GEF and GEDVI;
reduced GEDVI might be the primary reason for the
increased SVV. The 30° left or right recumbent positions
have no effect on hemodynamic data and SVV.
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97 FAM 2015 Mar/Apr Vol.22 Issue 2