Vieillard‑Baron et al. CritCare (2020) 24:630
https://doi.org/10.1186/s13054-020-03345-z
Antoine Vieillard-Baron,Amélie Prigent,Xavier Repessé,et al.
Intensive Care Unit, University Hospital Ambroise Pare
Paris, France
Incidence of rightventricular (RV) failure in septic shock patients is not well known, andtricuspid annular plane systolic excursion (TAPSE) could be of limited value.We report the incidence of RV failure in patients with septic shock, itspotential impact on the response to fluids, as well as TAPSE values.
膿毒症休克病人右心室(RV)衰竭的發生率尚不清晰。通過收縮期三尖瓣環位移(TAPSE)進行判定可能價值有限。作者團隊報導膿毒症休克患者RV衰竭的發生率，對液體反應的潛在影響，以及TAPSE的價值。
試驗設計
Ancillary study of the HEMOPRED prospectivemulticenter study includes patients under mechanical ventilation withcirculatory failure. This is a multicenter intensive care unit study.
HEMOPRED前瞻性多中心研究的輔助研究，包括需要機械通氣合併循環衰竭的病人。這是一個多中心重症監護室研究。
納入病人
Two hundred and eighty-twopatients with septic shock were analyzed. Patients were classified in threegroups based on central venous pressure (CVP) and RV size (RV/LV end-diastolicarea, EDA). In group 1, patients had no RV dilatation (RV/LVEDA<0.6). Ingroup 2, patients had RV dilatation (RV/LVEDA≥0.6) with a CVP<8mmHg (no venouscongestion). RV failure was defined in group 3 by RV dilatation and a CVP≥8mmHg. Pulse pressure variation (PPV) wassystematically recorded.
分析了282位膿毒症休克的病人。病人根據中心靜脈壓(CVP)與RV大小(通過右室與左室舒張末面積比即RV/LVEDA衡量)分為三組。組1，病人無RV擴張(RV/LVEDA<0.6)。組2，病人有RV擴張證據，RV/LVEDA≥0.6且CVP<8mmHg(即無靜脈充血)。RV衰竭歸入組3，定義為RV擴張與CVP≥8mmHg。有系統地記錄脈壓變異率(PPV)。
主要結果
In total, 41% of patientswere in group 1, 17% in group 2 and 42% in group 3. A correlation between RVsize and CVP was only observed in group 3. Higher RV size was associated with alower response to passive leg raising for a given PPV. A large overlap of TAPSEvalues was observed between the 3 groups. 63.5% of patients with RV failure hada normal TAPSE.
總體來說，組1病人佔41%，組2佔17%，組3佔42%。在組3中觀察到RV大小與CVP存在相關性。對於一個給定的PPV，RV越大，病人對被動抬腿試驗的反應就越小。觀察到三組病人的TAPSE值有很大的重疊區間。63.5%的RV衰竭病人TAPSE值正常。
結論
RV failure, defined bycritical care echocardiography (RV dilatation) and a surrogate of venous congestion(CVP≥8mmHg), was frequently observed in septic shock patients and negatively associated withresponse to a fluid challenge despite significant PPV. TAPSE was unable todiscriminate patients with or without RV failure.
通過重症心臟超聲所發現的RV擴張以及CVP≥8mmHg所代表的靜脈充血來定義的RV衰竭，頻繁地發現於膿毒症休克的病人，與液體負荷後的反應呈負相關，儘管PPV提示有液體反應性。TAPSE無法區分這些病人是否有RV衰竭。
關鍵詞
Right ventricular failure,TAPSE, Fluid responsiveness, Central venous pressure, Critical care echocardiography.
右心室衰竭，TAPSE，液體反應性，中心靜脈壓，重症心臟超聲
posH君：每次見到不斷補液血壓都升不上去的病人，心都涼了。