tailieunhanh - Báo cáo y học: "Stroke volume and passive leg raising predict volume responsiveness in ICU patients: who is actually responsive"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Stroke volume and passive leg raising predict volume responsiveness in ICU patients: who is actually responsive? | Available online http content 13 5 423 Letter Stroke volume and passive leg raising predict volume responsiveness in ICU patients who is actually responsive Jasper van Bommel and Eva Klijn Department of Intensive Care Erasmus Medical Center s Gravendijkwal 230 PO Box 3000 CA Rotterdam the Netherlands Corresponding author Jasper van Bommel Published 30 October 2009 This article is online at http content 13 5 423 2009 BioMed Central Ltd See related research by Thiel et al. http content 13 4 R111 Critical Care 2009 13 423 doi ee8139 With much interest we read the article by Thiel and coworkers 1 who clearly demonstrate how a completely non-invasive technique can be used to determine changes in cardiac stroke volume in response to a passive leg raise maneuver PLR and actual fluid administration. Still I have some questions. First we wonder why the authors chose to enroll only the patients who were a priori considered to require volume expansion. Especially with the use of a non-invasive technique and the PLR being part of routine practice it would be very instructive to know which and how many patients from the general ICU population are actually fluid responsive or likely to be exposed to excess fluid administration. Second why did the authors perform the volume expansion after the PLR with the patients again in the semi-recumbent position Patients are put in this position to mobilize more volume for the actual PLR 2 but the stroke volume response is studied in the supine position which is also the normal position for most ICU patients . Because of a decreased preload it is very likely that more fluid has to be administered to these patients to evoke a similar response in stroke volume Finally did the authors anticipate this increased fluid requirement when they administered a rather large volume expansion 500 ml in relation to the volume they estimated to be mobilized with the PLR 150 to 200 ml .