A 25-year-old woman is admitted to the ICU after amotor vehicle collision. On ICU day four, she has diffuse body rash and shock. A retained tampon is found on tertiary survey. After receiving broad-spectrum antibiotics and three liters of crystalloid IV fluids, she remains hypotensive. She is started on vasopressors for refractory shock and intubated for respiratory distress.
Regarding the use of pulse pressure variation to help determine if she is volume responsive, which of the following is correct?
A. It is accurate if the patient is taking spontaneous breaths while on mechanical ventilation.
B. It is accurate if the patient is in atrial fibrillation.
C. It is accurate in patients with left ventricular and right ventricular dysfunction or valvular disorders.
D. A pulse pressure variation greater than 13% accurately predicts that the patient will be volume responsive.
答案解析：
确定容量反应性是复苏的关键步骤。考虑到这种方法的生理学优越性以及静态标志物（如中心静脉压）的灵敏度和特异性较差，使用前负荷反应性的动态标志物正在增加。脉压变化、每搏输出量变化和超声评估等动态测量可更准确地确定患者在Frank-Starling曲线上的位置。文献中经常引用脉压变化作为确定容积状态的最精确测量之一，但重要的是要注意适用特定条件。正压通气诱导右心室和左心室前负荷和后负荷的周期性变化，当患者处于Frank-Starling曲线的陡峭部分时更明显。文献中验证的脉压变化大于13%，表明患者可能具有容量反应性。但是，为了使其准确，患者必须为窦性心律，不得自主呼吸，理想情况下不应使用非常低的潮气量进行通气，并且不应存在显著的左心室或右心室功能障碍。该病例还证明了对所有创伤患者进行三级调查的重要性。
正确答案：D
补充内容：
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