Clinical significance of CT enhanced scanning in evaluating volume responsiveness in critically Ill patients

doi:10.3877/cma.j.issn.2095-9133.2025.05.002

Abstract

Abstract:

Objective

To explore the clinical value of CT enhanced scanning in evaluating volume responsiveness in critically ill patients.

Methods

A total of 75 critically ill patients admitted from January 2022 to June 2024 were selected prospectively. Based on changes in cardiac output after volume loading tests, patients were divided into a volume-responsive positive group (n=42) and a negative group (n=33). All patients underwent CT enhanced scanning to measure parameters such as the variability of abdominal aortic cross-sectional area (IVCI), superior vena cava cross-sectional area (IVCV), and pulmonary artery cross-sectional area (PAVI). Simultaneously, bedside ultrasound was used to assess inferior vena cava variability index (IVC-VI) and passive leg raising (PLR) tests. The accuracy of different methods in evaluating volume responsiveness was compared.

Results

IVCI, IVCV, and PAVI were significantly higher in the volume-responsive positive group than in the negative group (P<0.05). Receiver operating characteristic (ROC) curve analysis showed that the areas under the curve (AUC) for IVCI, IVCV, and PAVI in predicting volume responsiveness were 0.87, 0.83, and 0.78, respectively, which were superior to the traditional IVC-VI assessment method (AUC=0.72, P<0.05). The fluid management protocol guided by CT enhanced scanning significantly shortened the duration of mechanical ventilation and ICU stay (P<0.05).

Conclusion

CT enhanced scanning provides high accuracy in evaluating volume responsiveness for critically ill patients, offering a reliable basis for individualized fluid management and improving clinical outcomes.

Key words: CT enhanced scanning, Critically ill patients, Volume responsiveness, Fluid management, Hemodynamics, prognosis

Chao Yang, Shaobin Zhang. Clinical significance of CT enhanced scanning in evaluating volume responsiveness in critically Ill patients[J]. Chinese Journal of Hygiene Rescue(Electronic Edition), 2025, 11(05): 263-268.

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References 16

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组别	例数	性别（男性/女性）	年龄（岁，±s）	BMI（kg/m²，±s）	主要诊断
组别	例数	性别（男性/女性）	年龄（岁，±s）	BMI（kg/m²，±s）	重症肺炎	败血症	多发伤	其他
容量反应阳性组	42	24/18	57.44±15.17	22.83±3.25	16（38.1）	11（26.2）	8（19.0）	7（16.7）
容量反应阴性组	33	19/14	59.95±13.29	23.46±3.57	14（42.4）	7（21.2）	5（15.2）	7（21.2）
t/χ²值		0.00	-0.75	-0.80	0.64
P值		>0.05	>0.05	>0.05	>0.05
组别	例数	APACHEⅡ评分	SOFA评分	有创机械通气	PEEP（cmH₂O）	潮气量（mL/kg）
容量反应阳性组	42	18.62±5.33	8.24±3.17	38（90.5）	7.35±2.13	6.53±0.86
容量反应阴性组	33	19.21±4.84	8.74±2.96	31（93.9）	7.62±1.97	6.31±0.75
t/χ²值		-0.50	-0.70	0.01	-0.56	1.16
P值		>0.05	>0.05	>0.05	>0.05	>0.05

组别	例数	性别（男性/女性）	年龄（岁，±s）	BMI（kg/m²，±s）	主要诊断
组别	例数	性别（男性/女性）	年龄（岁，±s）	BMI（kg/m²，±s）	重症肺炎	败血症	多发伤	其他
容量反应阳性组	42	24/18	57.44±15.17	22.83±3.25	16（38.1）	11（26.2）	8（19.0）	7（16.7）
容量反应阴性组	33	19/14	59.95±13.29	23.46±3.57	14（42.4）	7（21.2）	5（15.2）	7（21.2）
t/χ²值		0.00	-0.75	-0.80	0.64
P值		>0.05	>0.05	>0.05	>0.05
组别	例数	APACHEⅡ评分	SOFA评分	有创机械通气	PEEP（cmH₂O）	潮气量（mL/kg）
容量反应阳性组	42	18.62±5.33	8.24±3.17	38（90.5）	7.35±2.13	6.53±0.86
容量反应阴性组	33	19.21±4.84	8.74±2.96	31（93.9）	7.62±1.97	6.31±0.75
t/χ²值		-0.50	-0.70	0.01	-0.56	1.16
P值		>0.05	>0.05	>0.05	>0.05	>0.05

组别	例数	HR（次/min）	MAP（mmHg）	CVP（mmHg）	CO（L/min）	CI（L·min^-1·m^-2）	SV（mL）	SVV（%）
容量反应阳性组	42	105.32±18.63	72.61±11.34	6.33±2.65	4.23±1.05	2.45±0.67	40.83±10.27	16.53±4.82
容量反应阴性组	33	93.85±15.48	75.46±10.57	9.14±3.28	4.57±1.29	2.64±0.78	48.65±14.36	9.25±3.17
t值		2.85	-1.11	-4.11	-1.26	-1.13	-2.75	7.49
P值		<0.05	>0.05	<0.001	>0.05	>0.05	<0.05	<0.001

组别	例数	HR（次/min）	MAP（mmHg）	CVP（mmHg）	CO（L/min）	CI（L·min^-1·m^-2）	SV（mL）	SVV（%）
容量反应阳性组	42	105.32±18.63	72.61±11.34	6.33±2.65	4.23±1.05	2.45±0.67	40.83±10.27	16.53±4.82
容量反应阴性组	33	93.85±15.48	75.46±10.57	9.14±3.28	4.57±1.29	2.64±0.78	48.65±14.36	9.25±3.17
t值		2.85	-1.11	-4.11	-1.26	-1.13	-2.75	7.49
P值		<0.05	>0.05	<0.001	>0.05	>0.05	<0.05	<0.001

组别	例数	IVCI（%）	IVCV（%）	PAVI（%）	PV/PA	IVC-VI（%）
容量反应阳性组	42	23.64±5.87	35.73±8.36	18.91±5.48	0.78±0.14	24.54±7.22
容量反应阴性组	33	12.44±4.25	19.57±6.78	10.32±4.14	0.93±0.15	14.85±5.37
t值		9.22	9.01	7.48	-4.46	6.43
P值		<0.001	<0.001	<0.001	<0.001	<0.001

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