Evaluation of least significant changes of pulse contour analysis-derived parameters
Evaluation of least significant changes of pulse contour analysis-derived parameters
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DOI：
10.1186/s13613-019-0590-z
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发表时间：
2019-10-11
影响因子：
8.1
通讯作者：
Biais, Matthieu
中科院分区：
文献类型：
--
作者：
de Courson, Hugues;Ferrer, Loic;Biais, Matthieu
背景资料：当心脏指数、每搏输出量指数、每搏输出量变异或脉压变异发生微小变化时，许多评估液体反应性的动作（微型液体激发、肺复张动作、呼气末阻塞试验、被动抬腿）被视为阳性。脉搏轮廓分析允许连续和实时的心脏指数、每搏输出量、每搏输出量变化和脉压变化估计。为了将这些操作与脉搏轮廓分析一起使用，必须研究需要由设备测量以识别真实的变化（最不显著的变化）的最小变化的知识。本研究的目的是评价使用脉搏轮廓分析（ProAQT（R），Pulsion Medical System，德国）获得的心脏指数、每搏输出量指数、每搏输出量变异和脉压变异的最小显著变化。方法：在这项观察性研究中，我们纳入了50例在手术室接受神经外科手术的机械通气患者。在15分钟的稳态期间，每12秒记录一次使用ProAQT（R）（Pulsion Medical System，德国）获得的心脏指数、心搏量指数、脉压变化和心搏量变化。每分钟计算最不显著的变化。结果如下：随着时间的推移，心脏指数、每搏输出量指数、脉压变异和每搏输出量变异的最小显著变化具有统计学差异（p < 0.001）。最不显著的变化范围为心脏指数1.3 - 0.7%，每搏输出量指数1.3 - 0.8%，脉压变异10 - 4.9%，每搏输出量变异10.8 - 4.3%。结论：综上所述，本研究表明，脉搏轮廓分析能够检测心脏指数和每搏输出量指数的快速和微小变化，但必须谨慎解释快速和微小变化的脉压变异和每搏输出量变异。
Background: Many maneuvers assessing fluid responsiveness (minifluid challenge, lung recruitment maneuver, endexpiratory occlusion test, passive leg raising) are considered as positive when small variations in cardiac index, stroke volume index, stroke volume variation or pulse pressure variation occur. Pulse contour analysis allows continuous and real-time cardiac index, stroke volume, stroke volume variation and pulse pressure variation estimations. To use these maneuvers with pulse contour analysis, the knowledge of the minimal change that needs to be measured by a device to recognize a real change (least significant change) has to be studied. The aim of this study was to evaluate the least significant change of cardiac index, stroke volume index, stroke volume variation and pulse pressure variation obtained using pulse contour analysis -(ProAQT (R), Pulsion Medical System, Germany). Methods: In this observational study, we included 50 mechanically ventilated patients undergoing neurosurgery in the operating room. Cardiac index, stroke volume index, pulse pressure variation and stroke volume variation obtained using -ProAQT (R) (Pulsion Medical System, Germany) were recorded every 12 s during 15-min steady-state periods. Least significant changes were calculated every minute. Results: Least significant changes statistically differed over time for cardiac index, stroke volume index, pulse pressure variation and stroke volume variation (p < 0.001). Least significant changes ranged from 1.3 to 0.7% for cardiac index, from 1.3 to 0.8% for stroke volume index, from 10 to 4.9% for pulse pressure variation and from 10.8 to 4.3% for stroke volume variation. Conclusion: To conclude, the present study suggests that pulse contour analysis is able to detect rapid and small changes in cardiac index and stroke volume index, but the interpretation of rapid and small changes of pulse pressure variation and stroke volume variation must be done with caution.