Impact of arterial load on the agreement between pulse pressure analysis and esophageal Doppler.
Impact of arterial load on the agreement between pulse pressure analysis and esophageal Doppler.
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DOI：
10.1186/cc12785
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发表时间：
2013-06-20
期刊：
影响因子：
--
通讯作者：
Cecconi M
中科院分区：
文献类型：
--
作者：
Monge García MI;Romero MG;Cano AG;Rhodes A;Grounds RM;Cecconi M
已知脉压分析估计心输出量的可靠性受动脉负荷变化的影响。然而，动脉负荷的每个方面的贡献可能是实质上不同的。在这项研究中，我们评估了8个非商业算法的脉压分析估计心输出量（PPCO）与食管多普勒心输出量（EDCO）在动脉负荷的急性变化的协议。此外，我们旨在确定最佳动脉负荷参数，该参数可检测PPCO和EDCO之间的临床显著差异。我们纳入了接受液体挑战或引入或修改了血管活性药物的使用原型食管多普勒（Deltex Medical，奇切斯特，UK）和留置动脉导管监测的机械通气患者。用EDCO的基线值对PPCO进行了初步标定。我们评估了动脉负荷的几个方面：总全身血管阻力（TSVR =平均动脉压[MAP]/EDCO * 80）、净动脉顺应性（C = EDCO导出的每搏输出量/脉压）和有效动脉弹性（Ea = 0.9 * 收缩压/EDCO导出的每搏输出量）。我们比较了CO值与Bland-Altman分析，四象限图和修改的极坐标图（最小显著变化分析）。共对53例患者进行了16，964对测量（中位数271;四分位数范围：180-415）。所有PPCO算法与EDCO的一致性受到动脉负荷变化的显著影响，尽管在血管加压药治疗变化期间影响更为明显。当观察动脉负荷的不同参数时，在所有PPCO算法中，Ea和C的预测能力上级TSVR和MAP变化，以检测PPCO-EDCO差异≥ 10%。在大多数算法中，绝对Ea变化> 8.9 ± 1.7%与PPCO-EDCO差异≥ 10%相关。动脉负荷的变化深刻地影响PPCO和EDCO的一致性，尽管动脉负荷的各个方面对PPCO-EDCO差异的贡献是显著不同的。Ea和C的变化主要决定PPCO-EDCO差异。
The reliability of pulse pressure analysis to estimate cardiac output is known to be affected by arterial load changes. However, the contribution of each aspect of arterial load could be substantially different. In this study, we evaluated the agreement of eight non-commercial algorithms of pulse pressure analysis for estimating cardiac output (PPCO) with esophageal Doppler cardiac output (EDCO) during acute changes of arterial load. In addition, we aimed to determine the optimal arterial load parameter that could detect a clinically significant difference between PPCO and the EDCO. We included mechanically ventilated patients monitored with a prototype esophageal Doppler (CardioQ-Combi™, Deltex Medical, Chichester, UK) and an indwelling arterial catheter who received a fluid challenge or in whom the vasoactive medication was introduced or modified. Initial calibration of PPCO was made with the baseline value of EDCO. We evaluated several aspects of arterial load: total systemic vascular resistance (TSVR = mean arterial pressure [MAP]/EDCO * 80), net arterial compliance (C = EDCO-derived stroke volume/pulse pressure), and effective arterial elastance (Ea = 0.9 * systolic blood pressure/EDCO-derived stroke volume). We compared CO values with Bland-Altman analysis, four-quadrant plot and a modified polar plot (with least significant change analysis). A total of 16,964-paired measurements in 53 patients were performed (median 271; interquartile range: 180-415). Agreement of all PPCO algorithms with EDCO was significantly affected by changes in arterial load, although the impact was more pronounced during changes in vasopressor therapy. When looking at different parameters of arterial load, the predictive abilities of Ea and C were superior to TSVR and MAP changes to detect a PPCO-EDCO discrepancy ≥ 10% in all PPCO algorithms. An absolute Ea change > 8.9 ± 1.7% was associated with a PPCO-EDCO discrepancy ≥ 10% in most algorithms. Changes in arterial load profoundly affected the agreement of PPCO and EDCO, although the contribution of each aspect of arterial load to the PPCO-EDCO discrepancies was significantly different. Changes in Ea and C mainly determined PPCO-EDCO discrepancy.
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影响因子：
9.8
作者：
Metzelder, S.;Coburn, M.;Rex, S.
通讯作者：
Rex, S.
影响因子：
3.3
作者：
Jonas, Max M;Tanser, Suzie J
通讯作者：
Tanser, Suzie J
影响因子：
20.1
作者：
KOUCHOUKOS, NT;SHEPPARD, LC;MCDONALD, DA
通讯作者：
MCDONALD, DA
DOI：
10.1002/ccd.1810120604
发表时间：
1986-01-01
期刊：
CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS
影响因子：
--
作者：
FERGUSON, JJ;RANDALL, OS
通讯作者：
RANDALL, OS
影响因子：
37.8
作者：
KELLY, RP;TING, CT;KASS, DA
通讯作者：
KASS, DA