Noninvasive cardiac output monitoring (NICOM): a clinical validation
Noninvasive cardiac output monitoring (NICOM): a clinical validation
复制标题
DOI：
10.1007/s00134-007-0640-0
复制
发表时间：
2007-07-01
影响因子：
38.9
通讯作者：
Dubois, Claude
中科院分区：
文献类型：
--
作者：
Squara, Pierre;Denjean, Dominique;Dubois, Claude
目的：评价一种基于胸部生物电抗的连续无创心输出量监测（NICOM）新器械与使用肺动脉导管（PAC-CCO）通过热稀释法半连续测量的心输出量相比的临床实用性。设计：前瞻性单中心研究。设置：重症监护室。患者：心脏手术后即刻的连续成人患者。干预措施：在110例患者中，同时记录NICOM和热稀释法获得的心输出量测量值，并进行比较。我们评价了NICOM检测心输出量变化的准确性、精密度、反应性和可靠性。测量和结果：共收集了65,888对心输出量测量结果。心输出量的平均参考值范围为2.79至9.271/min。（斜率<± 10%，2SD/mean < 20%），NICOM与热稀释法的相关性为R=0.82;偏倚为+0.16 +/- 0.521/min（+4.0 +/- 11.3%），相对误差为9.1%+/-7.8%。在85%的患者中，相对误差<20%。在输出增加期间，96%的患者的斜率与两种方法相似，96%的患者的类内相关性为正。产量下降期间的相应值分别为90%和84%。NICOM的精确度始终优于热稀释法。在血流动力学激发期间，NICOM的变化快3.1 +/-3.8分钟（p < 0.01），变化幅度无显著差异。结论：NICOM测量心输出量的准确性、精密度和反应性在各种循环状态下均可接受。
Objective: To evaluate the clinical utility of a new device for continuous noninvasive cardiac output monitoring (NICOM) based on chest bio-reactance compared with cardiac output measured semi-continuously by thermodilution using a pulmonary artery catheter (PAC-CCO).Design: Prospective, single-center study.Setting: Intensive care unit.Patients: Consecutive adult patients immediately after cardiac surgery.Interventions: Cardiac output measurements obtained from NICOM and thermodilution were simultaneously recorded minute by minute and compared in 110 patients. We evaluated the accuracy, precision, responsiveness, and reliability of NICOM for detecting cardiac output changes. Tolerance for each of these parameters was specified prospectively.Measurements and results: A total of 65,888 pairs of cardiac output measurements were collected. Mean reference values for cardiac output ranged from 2.79 to 9.271/min. During periods of stable PAC-CCO (slope < +/- 10%, 2SD/mean < 20%), the correlation between NICOM and thermodilution was R=0.82; bias was +0.16 +/- 0.521/min (+4.0 +/- 11.3%), and relative error was 9.1%+/- 7.8%. In 85% of patients the relative error was < 20%. During periods of increasing output, slopes were similar with the two methods in 96% of patients and intra-class correlation was positive in 96%. Corresponding values during periods of decreasing output were 90% and 84%, respectively. Precision was always better with NICOM than with thermodilution. During hemodynamic challenges, changes were 3.1 +/- 3.8min faster with NICOM (p < 0.01) and amplitude of changes did not differ significantly. Finally, sensitivity of the NICOM for detecting significant directional changes was 93% and specificity was 93%.Conclusion:Cardiac output measured by NICOM had most often acceptable accuracy, precision, and responsiveness in a wide range of circulatory situations.