Multicenter study of noninvasive monitoring systems as alternatives to invasive monitoring of acutely ill emergency patients
Multicenter study of noninvasive monitoring systems as alternatives to invasive monitoring of acutely ill emergency patients
复制标题
DOI：
10.1378/chest.114.6.1643
复制
发表时间：
1998-12-01
期刊：
影响因子：
9.6
通讯作者：
Demetriades, D
中科院分区：
文献类型：
--
作者：
Shoemaker, WC;Belzberg, H;Demetriades, D
背景资料：最近的报告显示，肺动脉导管插入术在危重内科患者和器官衰竭的相对晚期手术患者中缺乏有效性。由于侵入性监测需要重症监护环境，早期血流动力学模式可能黑尔错过。理想情况下，早期的无创血流动力学监测系统，如果可靠的话，可以用作有创监测的“前端”，以提供更完整的循环病理生理学描述。目的：评价无创血流动力学监测的准确性和可靠性，包括一种新的生物阻抗方法，用于估计心输出量，结合动脉血压，脉搏血氧仪和经皮Po-2和Pco（2）;我们比较了这种无创监测系统与同时进行的有创测量，以评估入院后进行有创监测不容易获得的急性病患者的循环缺陷。我们还初步探讨了幸存者和非幸存者的时间血流动力学模式的早期差异。设计和设置：前瞻性比较同时进行的有创和无创循环功能测量与回顾性分析，分析了大学运营的县级医院、大学医院和附属教学医院以及社区私立医院的数据。我们研究了680例患者，包括139例急诊科（艾德）的严重受伤或衰老患者，129例内科结果：274例高危外科手术患者和138例近期入住ICU的患者中，有138例患者在急诊科（艾德）接受了手术治疗。一种新的无创阻抗设备提供了心输出量估计的条件下，侵入性热稀释测量通常不适用。有2,192个同时进行的生物阻抗和热稀释心脏指数测量;相关系数r = 0.85，r（2）= 0.73，p < 0.001，精密度和偏倚为-0.124 +/- 0.75 L/min/m（2）。有创和无创监测系统提供了相似的信息，并确定了低血压、低心脏指数、动脉血红蛋白去饱和、低经皮O-2、高经皮CO2和初始复苏前和复苏期间的低氧耗的发作。描述了无创系统的局限性。非侵入性监测系统提供了连续显示的生理数据，这些数据可以提供信息，从而可以早期识别低流速和组织灌注不良，在非幸存者中明显。在没有侵入性监测的情况下，非侵入性系统可能是可接受的替代方案。
Background: Recent reports showed lack of effectiveness of pulmonary artery catheterization in critically ill medical patients and relatively late-stage surgical patients with organ failure. Since invasive monitoring requires critical care environments, the early hemodynamic patterns may hale been missed. Ideally, early noninvasive hemodynamic monitoring systems, if reliable, could he used as the "front end" of invasive monitoring to supply more complete descriptions of circulatory pathophysiology,Objectives: To evaluate the accuracy and reliability of noninvasive hemodynamic monitoring consisting of a new bioimpedance method for estimating cardiac output combined with arterial BP, pulse oximetry, and transcutaneous Po-2 and Pco(2); we compared this system of noninvasive monitoring with simultaneous invasive measurements to evaluate circulatory deficiencies in acutely ill patients shot-try after hospital admission where invasive monitoring was not readily available. We also preliminarily explored early differences in temporal hemodynamic patterns of survivors and nonsurvivors,Design and setting: Prospective comparison of simultaneous invasive and noninvasive measurements of circulatory function with retrospective anal,sis of data in university-run county hospitals, university hospitals and affiliated teaching hospitals, and a community private hospital.Patients: We studied 680 patients, including 139 severely injured or hemorrhaging patients in the emergency department (ED), 129 medical (nontrauma) patients on admission to the ED, 274 high-risk surgical patients intraoperatively, and 138 patients recently admitted to the ICU.Results: A new noninvasive impedance device provided cardiac output estimations under conditions in which invasive thermodilution measurements were not usually applied. There were 2,192 simultaneous bioimpedance and thermodilution cardiac index measurements; the correlation coefficient, r = 0.85, r(2) = 0.73, p < 0.001, The precision and bias was -0.124 +/- 0.75 L/min/m(2). Both invasive and noninvasive monitoring systems provide similar information and identified episodes of hypotension, low cardiac index, arterial hemoglobin desaturation, low transcutaneous O-2, high transcutaneous CO2, and low oxygen consumption before and during initial resuscitation, The limitations of noninvasive systems were described.Conclusions: Noninvasive monitoring systems gave continuous displays of physiologic data that presided information allowing early recognition of low now and poor tissue perfusion that were more pronounced in the nonsurvivors. Noninvasive systems may be acceptable alternatives where invasive monitoring is not available.