Performance of a minimally invasive uncalibrated cardiac output monitoring system (Flotrac™/Vigileo™) in haemodynamically unstable patients
Performance of a minimally invasive uncalibrated cardiac output monitoring system (Flotrac™/Vigileo™) in haemodynamically unstable patients
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DOI：
10.1093/bja/aem409
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发表时间：
2008-04-01
影响因子：
9.8
通讯作者：
Schaefer, J. -H.
中科院分区：
文献类型：
--
作者：
Compton, F. D.;Zukunft, B.;Schaefer, J. -H.
背景资料。早期血流动力学评估在评估血流动力学受损的患者中特别重要，但由于已建立的心输出量(CO)监测技术的侵袭性和复杂性，早期血流动力学评估通常是不可能的。FloTrac(TM)/Vigileo(TM)系统可以根据来自任何标准动脉导管的动脉压力波形进行微创CO测定，最近对CO计算的算法进行了修改，以便更准确地估计主动脉顺应性。使用新的软件，我们研究了25名血液动力学不稳定的患者，他们使用了放射状动脉导管，并使用PICCO(TM)系统进行了侵入性血流动力学监测。将Picco(TM)经肺热稀释和脉搏等值线CO(Reference-CO)与FloTrac(TM)/Vigileo(TM)系统(AP-CO)测得的CO值进行比较。报告的CO值以身体表面积为指标。采用Bland Altman统计方法对常规临床护理中记录的参考CO和AP-CO之间的一致性进行评估。参考CO与AP-CO之间的总偏差为0.68L min(-1)m(-2)，高百分比误差为+/-58.8%(95%的符合限+/-1.94 L min 21m(-2))。平均动脉压与股动脉压之间有显著差异(P<；0.001)，平均动脉压差<5 mm Hg的偏差更大(0.93vs0.57L min(-1)m(-2)，P=0.032)。未发现去甲肾上腺素剂量与CO协议之间的联系。尽管更新了算法，AP-CO仍然与参考CO显示出有限的一致性，并且系统地低估了CO，因此该方法目前不适合取代有创CO监测。
Background. Early haemodynamic assessment is of particular importance in the evaluation of haemodynamically compromised patients, but is often precluded by the invasiveness and complexity of the established cardiac output ( CO) monitoring techniques. The FloTrac (TM)/Vigileo (TM) system allows minimally invasive CO determination based on the arterial pressure waveform derived from any standard arterial catheter, and the algorithm underlying CO calculation was recently modified to allow a more precise estimate of aortic compliance.Methods. Using the new software, we studied 25 haemodynamically unstable patients who had a radial artery catheter and underwent invasive haemodynamic monitoring with the PiCCO (TM) system. PiCCO (TM) - derived transpulmonary thermodilution and pulse contour CO (reference-CO) were compared with the CO values obtained with the FloTrac (TM)/Vigileo (TM) system (AP-CO). Reported CO values are indexed to body surface area. Agreement between reference-CO and AP-CO recorded during routine clinical care was assessed using Bland Altman statistics.Results. Overall bias between the reference-CO and the AP-CO (n = 324) was 0.68 litre min(-1) m(-2) with a high percentage error of +/- 58.8% (95% limits of agreement +/- 1.94 l min 21 m(-2)). There was a significant difference (P < 0.001) between the radial and the femoral mean arterial pressures, and bias was significantly larger for a mean pressure difference of > 5 mm Hg ( 0.93 vs 0.57 litre min(-1) m(-2), P = 0.032). No connection was found between the norepinephrine dose and the CO agreement.Conclusions. Despite the updated algorithm, AP-CO still showed a limited agreement with the reference-CO and systematically underestimated the CO so that the method is not suitable to replace invasive CO monitoring at present.