Monitoring of pulse pressure variation using a new smartphone application (Capstesia) versus stroke volume variation using an uncalibrated pulse wave analysis monitor: a clinical decision making study during major abdominal surgery
Monitoring of pulse pressure variation using a new smartphone application (Capstesia) versus stroke volume variation using an uncalibrated pulse wave analysis monitor: a clinical decision making study during major abdominal surgery
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DOI：
10.1007/s10877-018-00241-4
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发表时间：
2019-10-01
影响因子：
2.2
通讯作者：
Saugel, Bernd
中科院分区：
文献类型：
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作者：
Joosten, Alexandre;Jacobs, Alexandra;Saugel, Bernd
脉压变化 (PPV) 和每搏输出量变化 (SVV) 可用于评估手术室中的液体状态，但通常需要专用的高级血液动力学监测仪。最近，开发了一款智能手机应用程序（Capstesia（TM）），它可以根据任何监视器屏幕（PPVCAP）的有创动脉压波形图片自动计算 PPV。本研究的目的是比较 PPVCAP 与未校准脉搏波分析监测仪 (SVVPC) 的 SVV。在 40 名接受腹部大手术的患者中，我们在诱导后、切口前、切口后、手术结束以及每次低血压发作期间（平均动脉压 < 65 mmHg）比较了 PPVCAP 与 SVVPC。我们将 PPVCAP 和 SVVPC 分为三类，反映了用于决定输液的阈值：不输液（PPV 和 SVV < 9%）、灰色区域（PPV 和 SVV 9-13%）以及输液（PPV 和 SVV > 13%）。这三个类别的 SVVPC 和 PPVCAP 之间的一致性通过一致配对测量数除以配对测量总数和 Cohen kappa 系数来衡量。在获得的549对PPV-SVV数据中，PPVCAP与SVVPC的总体一致性为79%，kappa系数适中（0.55）。手术切开前麻醉诱导后观察到最高一致性和卡帕系数值。在 1% 的病例中，PPVCAP 和 SVVPC 会导致有关输液的完全相反的临床决策。在这项针对接受腹部大手术的患者的临床决策研究中，我们观察到 PPVCAP 和 SVVPC 在用于指导输液的类别方面存在一定程度的一致性。试验注册：Clinical Trials.gov (NCT03137901)。
Pulse pressure variation (PPV) and stroke volume variation (SVV) can be used to assess fluid status in the operating room but usually require dedicated advanced hemodynamic monitors. Recently, a smartphone application (Capstesia (TM)), which automatically calculates PPV from a picture of the invasive arterial pressure waveform from any monitor screen (PPVCAP), has been developed. The purpose of this study was to compare PPVCAP with SVV from an uncalibrated pulse wave analysis monitor (SVVPC). In 40 patients undergoing major abdominal surgery, we compared PPVCAP with SVVPC at post-induction, pre-incision, post-incision, end of surgery, and during every hypotensive episode (mean arterial pressure < 65 mmHg). We classified PPVCAP and SVVPC into three categories reflecting the thresholds used for the decision to administer fluids: no fluid administration (PPV and SVV < 9%), gray zone (PPV and SVV 9-13%), and fluid administration (PPV and SVV > 13%). The agreement between SVVPC and PPVCAP for these three categories was measured by the number of concordant paired measurements divided by the total number of paired measurements and Cohen's kappa coefficient. In the 549 pairs of PPV-SVV data obtained, the overall agreement of PPVCAP with SVVPC was 79%, and the kappa coefficient was moderate (0.55). The highest agreement and kappa coefficient value were observed after the induction of anesthesia before surgical incision. PPVCAP and SVVPC would have resulted in completely opposite clinical decisions regarding fluid administration in 1% of the cases. In this clinical decision making study in patients undergoing major abdominal surgery, we observed a moderate agreement between PPVCAP and SVVPC with regard to categories used to guide fluid administration. Trial Registration: Clinical Trials.gov (NCT03137901).