Comparison of uncalibrated arterial waveform analysis in cardiac surgery patients with thermodilution cardiac output measurements
Comparison of uncalibrated arterial waveform analysis in cardiac surgery patients with thermodilution cardiac output measurements
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DOI：
10.1186/cc5103
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发表时间：
2006-01-01
期刊：
影响因子：
15.1
通讯作者：
von Heymann, Christian
中科院分区：
文献类型：
--
作者：
Sander, Michael;Spies, Claudia D.;von Heymann, Christian
简介心输出量(CO)监测仅适用于选定的患者。在心脏外科患者中，围手术期的血流动力学管理通常通过肺动脉插管(COPAC)的CO测量来指导。CO测定的替代策略在临床实践中已被越来越多地接受，因为从PAC获得的数据指导治疗的益处仍有待证实，而且有更少侵入性的替代方案可用。最近，介绍了一种通过动脉波形分析(COWave)提供未校准CO测量的装置。然而，就这种方法而言，所获得的CO测量的有效性完全不清楚。因此，本研究的目的是比较冠状动脉旁路移植术(CABG)手术前、术中和术后4个特定时间点的COWave的偏差和一致限度(LOAS)(两个标准差)，同时测量金标准COPAC和主动脉经肺热稀释CO(COTranspulm)。方法对30例患者的数据进行分析。所有患者在冠脉搭桥术前、术中、术后4个不同时间点测定COPAC、COTranspulm和COWave。在PAC的中心静脉线内三次注射10ml冰冻的等效酮氯化钠溶液，测量COPAC和COTranspulm。结果COPAC与COWave的相关系数分别为0.53(p<；0.01)和0.84(p<；0.01)。Bland-Altman分析显示COPAC和COWave的平均偏倚和LOAS分别为0.6升/分钟和-2.2~+3.4升/分钟，COPAC和COTRAN的平均偏差和LOAS分别为-0.1升/分钟和-1.8~+1.6升/分钟。结论动脉波形分析和未校准算法COWave低估了COPAC的临床意义。贷款安排的范围很广，需要进一步评估。改进的新算法可能会得到更好的结果。相反，我们观察到在CABG手术前、术中和术后热稀释COTRANSPUM和热稀释COPAC测量之间有更好的相关性。
Introduction Cardiac output (CO) monitoring is indicated only in selected patients. In cardiac surgical patients, perioperative haemodynamic management is often guided by CO measurement by pulmonary artery catheterisation (COPAC). Alternative strategies of CO determination have become increasingly accepted in clinical practice because the benefit of guiding therapy by data derived from the PAC remains to be proven and less invasive alternatives are available. Recently, a device offering uncalibrated CO measurement by arterial waveform analysis (COWave) was introduced. As far as this approach is concerned, however, the validity of the CO measurements obtained is utterly unclear. Therefore, the aim of this study was to compare the bias and the limits of agreement (LOAs) ( two standard deviations) of COWave at four specified time points prior, during, and after coronary artery bypass graft (CABG) surgery with a simultaneous measurement of the gold standard COPAC and aortic transpulmonary thermodilution CO (COTranspulm).Methods Data from 30 patients were analysed during this prospective study. COPAC, COTranspulm, and COWave were determined in all patients at four different time points prior, during, and after CABG surgery. The COPAC and the COTranspulm were measured by triple injection of 10 ml of iced isotone sodium chloride solution into the central venous line of the PAC. Measurements of COWave were simultaneously taken at these time points.Results The overall correlation showed a Spearman correlation coefficient between COPAC and COWave of 0.53 ( p < 0.01) and 0.84 ( p < 0.01) for COPAC and COTranspulm. Bland-Altman analysis showed a mean bias and LOAs of 0.6 litres per minute and - 2.2 to + 3.4 litres per minute for COPAC versus COWave and - 0.1 litres per minute and - 1.8 to + 1.6 litres per minute for COPAC versus COTranspulm.Conclusion Arterial waveform analysis with an uncalibrated algorithm COWave underestimated COPAC to a clinically relevant extent. The wide range of LOAs requires further evaluation. Better results might be achieved with an improved new algorithm. In contrast to this, we observed a better correlation of thermodilution COTranspulm and thermodilution COPAC measurements prior, during, and after CABG surgery.