Evaluation of a New Software Version of the FloTrac/Vigileo (Version 3.02) and a Comparison with Previous Data in Cirrhotic Patients Undergoing Liver Transplant Surgery
Evaluation of a New Software Version of the FloTrac/Vigileo (Version 3.02) and a Comparison with Previous Data in Cirrhotic Patients Undergoing Liver Transplant Surgery
复制标题
DOI：
10.1213/ane.0b013e31822401b2
复制
发表时间：
2011-09-01
影响因子：
5.7
通讯作者：
Filipponi, Franco
中科院分区：
文献类型：
--
作者：
Biancofiore, Gianni;Critchley, Lester A. H.;Filipponi, Franco
背景技术背景：可靠的心输出量监测在接受肝移植手术的肝硬化患者中特别有用，因为肝硬化与血管舒张和高输出量状态相关，称为舒张性心肌病，这挑战了脉搏轮廓心输出量技术的可靠性。肝硬化时心室的收缩力受损，尽管由于外周阻力低而使射血分数和心输出量升高，但仍可耐受。然而，在手术过程中，由于生理变化和手术压力，动脉粥样硬化患者可能会失代偿。最近，我们发现FloTrac/Vigileo（TM）未能在接受移植手术的移植患者中发挥作用。作为回应，该公司升级了软件。因此，我们已经评估了这个新的第三代（版本3.02）FloTrac/Vigileo算法软件在相同setting.METHODS的准确性和可靠性：心脏指数同时测量单团热稀释法（CITD），使用肺动脉导管，脉搏轮廓分析，使用FloTrac/Vigileo（CIV）。在21例患者的肝移植手术期间和术后的10个时间点进行读数。与我们的2009年的研究，其中使用第二代（版本01.10）软件的数据进行了比较，也made.RESULTS：我们的新数据表明，版本3.02软件显着减少了不利影响的脉搏轮廓心输出量阅读偏置在低外周阻力状态，从而提高了系统的整体精度和趋势能力。CITD和CIV之间的回归分析显示相关性为中度（r = 0.67，95%置信区间，0.40至0.86）。Bland和Altman分析显示偏倚为0.4 L.min（-1）.m（-2），百分比误差为52%（95%置信区间，49%至55%）。新软件的趋势分析能力也得到了改善，但仍远低于当前的基准。结论：新软件（版本3.02）提供了比以前的版本更好的整体精度和趋势分析能力的实质性改进。进一步的算法改进将增加该技术的可靠性，以广泛用于接受肝移植的高度复杂的肝硬化患者。（Anesth Analg 2011; 113：515-22）
BACKGROUND: Reliable cardiac output monitoring is particularly useful in the cirrhotic patient undergoing liver transplant surgery, because cirrhosis of the liver is associated with a vasodilated and high output state, known as cirrhotic cardiomyopathy, that challenges the reliability of pulse contour cardiac output technology. The contractility of the ventricle in cirrhosis is impaired, which is tolerated even though the ejection fraction and cardiac output are elevated because of the low peripheral resistance. However, during surgery the cirrhotic patient can decompensate because of the physiological changes and stress of surgery. Recently, we showed that the FloTrac/Vigileo (TM) failed to perform in cirrhotic patients undergoing transplant surgery. In response, the company upgraded their software. Therefore, we have assessed the accuracy and reliability of this new third-generation (version 3.02) FloTrac/Vigileo algorithm software in the same setting.METHODS: The cardiac index was measured simultaneously by single-bolus thermodilution (CITD), using a pulmonary artery catheter, and pulse contour analysis, using the FloTrac/Vigileo (CIV). Readings were made at 10 time points during and after liver transplant surgery in 21 patients. Comparisons with data from our 2009 study, which used second-generation (version 01.10) software, were also made.RESULTS: Our new data show that version 3.02 software significantly reduced the adverse effect on pulse contour cardiac output reading bias in low peripheral resistance states, and thus improves the overall precision and trending ability of the system. Regression analysis between CITD and CIV showed that the correlation was moderate (r = 0.67, 95% confidence interval, 0.40 to 0.86). The Bland and Altman analysis showed that bias was 0.4 L.min(-1).m(-2), and the percentage error was 52% (95% confidence interval, 49% to 55%). Trending ability of the new software also was improved but was still well below the current benchmarks.CONCLUSION: The new software (version 3.02) provided substantial improvements over the previous versions with better overall precision and trending ability. Further algorithm refinements will increase this technology's reliability to be extensively used in the highly complex setting of cirrhotic patients undergoing liver transplantation. (Anesth Analg 2011; 113: 515-22)