Effects of changes in vascular tone on the agreement between pulse contour and transpulmonary thermodilution cardiac output measurements within an up to 6-hour calibration-free period
Effects of changes in vascular tone on the agreement between pulse contour and transpulmonary thermodilution cardiac output measurements within an up to 6-hour calibration-free period
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DOI：
10.1097/01.ccm.ob013e318161fec4
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发表时间：
2008-02-01
影响因子：
8.8
通讯作者：
Teboul, Jean-Louis
中科院分区：
文献类型：
--
作者：
Hamzaoui, Olfa;Monnet, Xavier;Teboul, Jean-Louis
目的：研究脉搏轮廓和经肺热稀释法心脏指数（CI）测量之间的一致性是否会因6小时无校准期内血管张力的变化而改变。设计：观察性研究。设置：一所大学医院的医学重症监护室。患者：59名危重患者。干预：无。测量和主要结果：回顾性分析了59例配备PiCCO器械的重症患者的数据。数据库包含在每个时间点获得的经肺热稀释CI（CIT）值，校准器械，并在该时间点之前立即记录脉搏轮廓CI（CIPC）值。根据从先前校准开始经过的时间间隔（前30分钟内，30分钟至1小时之间，以及每小时至6小时）定义CI对的七个子集。在整个400个CI对中，CIPC与CIT相关（r（2）= 0.68，p <0.001）。偏倚+/- SD为0.12 +/- 0.61 L/min/m（2），百分比误差为35%。在7个时间间隔子集中，仅前两个子集的百分比误差< 30%（分别为27%和26%）。当体循环血管阻力变化> 15%（129次）时，CIPC与CIT相关（r（2）= 0.64），偏差+/- SD为0.12 +/- 0.62 L/min/m（2），百分比误差为36%。在1小时无校准期内记录的CI对子集中，当血管阻力变化> 15%时（n = 32），偏倚+/- SD为0.04 +/- 0.47 L/min/m（2），百分比误差为29%。我们在危重患者中的研究表明，脉搏轮廓心输出量和经肺热稀释心输出量之间的一致性是不受血管张力变化的显著影响。然而，在1小时的无校准期后，可能会鼓励重新校准。这样的程序提供了从其他热稀释衍生变量中提取的有用信息。
Objectives: To examine whether the agreement between pulse contour and transpulmonary thermodilution cardiac index (CI) measurements is altered by changes in vascular tone within an up to 6-hr calibration-free period.Design: Observational study.Setting: Medical intensive care unit of a university hospital.Patients: Fifty-nine critically ill patients.Interventions: None.Measurements and Main Results: Data from 59 critically ill patients equipped with a PiCCO device were retrospectively analyzed. The database contained the transpulmonary thermodilution CI (CIT) value obtained at each time point the device was calibrated and the pulse contour CI (CIpc) value recorded immediately before this time point. Seven subsets of CI pairs were defined according to intervals of time elapsed from the previous calibration (within the first 30 mins, between 30 mins and 1 hr, and every hour up to 6 hrs). In the whole set of 400 CI pairs, CIpc correlated with CIT (r(2) = .68, p < .001). The bias +/- SD was 0.12 +/- 0.61 L/min/m(2), and the percentage error was 35%. Among the seven time-interval subsets, the percentage error was < 30% only in the two first ones (27% and 26%, respectively). When changes in systemic vascular resistance by > 15% occurred (129 times), CIpc correlated with CIT (r(2) = .64), the bias +/- SD was 0.12 +/- 0.62 L/min/m(2), and the percentage error was 36%. In the subset of CI pairs recorded within the 1-hr calibration-free period while vascular resistance changed by > 15% (n = 32), the bias +/- SD was 0.04 +/- 0.47 L/min/m(2) and the percentage error was 29%.Conclusions: Our study in critically ill patients suggests that the agreement between pulse contour cardiac output and transpulmonary thermodilution cardiac output was not significantly influenced by changes in vascular tone. However, after a 1-hr calibration-free period, recalibration may be encouraged. Such a procedure provides helpful information drawn from other thermodilution-derived variables.