Transpulmonary thermodilution: advantages and limits.
Transpulmonary thermodilution: advantages and limits.
复制标题
DOI：
10.1186/s13054-017-1739-5
复制
发表时间：
2017-06-19
期刊：
影响因子：
--
通讯作者：
Teboul JL
中科院分区：
文献类型：
--
作者：
Monnet X;Teboul JL
对于重症监护病房或手术室中的复杂患者，关于他们的血流动力学管理的许多问题不能通过简单的临床检查来回答。特别值得一提的是，动脉压只能粗略估计心输出量。经肺热稀释是一种通过心输出量和其他指标提供全面血流动力学评估的技术。通过对静脉循环注射冷丸后动脉导管末端记录的热稀释曲线的分析，经肺热稀释间歇性地测量心输出量。该测量允许对脉冲轮廓分析进行校准。这提供了连续和实时的心输出量监测，这是使用肺动脉导管所不可能做到的。经肺热稀释提供了心输出量以外的几个变量。它估计四个心腔的舒张末容量，这是心脏前负荷的标志。它提供了对组合脑室收缩功能的估计。它比肺动脉导管更直接，但不能清楚地估计右心和左心功能。它比超声心动图更容易、更快，但不能提供心脏结构和功能的全面评估。经肺热稀释具有独特的优势，能够在床边估计血管外肺水量和肺血管通透性，前者可以量化肺水肿的体积，后者可以量化肺毛细血管渗漏的程度。这两项指标都有助于指导液体策略，特别是在急性呼吸窘迫综合征的情况下。经肺热稀释术提供了全面的心血管评估，使人们能够回答许多关于血流动力学管理的问题。它属于“高级”设备类别，适用于最危重和/或复杂的患者。
For complex patients in the intensive care unit or in the operating room, many questions regarding their haemodynamic management cannot be answered with simple clinical examination. In particular, arterial pressure allows only a rough estimation of cardiac output. Transpulmonary thermodilution is a technique that provides a full haemodynamic assessment through cardiac output and other indices. Through the analysis of the thermodilution curve recorded at the tip of an arterial catheter after the injection of a cold bolus in the venous circulation, transpulmonary thermodilution intermittently measures cardiac output. This measure allows the calibration of pulse contour analysis. This provides continuous and real time monitoring of cardiac output, which is not possible with the pulmonary artery catheter. Transpulmonary thermodilution provides several variables beyond cardiac output. It estimates the end-diastolic volume of the four cardiac cavities, which is a marker of cardiac preload. It provides an estimation of the systolic function of the combined ventricles. It is more direct than the pulmonary artery catheter, but does not allow the distinct estimation of right and left cardiac function. It is easier and faster to perform than echocardiography, but does not provide a full evaluation of the cardiac structure and function. Transpulmonary thermodilution has the unique advantage of being able to estimate at the bedside extravascular lung water, which quantifies the volume of pulmonary oedema, and pulmonary vascular permeability, which quantifies the degree of a pulmonary capillary leak. Both indices are helpful for guiding fluid strategy, especially in case of acute respiratory distress syndrome. Transpulmonary thermodilution provides a full cardiovascular evaluation that allows one to answer many questions regarding haemodynamic management. It belongs to the category of “advanced” devices that are indicated for the most critically ill and/or complex patients.