Performance of Third-generation FloTrac/Vigileo system during hyperdynamic therapy for delayed cerebral ischemia after subarachnoid hemorrhage.
Performance of Third-generation FloTrac/Vigileo system during hyperdynamic therapy for delayed cerebral ischemia after subarachnoid hemorrhage.
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DOI：
10.4103/2152-7806.100195
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发表时间：
2012
影响因子：
--
通讯作者：
Yasui N
中科院分区：
文献类型：
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作者：
Mutoh T;Ishikawa T;Kobayashi S;Suzuki A;Yasui N
监测心输出量（CO）对于蛛网膜下腔出血（SAH）后迟发性脑缺血（DCI）的目标导向血流动力学治疗有希望的安全方法很重要，但经常被持续监测方式的侵入性和复杂性所排除。我们研究了在sah后DCI高动力治疗期间使用未经校准的动脉压力波形衍生心输出量（APCO）监测仪（第三代FloTrac/Vigileo， Edwards, Irvine， CA， USA）进行无创管理的临床应用，并与经肺热稀释（PiCCO, pel, Munich, Germany）作为参考技术进行比较。研究了45例SAH发病24小时内接受手术夹持，随后因DCI导致临床恶化的患者。将20例患者在多巴酚丁胺诱导的高动力治疗期间apco衍生的心脏指数（CI）与经肺热稀释分析的参考CI进行比较。在随后的48例试验中，比较了使用每种装置的患者的总体临床结果。与经肺热稀释相比，APCO低估了CI，总体偏差±SD为0.33±0.26 L/min/m2，误差为14.9%。两种方法在每次多巴酚丁胺剂量下的CI趋势相似（r2= 0.77; P < 0.0001）。3个月时，在神经系统改善、脑梗死、心肺并发症或功能结局的频率上，两组之间没有统计学上的显著差异。这些数据表明，在用多巴酚丁胺进行高动力治疗以逆转DCI的过程中，与参考的经肺热稀释相比，改进的APCO倾向于低估CI，但在这类患者中可能是可以接受的，以获得可比的临床结果。
Monitoring of cardiac output (CO) is important for promising safe approach to goal-directed hemodynamic therapy for delayed cerebral ischemia (DCI) after subarachnoid hemorrhage (SAH), but is often precluded by the invasiveness and complexity of ongoing monitoring modalities. We examined the clinical utility of less-invasive management using an uncalibrated arterial pressure waveform-derived cardiac output (APCO) monitor with refined algorithm (Third-generation FloTrac/Vigileo, Edwards, Irvine, CA, USA) during hyperdynamic therapy for post-SAH DCI, compared with transpulmonary thermodilution (PiCCO, Pulsion, Munich, Germany) as a reference technique. Forty-five patients who underwent surgical clipping within 24 h of SAH onset and subsequently developed clinical deterioration attributable to DCI were investigated. Validation of the APCO-derived cardiac index (CI) during dobutamine-induced hyperdynamic therapy was compared with a reference CI analyzed by transpulmonary thermodilution in 20 patients. In a subsequent trial of 48 cases, the overall clinical results from patients managed with each device were compared. The APCO underestimated CI with an overall bias ± SD of 0.33 ± 0.26 L/min/m2 compared with transpulmonary thermodilution, resulting in an error of 14.9%. The trends of CI for both techniques at each dobutamine dose were similar (r2= 0.77; P < 0.0001). No statistically significant differences were observed between the device groups for frequencies of neurological improvement, cerebral infarction, cardiopulmonary complications, or functional outcomes at 3 months. These data suggest that the refined APCO tends to underestimate CI compared with reference transpulmonary thermodilution during hyperdynamic therapy with dobutamine for reversing DCI, but may be acceptable in this select category of patients to obtain comparable clinical results.