Ultrasound dilution: an accurate means of determining cardiac output in children.
Ultrasound dilution: an accurate means of determining cardiac output in children.
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DOI：
10.1097/pcc.0b013e3182196804
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发表时间：
2012-01
期刊：
影响因子：
--
通讯作者：
Kim JJ
中科院分区：
文献类型：
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作者：
Crittendon I 3rd;Dreyer WJ;Decker JA;Kim JJ
心输出量（CO）是衡量心肌性能的有用指标。CO监测经常在重症成人中进行，以指导医生的治疗策略。然而，确定儿童CO的标准方法并非没有风险，并且由于其侵入性和其他技术问题而可能存在问题。基于超声稀释技术的COstatus®系统（Transonic Systems Inc，NY，USA），在原位导管上工作，并使用无害的指示剂，以允许对儿科患者的心输出量和血容量进行常规测量。本研究的目的是验证COstatus®测量的CO与肺动脉（PAC）热稀释临床标准技术获得的CO。这是一项在单一机构进行的前瞻性评价。任何在心导管实验室接受血流动力学评价的心脏结构正常的儿童均纳入研究。行右心导管插入术，首先用PAC热稀释法测定CO。然后将热稀释结果与使用COstatus系统获得的CO测量值进行比较。结果采用标准相关、Bland-Altman、Crichtley和Critchley分析进行分析。28例患者接受了评价，中位年龄为8岁，中位体重为31 kg。平均热稀释心脏指数= 3.18 L/min（+/− 1.35 L/min），平均COstatus®心脏指数= 3.17 L/min（+/− 1.31 L/min）。标准皮尔森相关性检验揭示了极好的相关系数0.95（p<0.0001）。Bland-Altman分析显示临床一致性良好，平均差异为−0.004 L/min，精密度为0.8 L/min/（2 SD）。在本研究中观察到25.4%的百分比误差，低于临床可接受限度。使用COstatus®系统测定CO的超声稀释技术提供了一种比传统肺动脉热稀释法侵入性更小的方法，可准确测定儿童的心输出量。这是COstatus®系统在儿科患者中的首次验证。需要进一步的研究来确定其在患有心脏分流和其他血流动力学不稳定疾病的儿科患者中的准确性。
Cardiac output (CO) is a useful measure of myocardial performance. CO monitoring is frequently performed in critically ill adults in order to guide physicians’ treatment strategies. However, standard methods of determining CO in children are not without risk and can be problematic secondary to their invasive nature and other technical problems. COstatus® system (Transonic Systems Inc, NY, USA), which is based on ultrasound dilution technology, works off in situ catheters and uses an innocuous indicator to allow for routine measurements of cardiac output and blood volumes in pediatric patients. The purpose of this study was to validate CO measured by COstatus® with those obtained by the clinical standard technique of pulmonary artery (PAC) thermodilution. This was a prospective evaluation performed at a single institution. Any child with a structurally normal heart undergoing hemodynamic evaluation in the cardiac catheterization laboratory was included. A prograde right heart catheterization was performed, and CO was first determined by using the PAC thermodilution technique. Thermodilution results were then compared with CO measurements obtained using the COstatus system. The results were analyzed by standard correlation, Bland-Altman, and Crichtley and Critchley analyses. Twenty-eight patients were evaluated with a median age of 8 yrs and a median weight of 31 kg. The mean thermodilution cardiac index = 3.18 L/min (+/− 1.35 L/min), and the mean COstatus® cardiac index = 3.17 L/min (+/− 1.31 L/min). Standard Pearson correlation tests revealed an excellent correlation coefficient of 0.95 (p<0.0001). Bland-Altman analysis revealed good clinical agreement with a mean difference of −0.004 L/min with a precision of 0.8 L/min/ at 2 SD. A percentage error of 25.4% was noticed in this study which is less than the clinically acceptable limit. The ultrasound dilution technique of determining CO using the COstatus® system provides a less invasive method than the traditional pulmonary artery thermodilution for accurately determining cardiac output in children. This is the first validation of the COstatus® system in pediatric patients. Further studies are required to establish its accuracy in pediatric patients with cardiac shunts and other hemodynamically unstable conditions.