Accuracy and precision of calibrated arterial pulse contour analysis in patients with subarachnoid hemorrhage requiring high-dose vasopressor therapy: a prospective observational clinical trial
Accuracy and precision of calibrated arterial pulse contour analysis in patients with subarachnoid hemorrhage requiring high-dose vasopressor therapy: a prospective observational clinical trial
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DOI：
10.1186/cc13715
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发表时间：
2014-01-01
期刊：
影响因子：
15.1
通讯作者：
Rex, Steffen
中科院分区：
文献类型：
--
作者：
Metzelder, Sebastian M.;Coburn, Mark;Rex, Steffen
校准动脉脉搏轮廓分析已成为心输出量（PCCO）连续监测的一种既定方法。然而，其有效性的数据在血流动力学不稳定的病人超出心脏手术的设置是稀缺的。我们进行了本研究，以评估使用PiCCO （TM）装置测量pcco的有效性和准确性，并将其与经肺热稀释衍生心输出量（TPCO）作为需要大剂量血管加压剂治疗的神经外科患者的参考技术。方法：本前瞻性观察性临床试验共纳入20例患者，其中女性16例，男性4例。所有患者均因脑动脉瘤破裂发生蛛网膜下腔出血（Hunt&Hess分级I-V级），并接受大剂量血管加压治疗以预防/治疗延迟性脑缺血（DCI）。在基线以及入组后2 h、6 h、12 h、24 h、48 h和72 h同时进行TPCO和PCCO的测量。结果：pcco和tpco在基线以及入组后2 h、6 h、12 h、24 h、48 h和72 h测量。患者接受血管活性支持（平均+/-标准差，SD） 0.57 +/- 0.49 μ g.kg(-1) min（-1）去甲肾上腺素，平均动脉压为103 +/- 13 mmHg，全身血管阻力为943 +/- 248 dyn.s.cm（-5）。共分析136对CO-data。TPCO范围为5.2 ~ 14.3 l.min(-1)（平均+/- SD 8.5 +/- 2.0 l.min(-1)）， PCCO范围为5.0 ~ 14.4 l.min(-1)（平均+/- SD 8.6 +/- 2.0 l.min(-1)）。偏差和一致性限（偏差的1.96 SD）分别为-0.03±0.82 l min（-1）和1.62 l min(-1)，导致总体百分比误差为18.8%。pcco测定精度为17.8%。一致性率为74%(隔离区为15% （1.29 l.min(-1)）和67%（无隔离区），极线图分析表明趋势能力不足。结论：在需要广泛血管活性支持的神经外科患者中，经校准的PCCO获得的CO值在临床上和统计学上与tcco测量值一致，但一致性和极坐标图分析的结果表明趋势能力不可靠。
Introduction: Calibrated arterial pulse contour analysis has become an established method for the continuous monitoring of cardiac output (PCCO). However, data on its validity in hemodynamically instable patients beyond the setting of cardiac surgery are scarce. We performed the present study to assess the validity and precision of PCCO-measurements using the PiCCO (TM)-device compared to transpulmonary thermodilution derived cardiac output (TPCO) as the reference technique in neurosurgical patients requiring high-dose vasopressor-therapy.Methods: A total of 20 patients (16 females and 4 males) were included in this prospective observational clinical trial. All of them suffered from subarachnoid hemorrhage (Hunt&Hess grade I-V) due to rupture of a cerebral arterial aneurysm and underwent high-dose vasopressor therapy for the prevention/treatment of delayed cerebral ischemia (DCI). Simultaneous CO measurements by bolus TPCO and PCCO were obtained at baseline as well as 2 h, 6 h, 12 h, 24 h, 48 h and 72 h after inclusion.Results: PCCO-and TPCO-measurements were obtained at baseline as well as 2 h, 6 h, 12 h, 24 h, 48 h and 72 h after inclusion. Patients received vasoactive support with (mean +/- standard deviation, SD) 0.57 +/- 0.49 mu g.kg(-1) min(-1) norepinephrine resulting in a mean arterial pressure of 103 +/- 13 mmHg and a systemic vascular resistance of 943 +/- 248 dyn.s.cm(-5). 136 CO-data pairs were analyzed. TPCO ranged from 5.2 to 14.3 l.min(-1) (mean +/- SD 8.5 +/- 2.0 l.min(-1)) and PCCO ranged from 5.0 to 14.4 l.min(-1) (mean +/- SD 8.6 +/- 2.0 l.min(-1)). Bias and limits of agreement (1.96 SD of the bias) were -0.03 +/- 0.82 l.min(-1) and 1.62 l.min(-1), resulting in an overall percentage error of 18.8%. The precision of PCCO-measurements was 17.8%. Insufficient trending ability was indicated by concordance rates of 74% (exclusion zone of 15% (1.29 l.min(-1))) and 67% (without exclusion zone), as well as by polar plot analysis.Conclusions: In neurosurgical patients requiring extensive vasoactive support, CO values obtained by calibrated PCCO showed clinically and statistically acceptable agreement with TPCO-measurements, but the results from concordance and polar plot analysis indicate an unreliable trending ability.