Evaluation of a new arterial pressure-based cardiac output device requiring no external calibration.
Evaluation of a new arterial pressure-based cardiac output device requiring no external calibration.
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DOI：
10.1186/1471-2253-7-9
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发表时间：
2007-11-09
影响因子：
2.2
通讯作者：
Wiesenack, Christoph
中科院分区：
文献类型：
--
作者：
Prasser, Christopher;Bele, Sylvia;Wiesenack, Christoph
背景：已经讨论了几种替代间歇性推注热稀释心输出量(COPAC)的技术，即用肺动脉导管(PAC)测量。然而，这些技术通常需要中心静脉管道、额外的导管或特殊的校准程序。一种新的基于动脉压的心输出量(COAP)设备(FloTractrade商标，VigileoTrade商标；Edwards Lifesciences，美国加利福尼亚州欧文)只需要使用标准动脉导管进入桡动脉或股动脉，不需要外部校准。我们使用COPAC作为参考方法，在重症监护病房(ICU)的危重患者中验证了这项技术。方法：我们研究了20名危重患者，年龄16-74岁(平均55.5+/-18.8岁)，他们同时需要动脉和肺动脉压力监测。COPAC测量至少每4小时进行一次，并按3次测量的平均值计算，而COAP值在给药结束时立即测量。使用Bland和Altman描述的方法，通过计算偏差和一致限值来评估测量的准确性。结果：总共获得164个耦合测量。COPAC绝对值在2.8~10.80 L/分之间，平均值为5.93+/-1.55 L/分。COPAC和COAP对重复数不相等的一致性的偏差和限值为0.02+/-2.92 L/分钟。COPAC与COAP的百分比误差为49.3%。连续测量的COPAC百分比变化(DeltaCOPAC)和COAP百分比变化(DeltaCOAP)之间的偏差为-0.70%+/-32.28%。COPAC和COAP之间的皮尔逊相关系数为0.58(p<；0.01)，而DeltaCOPAC和DeltaCOAP之间的相关系数为0.46(p<；0.01)。结论：尽管COAP算法在一个不均匀的危重患者组中显示出与COPAC在很大范围内的最小偏差，但数据的散布仍然相对较大。因此，与心输出量测定的临床标准相比，所使用的算法(V1.03)不能表现出可接受的准确性。
BACKGROUND: Several techniques have been discussed as alternatives to the intermittent bolus thermodilution cardiac output (COPAC) measurement by the pulmonary artery catheter (PAC). However, these techniques usually require a central venous line, an additional catheter, or a special calibration procedure. A new arterial pressure-based cardiac output (COAP) device (FloTractrade mark, Vigileotrade mark; Edwards Lifesciences, Irvine, CA, USA) only requires access to the radial or femoral artery using a standard arterial catheter and does not need an external calibration. We validated this technique in critically ill patients in the intensive care unit (ICU) using COPAC as the method of reference.METHODS: We studied 20 critically ill patients, aged 16 to 74 years (mean, 55.5 +/- 18.8 years), who required both arterial and pulmonary artery pressure monitoring. COPAC measurements were performed at least every 4 hours and calculated as the average of 3 measurements, while COAP values were taken immediately at the end of bolus determinations. Accuracy of measurements was assessed by calculating the bias and limits of agreement using the method described by Bland and Altman.RESULTS: A total of 164 coupled measurements were obtained. Absolute values of COPAC ranged from 2.80 to 10.80 l/min (mean 5.93 +/- 1.55 l/min). The bias and limits of agreement between COPAC and COAP for unequal numbers of replicates was 0.02 +/- 2.92 l/min. The percentage error between COPAC and COAP was 49.3%. The bias between percentage changes in COPAC (DeltaCOPAC) and percentage changes in COAP (DeltaCOAP) for consecutive measurements was -0.70% +/- 32.28%. COPAC and COAP showed a Pearson correlation coefficient of 0.58 (p < 0.01), while the correlation coefficient between DeltaCOPAC and DeltaCOAP was 0.46 (p < 0.01).CONCLUSION: Although the COAP algorithm shows a minimal bias with COPAC over a wide range of values in an inhomogeneous group of critically ill patients, the scattering of the data remains relative wide. Therefore, the used algorithm (V 1.03) failed to demonstrate an acceptable accuracy in comparison to the clinical standard of cardiac output determination.