Clinical assessment of cardiac performance in infants and children following cardiac surgery
Clinical assessment of cardiac performance in infants and children following cardiac surgery
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DOI：
10.1007/s00134-005-2569-5
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发表时间：
2005-04-01
影响因子：
38.9
通讯作者：
Winlaw, DS
中科院分区：
文献类型：
--
作者：
Egan, JR;Festa, M;Winlaw, DS
目的：比较有创性血流动力学监测与心功能评价的临床效果。设计和设置：在一个16张病床的三级儿科重症监护病房进行的前瞻性观察研究。患者和参与者：接受心肺转流和先天性心脏病手术修复的婴儿和儿童。干预措施：根据儿科重症监护室的体格检查和常规血液动力学监测，医务人员和护理人员评估了心脏指数、全身血管阻力指数和容量状态。临床评估与心脏指数，全身血管阻力指数和整体舒张末期容积指数，通过股动脉热稀释法获得比较。测量和结果：在16例接受先天性心脏病双心室修补术的婴儿和儿童中，共对这三个参数进行了76次临床评估。确定所有三个心脏性能参数的临床和有创方法之间的一致性较差。心脏指数在临床上被显著低估;平均差异为0.71 l min（-1）m（-2）（95%的一致性范围+/- 2.7）。全身血管阻力（加权kappa = 0.15）和容量状态（加权kappa = 0.04）的临床估计值与测量值的一致性较差，在临床上被高估。有1例并发症与股动脉导管相关，1例器械失效。结论：常规临床评估心脏功能参数与这些指标的侵入性测定不一致。基于不准确的临床评估的管理决策可能对患者有害。使用股动脉热稀释法进行的有创血流动力学监测需要谨慎进行进一步评价，因为与临床评估（目前在该患者人群中是标准的公认治疗）几乎没有一致性。
Objective: To compare clinical assessment of cardiac performance with an invasive method of haemodynamic monitoring. Design and setting: Prospective observational study in a 16-bed tertiary paediatric intensive care unit. Patients and participants: Infants and children undergoing cardiopulmonary bypass and surgical repair of congenital heart lesions. Interventions: Based on physical examination and routinely available haemodynamic monitoring in the paediatric intensive care unit, medical and nursing staff assessed cardiac index, systemic vascular resistance index and volume status. Clinical assessment was compared with cardiac index, systemic vascular resistance index and global end diastolic volume index, obtained by femoral artery thermodilution. Measurements and results: A total of 76 clinical estimations of the three parameters were made in 16 infants and children undergoing biventricular repair of congenital heart lesions. Agreement was poor between clinical and invasive methods of determining all three studied parameters of cardiac performance. Cardiac index was significantly underestimated clinically; mean difference was 0.71 l min(-1) m(-2) (95% range of agreement +/- 2.7). Clinical estimates of systemic vascular resistance (weighted kappa = 0.15) and volume status (weighted kappa = 0.04) showed poor levels of agreement with measured values and were overestimated clinically. There was one complication related to a femoral arterial catheter and one device failure. Conclusions: Routine clinical assessment of parameters of cardiac performance agreed poorly with invasive determinations of these indices. Management decisions based on inaccurate clinical assessments may be detrimental to patients. Invasive haemodynamic monitoring using femoral artery thermodilution warrants cautious further evaluation as there is little agreement with clinical assessment which is presently standard accepted care in this patient population.