Hoeper M M, Maier R, Tongers J, Niedermeyer J, Hohlfeld J M, Hamm M, Fabel H
Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.
Am J Respir Crit Care Med. 1999 Aug;160(2):535-41. doi: 10.1164/ajrccm.160.2.9811062.
Assessment of cardiac output is an important part of the management of patients with pulmonary hypertension. The accuracy of the thermodilution technique in patients with low cardiac output or severe tricuspid regurgitation has been questioned. To address this issue, we simultaneously compared 105 cardiac output measurements by the Fick method and thermodilution in 35 patients with pulmonary hypertension. Moreover, we evaluated the acetylene rebreathing technique, a noninvasive method of determining cardiac output. The mean difference +/- 95% limit of agreement between thermodilution and the Fick method was +0.01 +/- 1.1 L/min. The mean difference +/- 95% limit of agreement between acetylene rebreathing and the Fick method was -0.23 +/- 1.14 L/min. Neither the mean agreement nor the 95% limits of agreement of both thermodilution and acetylene rebreathing with the Fick method were affected by the presence of low cardiac output or severe tricuspid regurgitation. We conclude that thermodilution and acetylene rebreathing are useful tools for assessing cardiac output in patients with pulmonary hypertension, even in the presence of low cardiac output or severe tricuspid regurgitation.
心输出量评估是肺动脉高压患者管理的重要组成部分。热稀释技术在低心输出量或严重三尖瓣反流患者中的准确性受到质疑。为解决这一问题，我们对35例肺动脉高压患者同时采用Fick法和热稀释法进行了105次心输出量测量比较。此外，我们评估了乙炔重呼吸技术，这是一种测定心输出量的非侵入性方法。热稀释法与Fick法之间的平均差值±95%一致性界限为+0.01±1.1L/分钟。乙炔重呼吸法与Fick法之间的平均差值±95%一致性界限为-0.23±1.14L/分钟。低心输出量或严重三尖瓣反流的存在并不影响热稀释法和乙炔重呼吸法与Fick法的平均一致性及95%一致性界限。我们得出结论，热稀释法和乙炔重呼吸法是评估肺动脉高压患者心输出量的有用工具，即使存在低心输出量或严重三尖瓣反流。
