Hirschl M M, Kittler H, Woisetschläger C, Siostrzonek P, Staudinger T, Kofler J, Oschatz E, Bur A, Gwechenberger M, Laggner A N
Department of Emergency Medicine, University of Vienna, Austria.
Crit Care Med. 2000 Jun;28(6):1798-802. doi: 10.1097/00003246-200006000-00017.
To compare the accuracy and reliability of thoracic electrical bioimpedance (TEB) and the arterial pulse waveform analysis with simultaneous measurement of thermodilution cardiac output (TD-CO) in critically ill patients.
Prospective data collection.
Emergency department and critical care unit in a 2,000-bed inner-city hospital.
A total of 29 critically ill patients requiring invasive hemodynamic monitoring for clinical management were prospectively studied.
Noninvasive cardiac output was simultaneously measured by a TEB device and by analysis of the arterial pulse waveform derived from the finger artery. Invasive cardiac output was determined by the thermodilution technique.
A total of 175 corresponding TD-CO and noninvasive hemodynamic measurements were collected in 30-min intervals. They revealed an overall bias of 0.34 L/min/m2 (95% confidence interval, 0.24-0.44 L/min/m2; p < .001) for the arterial pulse waveform analysis and of 0.61 L/min/m2 (95% confidence interval, 0.50-0.72 L/min/m2; p < .001) for the TEB. In 39.4% (n = 69) of all measurements, the discrepancy between arterial pulse waveform analysis and TD-CO was >0.50 L/min/m2. The discrepancies of the arterial pulse waveform analysis correlated positively with the magnitude of the cardiac index (r2 = 0.29; p < .001). In 56.6% (n = 99) of all measurements, the discrepancy between TEB and TD-CO was >0.50 L/min/m2. The magnitude of the discrepancies of the TEB was significantly correlated with age (r2 = 0.17; p = .02). Measurements were in phase in 93.2% of all arterial pulse waveform analysis and in 84.9% of all TEB readings (p < .001).
The arterial pulse waveform analysis exhibits a greater accuracy and reliability as compared with the TEB with regard to overall bias, number of inaccurate readings, and phase lags. The arterial pulse waveform analysis may be useful for the monitoring of hemodynamic changes. However, both methods fail to be a substitute for the TD-CO because of a substantial percentage of inaccurate readings.
比较胸腔电阻抗（TEB）和动脉脉搏波形分析与热稀释法心输出量（TD-CO）同步测量在危重症患者中的准确性和可靠性。
前瞻性数据收集。
一家拥有2000张床位的市中心医院的急诊科和重症监护病房。
共有29例因临床管理需要进行有创血流动力学监测的危重症患者接受前瞻性研究。
通过TEB设备和分析来自指动脉的动脉脉搏波形同步测量无创心输出量。通过热稀释技术测定有创心输出量。
每隔30分钟收集175组相应的TD-CO和无创血流动力学测量值。结果显示，动脉脉搏波形分析的总体偏差为0.34L/min/m²（95%置信区间，0.24-0.44L/min/m²；p<.001），TEB的总体偏差为0.61L/min/m²（95%置信区间，0.50-0.72L/min/m²；p<.001）。在所有测量值中，39.4%（n=69）的动脉脉搏波形分析与TD-CO之间的差异>0.50L/min/m²。动脉脉搏波形分析的差异与心脏指数大小呈正相关（r²=0.29；p<.001）。在所有测量值中，56.6%（n=99）的TEB与TD-CO之间的差异>0.50L/min/m²。TEB差异的大小与年龄显著相关（r²=0.17；p=.02）。在所有动脉脉搏波形分析测量值中，93.2%的测量值相位一致，在所有TEB读数中，84.9%的读数相位一致（p<.001）。
在总体偏差、不准确读数数量和相位滞后方面，动脉脉搏波形分析比TEB具有更高的准确性和可靠性。动脉脉搏波形分析可能有助于监测血流动力学变化。然而，由于存在相当比例的不准确读数，这两种方法都不能替代TD-CO。
