Martin Matthew, Brown Carlos, Bayard David, Demetriades Demetrios, Salim Ali, Gertz Ryan, Azarow Kenneth, Wo Charles C J, Shoemaker William
Division of Trauma and Surgical Critical Care, Los Angeles County Hospital + USC Medical Center, Los Angeles, CA 90033, USA.
J Pediatr Surg. 2005 Dec;40(12):1957-63. doi: 10.1016/j.jpedsurg.2005.08.017.
The aim of this study was to assess the accuracy of a continuous survival probability prediction using noninvasive measures of cardiac performance and tissue perfusion in severely injured pediatric patients.
Review of all patients entered into a prospective noninvasive monitoring protocol. Cardiac index (CI) was measured using a thoracic bioimpedance device and tissue perfusion was assessed by transcutaneous carbon dioxide (Ptcco(2)) tension and oxygen tension indexed to the fraction of inspired oxygen (Ptco(2)/Fio(2)). Survival probability (SP) was continuously calculated using a stochastic analysis program.
There were 45 patients with a total of 953 data sets. The mean age was 11 years (range, 1-16 years) with a mean Injury Severity Score of 24 (+/-16). There was no difference between survivors (n = 32) and nonsurvivors (n = 13) at study entry for heart rate, blood pressure, CI, or pulse oximetry (all P > .05). However, survivors demonstrated higher Ptcco(2) (45 vs 35), higher Ptco(2)/Fio(2) (236 vs 156), and higher predicted SP (89% vs 62%) compared with nonsurvivors at study entry and throughout the monitoring period (all P < .01). For the entire data set, the strongest independent predictors of survival were Ptco(2)/Fio(2) and SP. The area under the receiver operating characteristic curve for mortality prediction was 0.83 for SP and 0.71 for Ptco(2)/Fio(2), compared with 0.6 for heart rate, 0.51 for blood pressure, and 0.53 for CI. Similar hemodynamic patterns were observed for all injury patterns with the exception of those with severe brain injury.
Thoracic bioimpedance and transcutaneous monitoring give critical real-time hemodynamic and tissue perfusion data that can provide early identification of pathologic flow patterns and accurately predict survival.
本研究旨在评估使用严重受伤儿科患者心脏功能和组织灌注的非侵入性测量方法进行连续生存概率预测的准确性。
回顾所有纳入前瞻性非侵入性监测方案的患者。使用胸部生物阻抗装置测量心脏指数（CI），并通过经皮二氧化碳（Ptcco(2)）张力和与吸入氧分数（Ptco(2)/Fio(2)）相关的氧张力评估组织灌注。使用随机分析程序连续计算生存概率（SP）。
共有45例患者，总计953个数据集。平均年龄为11岁（范围1 - 16岁），平均损伤严重度评分24（±16）。在研究开始时，幸存者（n = 32）和非幸存者（n = 13）在心率、血压、CI或脉搏血氧饱和度方面无差异（所有P > 0.05）。然而，与非幸存者相比，幸存者在研究开始时及整个监测期间的Ptcco(2)更高（45对35）、Ptco(2)/Fio(2)更高（236对156）、预测SP更高（89%对62%）（所有P < 0.01）。对于整个数据集，生存的最强独立预测因素是Ptco(2)/Fio(2)和SP。用于死亡率预测的受试者工作特征曲线下面积，SP为0.83，Ptco(2)/Fio(2)为0.71，相比之下，心率为0.6，血压为0.51，CI为0.53。除了严重脑损伤患者外，所有损伤类型均观察到相似的血流动力学模式。
胸部生物阻抗和经皮监测可提供关键的实时血流动力学和组织灌注数据，能够早期识别病理血流模式并准确预测生存。
