Suttner Stefan, Schöllhorn Thilo, Boldt Joachim, Mayer Jochen, Röhm Kerstin D, Lang Katrin, Piper Swen N
Department of Anesthesiology and Intensive Care Medicine, Klinikum der Stadt Ludwigshafen, Bremser Strasse 79, Ludwigshafen, Germany.
Intensive Care Med. 2006 Dec;32(12):2053-8. doi: 10.1007/s00134-006-0409-x. Epub 2006 Oct 13.
To compare noninvasive cardiac output (CO)measurement obtained with a new thoracic electrical bioimpedance (TEB) device, using a proprietary modification of the impedance equation, with invasive measurement obtained via pulmonary artery thermodilution.
Prospective, observational study.
Surgical intensive care unit (ICU) of a university-affiliated community hospital.
Seventy-four adult patients undergoing elective cardiac surgery with routine pulmonary artery catheter placement.
None.
Simultaneous paired CO and cardiac index (CI) measurements by TEB and thermodilution were obtained in mechanically ventilated patients upon admission to the ICU. For analysis of CI data the patients were subdivided into a hemodynamically stable group and a hemodynamically unstable group. The groups were analyzed using linear regression and tests of bias and precision. We found a significant correlation between thermodilution and TEB (r = 0.83; n < 0.001), accompanied by a bias of -0.01 l/min/m(2) and a precision of +/-0.57 l/min/m(2) for all CI data pairs. Correlation, bias, and precision were not influenced by stratification of the data. The correlation coefficient, bias, and precision for CI were 0.86 (n< 0.001), 0.03 l/min/m(2), and +/-0.47 l/min/m(2) in hemodynamically stable patients and 0.79 (n< 0.001), 0.06 l/min/m(2), and +/-0.68 l/min/m(2) in hemodynamically unstable patients.
Our results demonstrate a close correlation and clinically acceptable agreement and precision between CO measurements obtained with impedance cardiography using a new algorithm to calculate CO from variations in TEB, and those obtained with the clinical standard of care, pulmonary artery thermodilution, in hemodynamically stable and unstable patients after cardiac surgery.
比较采用新型胸部电阻抗（TEB）装置通过对阻抗方程进行专有修改获得的无创心输出量（CO）测量值与经肺动脉热稀释法获得的有创测量值。
前瞻性观察性研究。
大学附属医院社区医院的外科重症监护病房（ICU）。
74例接受择期心脏手术并常规放置肺动脉导管的成年患者。
无。
在机械通气患者入住ICU时，通过TEB和热稀释法同时进行配对的CO和心脏指数（CI）测量。为分析CI数据，将患者分为血流动力学稳定组和血流动力学不稳定组。采用线性回归以及偏差和精密度检验对两组进行分析。我们发现热稀释法与TEB之间存在显著相关性（r = 0.83；P < 0.001），所有CI数据对的偏差为-0.01 l/min/m²，精密度为±0.57 l/min/m²。相关性、偏差和精密度不受数据分层的影响。血流动力学稳定患者CI的相关系数、偏差和精密度分别为0.86（P<0.001）、0.03 l/min/m²和±0.47 l/min/m²，血流动力学不稳定患者分别为0.79（P<0.001）、0.06 l/min/m²和±0.68 l/min/m²。
我们的结果表明，在心脏手术后血流动力学稳定和不稳定的患者中，使用新算法根据TEB变化计算CO的阻抗心动图获得的CO测量值与临床护理标准肺动脉热稀释法获得的测量值之间具有密切相关性、临床可接受的一致性和精密度。
