Squara Pierre, Denjean Dominique, Estagnasie Philippe, Brusset Alain, Dib Jean Claude, Dubois Claude
CERIC, Clinique Ambroise Paré, 27, boulevard Victor Hugo, 92200, Neuilly-sur-Seine, France.
Intensive Care Med. 2007 Jul;33(7):1191-1194. doi: 10.1007/s00134-007-0640-0. Epub 2007 Apr 26.
To evaluate the clinical utility of a new device for continuous noninvasive cardiac output monitoring (NICOM) based on chest bio-reactance compared with cardiac output measured semi-continuously by thermodilution using a pulmonary artery catheter (PAC-CCO).
Prospective, single-center study.
Intensive care unit.
Consecutive adult patients immediately after cardiac surgery.
Cardiac output measurements obtained from NICOM and thermodilution were simultaneously recorded minute by minute and compared in 110 patients. We evaluated the accuracy, precision, responsiveness, and reliability of NICOM for detecting cardiac output changes. Tolerance for each of these parameters was specified prospectively.
A total of 65,888 pairs of cardiac output measurements were collected. Mean reference values for cardiac output ranged from 2.79 to 9.27 l/min. During periods of stable PAC-CCO (slope<+/-10%, 2SD/mean<20%), the correlation between NICOM and thermodilution was R=0.82; bias was +0.16+/-0.52 l/min (+4.0+/-11.3%), and relative error was 9.1%+/-7.8%. In 85% of patients the relative error was <20%. During periods of increasing output, slopes were similar with the two methods in 96% of patients and intra-class correlation was positive in 96%. Corresponding values during periods of decreasing output were 90% and 84%, respectively. Precision was always better with NICOM than with thermodilution. During hemodynamic challenges, changes were 3.1+/-3.8 min faster with NICOM (p<0.01) and amplitude of changes did not differ significantly. Finally, sensitivity of the NICOM for detecting significant directional changes was 93% and specificity was 93%.
Cardiac output measured by NICOM had most often acceptable accuracy, precision, and responsiveness in a wide range of circulatory situations.
评估一种基于胸部生物电阻抗的新型连续无创心输出量监测设备（NICOM）的临床实用性，并与使用肺动脉导管（PAC-CCO）通过热稀释法半连续测量的心输出量进行比较。
前瞻性单中心研究。
重症监护病房。
心脏手术后的连续成年患者。
在110例患者中，每分钟同时记录从NICOM和热稀释法获得的心输出量测量值并进行比较。我们评估了NICOM检测心输出量变化的准确性、精密度、反应性和可靠性。这些参数的每个容差均预先设定。
共收集了65888对心输出量测量值。心输出量的平均参考值范围为2.79至9.27升/分钟。在PAC-CCO稳定期间（斜率<±10%，2标准差/均值<20%），NICOM与热稀释法之间的相关性为R = 0.82；偏差为+0.16±0.52升/分钟（+4.0±11.3%），相对误差为9.1%±7.8%。85%的患者相对误差<20%。在输出量增加期间，96%的患者两种方法的斜率相似，组内相关性为正的比例为96%。在输出量减少期间，相应的值分别为90%和84%。NICOM的精密度始终优于热稀释法。在血流动力学挑战期间，NICOM检测变化的速度快3.1±3.8分钟（p<0.01），变化幅度无显著差异。最后，NICOM检测显著方向变化的敏感性为93%，特异性为93%。
在广泛的循环情况下，通过NICOM测量的心输出量大多具有可接受的准确性、精密度和反应性。
