Cannesson M, Attof Y, Rosamel P, Joseph P, Bastien O, Lehot J-J
Hospives Civils de Lyon, Hôpital Louis Pradel, Department of Anesthesiology, Bron, France.
Eur J Anaesthesiol. 2007 Oct;24(10):832-9. doi: 10.1017/S0265021507001056. Epub 2007 Aug 1.
Arterial pulse waveform analysis has been proposed for cardiac output (CO) determination and monitoring without calibration or thermodilution (FloTrac/Vigileo; Edwards Lifesciences, Irvine, CA, USA). The accuracy and clinical applicability of this technology has not been fully evaluated. We designed this prospective study to compare the accuracy of the FloTrac system (CO(FT)) vs. pulmonary artery catheter standard bolus thermodilution (CO(PAC) ) in patients undergoing coronary artery bypass grafting.
We studied 11 patients referred for coronary artery bypass grafting. CO(FT) and CO(PAC) were determined at six time points in the operating room including before and 5 min after volume expansion (500 mL 6% hetastarch). Measurements were performed on arrival in the intensive care unit and every 4 h afterwards. Bland-Altman analysis was used to assess the agreement between CO(FT) and CO(PAC).
CO(PAC) ranged from 2.0 to 7.6 L min-1 and CO(FT) ranged from 1.9 to 8.2 L min-1. There was a significant relationship between CO(PAC) and CO(FT) (r = 0.662; P < 0.001). Agreement between CO(PAC) and CO(FT) was -0.26 +/- 0.87 L min-1. Volume expansion induced a significant increase in both CO(PAC) and CO(FT) (from 3.4 +/- 0.8 to 4.4 +/- 1.0 L min-1; P < 0.001 and from 3.9 +/- 1.2 to 5.0 +/- 1.1 L min-1; P < 0.001, respectively) and there was a significant relationship between percent change in CO(PAC) and CO(FT) following volume expansion (r = 0.722; P = 0.01).
We found clinically acceptable agreement between CO(FT) and CO(PAC) in this setting. This new device has potential clinical applications.
动脉脉搏波形分析已被用于心输出量（CO）的测定和监测，无需校准或热稀释法（FloTrac/Vigileo；美国加利福尼亚州尔湾市爱德华兹生命科学公司）。该技术的准确性和临床适用性尚未得到充分评估。我们设计了这项前瞻性研究，以比较FloTrac系统（CO(FT)）与肺动脉导管标准团注热稀释法（CO(PAC)）在接受冠状动脉旁路移植术患者中的准确性。
我们研究了11例接受冠状动脉旁路移植术的患者。在手术室的六个时间点测定CO(FT)和CO(PAC)，包括扩容（500 mL 6%羟乙基淀粉）前和扩容后5分钟。在重症监护病房入院时及之后每4小时进行测量。采用Bland-Altman分析评估CO(FT)和CO(PAC)之间的一致性。
CO(PAC)范围为2.0至7.6 L min-1，CO(FT)范围为1.9至8.2 L min-1。CO(PAC)与CO(FT)之间存在显著相关性（r = 0.662；P < 0.001）。CO(PAC)与CO(FT)之间的一致性为-0.26 +/- 0.87 L min-1。扩容使CO(PAC)和CO(FT)均显著增加（分别从3.4 +/- 0.8增至4.4 +/- 1.0 L min-1；P < 0.001，从3.9 +/- 1.2增至5.0 +/- 1.1 L min-1；P < 0.001），扩容后CO(PAC)和CO(FT)的变化百分比之间存在显著相关性（r = 0.722；P = 0.01）。
我们发现在这种情况下，CO(FT)与CO(PAC)之间的一致性在临床上是可接受的。这种新设备具有潜在的临床应用价值。
