McGee William T, Horswell Jeffrey L, Calderon Joachim, Janvier Gerard, Van Severen Tom, Van den Berghe Greet, Kozikowski Lori
Critical Care Division, Baystate Medical Center, 759 Chestnut Street, Springfield, MA 01199, USA.
Crit Care. 2007;11(5):R105. doi: 10.1186/cc6125.
The present study compared measurements of cardiac output by an arterial pressure-based cardiac output (APCO) analysis method with measurement by intermittent thermodilution cardiac output (ICO) via pulmonary artery catheter in a clinical setting.
The multicenter, prospective clinical investigation enrolled patients with a clinical indication for cardiac output monitoring requiring pulmonary artery and radial artery catheters at two hospitals in the United States, one hospital in France, and one hospital in Belgium. In 84 patients (69 surgical patients), the cardiac output was measured by analysis of the arterial pulse using APCO and was measured via pulmonary artery catheter by ICO; to establish a reference comparison, the cardiac output was measured by continuous cardiac output (CCO). Data were collected continuously by the APCO and CCO technologies, and at least every 4 hours by ICO. No clinical interventions were made as part of the study.
For APCO compared with ICO, the bias was 0.20 l/min, the precision was +/- 1.28 l/min, and the limits of agreement were -2.36 l/m to 2.75 l/m. For CCO compared with ICO, the bias was 0.66 l/min, the precision was +/- 1.05 l/min, and the limits of agreement were -1.43 l/m to 2.76 l/m. The ability of APCO and CCO to assess changes in cardiac output was compared with that of ICO. In 96% of comparisons, APCO tracked the change in cardiac output in the same direction as ICO. The magnitude of change was comparable 59% of the time. For CCO, 95% of comparisons were in the same direction, with 58% of those changes being of similar magnitude.
In critically ill patients in the intensive care unit, continuous measurement of cardiac output using either APCO or CCO is comparable with ICO. Further study in more homogeneous populations may refine specific situations where APCO reliability is strongest.
本研究在临床环境中，将基于动脉压的心输出量（APCO）分析方法测量的心输出量与通过肺动脉导管进行的间歇性热稀释心输出量（ICO）测量结果进行了比较。
这项多中心、前瞻性临床研究纳入了在美国两家医院、法国一家医院和比利时一家医院中，有临床指征需要进行心输出量监测且需要放置肺动脉导管和桡动脉导管的患者。在84例患者（69例外科手术患者）中，使用APCO通过分析动脉脉搏来测量心输出量，并通过肺动脉导管经ICO测量心输出量；为建立参考比较，通过连续心输出量（CCO）测量心输出量。数据由APCO和CCO技术持续收集，ICO至少每4小时收集一次。作为研究的一部分，未进行临床干预。
与ICO相比，APCO的偏差为0.20升/分钟，精密度为±1.28升/分钟，一致性界限为-2.36升/分钟至2.75升/分钟。与ICO相比，CCO的偏差为0.66升/分钟，精密度为±1.05升/分钟，一致性界限为-1.43升/分钟至2.76升/分钟。将APCO和CCO评估心输出量变化的能力与ICO的进行了比较。在96%的比较中，APCO与ICO在心输出量变化方向上一致。在59%的时间里，变化幅度相当。对于CCO，95%的比较方向相同，其中58%的变化幅度相似。
在重症监护病房的危重病患者中，使用APCO或CCO连续测量心输出量与ICO相当。在更同质的人群中进行进一步研究可能会明确APCO可靠性最强的具体情况。
