Sun James X, Reisner Andrew T, Saeed Mohammed, Heldt Thomas, Mark Roger G
Division of Health Sciences and Technology, Massachusetts Institute of Technology, Massachusetts General Hospital, Boston, MA, USA.
Crit Care Med. 2009 Jan;37(1):72-80. doi: 10.1097/CCM.0b013e3181930174.
The value of different algorithms that estimate cardiac output (CO) by analysis of a peripheral arterial blood pressure (ABP) waveform has not been definitively identified. In this investigation, we developed a testing data set containing a large number of radial ABP waveform segments and contemporaneous reference CO by thermodilution measurements, collected in an intensive care unit (ICU) patient population during routine clinical operations. We employed this data set to evaluate a set of investigational algorithms, and to establish a public resource for the meaningful comparison of alternative CO-from-ABP algorithms.
A retrospective comparative analysis of eight investigational CO-from-ABP algorithms using the Multiparameter Intelligent Monitoring in Intensive Care II database.
Mixed medical/surgical ICU of a university hospital.
A total of 120 cases.
None.
CO estimated by eight investigational CO-from-ABP algorithms, and CO(TD) as a reference.
All investigational methods were significantly better than mean arterial pressure (MAP) at estimating direction changes in CO(TD). Only the formula proposed by Liljestrand and Zander in 1928 was a significantly better quantitative estimator of CO(TD) compared with MAP (95% limits-of-agreement with CO(TD): -1.76/+1.41 L/min versus -2.20/+1.82 L/min, respectively; p < 0.001, per the Kolmogorov-Smirnov test). The Liljestrand method was even more accurate when applied to the cleanest ABP waveforms. Other investigational algorithms were not significantly superior to MAP as quantitative estimators of CO.
Based on ABP data recorded during routine intensive care unit (ICU) operations, the Liljestrand and Zander method is a better estimator of CO(TD) than MAP alone. Our attempts to fully replicate commercially-available methods were unsuccessful, and these methods could not be evaluated. However, the data set is publicly and freely available, and developers and vendors of CO-from-ABP algorithms are invited to test their methods using these data.
通过分析外周动脉血压（ABP）波形来估算心输出量（CO）的不同算法的价值尚未得到明确界定。在本研究中，我们开发了一个测试数据集，其中包含大量桡动脉ABP波形片段以及通过热稀释测量得到的同期参考CO，这些数据是在重症监护病房（ICU）患者群体进行常规临床操作时收集的。我们利用该数据集评估了一组研究算法，并建立了一个公共资源，用于对从ABP估算CO的替代算法进行有意义的比较。
使用重症监护智能多参数监测II数据库对八种从ABP估算CO的研究算法进行回顾性比较分析。
大学医院的内科/外科混合ICU。
共120例。
无。
通过八种从ABP估算CO的研究算法估算的CO，以及作为参考的CO(TD)。
在估算CO(TD)的方向变化方面，所有研究方法均显著优于平均动脉压（MAP）。与MAP相比，只有1928年Liljestrand和Zander提出的公式是对CO(TD)显著更好的定量估算方法（与CO(TD)的95%一致性界限：分别为-1.76/+1.41 L/min和-2.20/+1.82 L/min；根据Kolmogorov-Smirnov检验，p<0.001）。当应用于最清晰的ABP波形时，Liljestrand方法更为准确。作为CO的定量估算方法，其他研究算法并不显著优于MAP。
基于重症监护病房（ICU）常规操作期间记录的ABP数据，Liljestrand和Zander方法比单独的MAP能更好地估算CO(TD)。我们完全复制商业可用方法的尝试未成功，因此无法对这些方法进行评估。然而，该数据集可公开免费获取，欢迎从ABP估算CO算法的开发者和供应商使用这些数据来测试他们的方法。
