Pestel Gunther, Fukui Kimiko, Hartwich Volker, Schumacher Peter M, Vogt Andreas, Hiltebrand Luzius B, Kurz Andrea, Fujita Yoshihisa, Inderbitzin Daniel, Leibundgut Daniel
Department of Anesthesiology, Johannes Gutenberg-University, Mainz, Germany.
Anesth Analg. 2009 Jun;108(6):1823-9. doi: 10.1213/ane.0b013e3181a2a8bf.
Difference in pulse pressure (dPP) reliably predicts fluid responsiveness in patients. We have developed a respiratory variation (RV) monitoring device (RV monitor), which continuously records both airway pressure and arterial blood pressure (ABP). We compared the RV monitor measurements with manual dPP measurements.
ABP and airway pressure (PAW) from 24 patients were recorded. Data were fed to the RV monitor to calculate dPP and systolic pressure variation in two different ways: (a) considering both ABP and PAW (RV algorithm) and (b) ABP only (RV(slim) algorithm). Additionally, ABP and PAW were recorded intraoperatively in 10-min intervals for later calculation of dPP by manual assessment. Interobserver variability was determined. Manual dPP assessments were used for comparison with automated measurements. To estimate the importance of the PAW signal, RV(slim) measurements were compared with RV measurements.
For the 24 patients, 174 measurements (6-10 per patient) were recorded. Six observers assessed dPP manually in the first 8 patients (10-min interval, 53 measurements); no interobserver variability occurred using a computer-assisted method. Bland-Altman analysis showed acceptable bias and limits of agreement of the 2 automated methods compared with the manual method (RV: -0.33% +/- 8.72% and RV(slim): -1.74% +/- 7.97%). The difference between RV measurements and RV(slim) measurements is small (bias -1.05%, limits of agreement 5.67%).
Measurements of the automated device are comparable with measurements obtained by human observers, who use a computer-assisted method. The importance of the PAW signal is questionable.
脉压差异（dPP）可可靠地预测患者的液体反应性。我们开发了一种呼吸变异（RV）监测设备（RV监测仪），它可以连续记录气道压力和动脉血压（ABP）。我们将RV监测仪的测量结果与手动dPP测量结果进行了比较。
记录了24例患者的ABP和气道压力（PAW）。数据输入到RV监测仪中，以两种不同方式计算dPP和收缩压变异：（a）同时考虑ABP和PAW（RV算法）和（b）仅考虑ABP（RV（精简版）算法）。此外，术中每隔10分钟记录一次ABP和PAW，以便稍后通过手动评估计算dPP。确定了观察者间的变异性。将手动dPP评估用于与自动测量结果进行比较。为了评估PAW信号的重要性，将RV（精简版）测量结果与RV测量结果进行了比较。
对于24例患者，共记录了174次测量（每位患者6 - 10次）。6名观察者对前8例患者进行了手动dPP评估（每隔10分钟，共53次测量）；使用计算机辅助方法未出现观察者间变异性。Bland - Altman分析显示，与手动方法相比，这两种自动方法的偏差和一致性界限均可接受（RV：-0.33%±8.72%，RV（精简版）：-1.74%±7.97%）。RV测量结果与RV（精简版）测量结果之间的差异很小（偏差-1.05%，一致性界限5.67%）。
自动设备的测量结果与使用计算机辅助方法的人类观察者获得的测量结果具有可比性。PAW信号的重要性值得怀疑。
