II Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Str 22, 81675 München, Germany.
Crit Care. 2010;14(3):R95. doi: 10.1186/cc9030. Epub 2010 May 25.
Advanced hemodynamic monitoring using transpulmonary thermodilution (TPTD) is established for measurement of cardiac index (CI), global end-diastolic volume index (GEDVI) and extra-vascular lung water index (EVLWI). TPTD requires indicator injection via a central venous catheter (usually placed via the jugular or subclavian vein). However, superior vena cava access is often not feasible due to the clinical situation. This study investigates the conformity of TPTD using femoral access.
This prospective study involved an 18-month trial at a medical intensive care unit at a university hospital. Twenty-four patients with both a superior and an inferior vena cava catheter at the same time were enrolled in the study.
TPTD-variables were calculated from TPTD curves after injection of the indicator bolus via jugular access (TPTDjug) and femoral access (TPTDfem). GEDVIfem and GEDVIjug were significantly correlated (rm = 0.88; P < 0.001), but significantly different (1,034 +/- 275 vs. 793 +/- 180 mL/m2; P < 0.001). Bland-Altman analysis demonstrated a bias of +241 mL/m2 (limits of agreement: -9 and +491 mL/m2). GEDVIfem, CIfem and ideal body weight were independently associated with the bias (GEDVIfem-GEDVIjug). A correction formula of GEDVIjug after femoral TPTD, was calculated. EVLWIfem and EVLWIjug were significantly correlated (rm = 0.93; P < 0.001). Bland-Altman analysis revealed a bias of +0.83 mL/kg (limits of agreement: -2.61 and +4.28 mL/kg). Furthermore, CIfem and CIjug were significantly correlated (rm = 0.95; P < 0.001). Bland-Altman analysis demonstrated a bias of +0.29 L/min/m2 (limits of agreement -0.40 and +0.97 L/min/m2; percentage-error 16%).
TPTD after femoral injection of the thermo-bolus provides precise data on GEDVI with a high correlation, but a self-evident significant bias related to the augmented TPTD-volume. After correction of GEDVIfem using a correction formula, GEDVIfem shows high predictive capabilities for GEDVIjug. Regarding CI and EVLWI, accurate TPTD-data is obtained using femoral access.
经肺温度稀释法（TPTD）的高级血流动力学监测可用于测量心指数（CI）、全心舒张末期容积指数（GEDVI）和血管外肺水指数（EVLWI）。TPTD 需要通过中心静脉导管（通常通过颈静脉或锁骨下静脉放置）注射指示剂。然而，由于临床情况，上腔静脉通路往往不可行。本研究探讨了经股动脉通路进行 TPTD 的一致性。
本前瞻性研究在一家大学医院的重症监护病房进行了 18 个月的试验。同时有上腔静脉和下腔静脉导管的 24 名患者入组本研究。
通过颈内静脉通路（TPTDjug）和股静脉通路（TPTDfem）注射指示剂后，从 TPTD 曲线计算出 TPTD 变量。GEDVIfem 和 GEDVIjug 显著相关（rm = 0.88；P < 0.001），但差异显著（1,034 +/- 275 与 793 +/- 180 mL/m2；P < 0.001）。Bland-Altman 分析显示存在 241 mL/m2 的偏差（一致性界限：-9 和 491 mL/m2）。GEDVIfem、CIfem 和理想体重与偏差（GEDVIfem-GEDVIjug）独立相关。计算了股静脉 TPTD 后 GEDVIjug 的校正公式。GEDVIfem 和 EVLWIjug 显著相关（rm = 0.93；P < 0.001）。Bland-Altman 分析显示存在 0.83 mL/kg 的偏差（一致性界限：-2.61 和 4.28 mL/kg）。此外，CIfem 和 CIjug 显著相关（rm = 0.95；P < 0.001）。Bland-Altman 分析显示存在 0.29 L/min/m2 的偏差（一致性界限：-0.40 和 0.97 L/min/m2；百分比误差 16%）。
股静脉注射热指示剂后进行 TPTD 可提供与 GEDVI 高度相关的精确数据，但与增加的 TPTD 容量相关的明显偏差是不可避免的。使用校正公式校正 GEDVIfem 后，GEDVIfem 对 GEDVIjug 具有较高的预测能力。对于 CI 和 EVLWI，股静脉通路可获得准确的 TPTD 数据。
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