AP-HP, Hôpital de Bicêtre, Service de Réanimation Médicale, 78 Rue du Général Leclerc, Le Kremlin-Bicêtre F-94270, France.
Crit Care. 2010;14(3):R109. doi: 10.1186/cc9058. Epub 2010 Jun 10.
We compared the ability of two devices estimating cardiac output from arterial pressure-curve analysis to track the changes in cardiac output measured with transpulmonary thermodilution induced by volume expansion and norepinephrine in sepsis patients.
In 80 patients with septic circulatory failure, we administered volume expansion (40 patients) or introduced/increased norepinephrine (40 patients). We measured the pulse contour-derived cardiac index (CI) provided by the PiCCO device (CIpc), the arterial pressure waveform-derived CI provided by the Vigileo device (CIpw), and the transpulmonary thermodilution CI (CItd) before and after therapeutic interventions.
The changes in CIpc accurately tracked the changes in CItd induced by volume expansion (bias, -0.20 +/- 0.63 L/min/m2) as well as by norepinephrine (bias, -0.05 +/- 0.74 L/min/m2). The changes in CIpc accurately detected an increase in CItd >or= 15% induced by volume expansion and norepinephrine introduction/increase (area under ROC curves, 0.878 (0.736 to 0.960) and 0.924 (0.795 to 0.983), respectively; P < 0.05 versus 0.500 for both). The changes in CIpw were less reliable for tracking the volume-induced changes in CItd (bias, -0.23 +/- 0.95 L/min/m2) and norepinephrine-induced changes in CItd (bias, -0.01 +/- 1.75 L/min/m2). The changes in CIpw were unable to detect an increase in CItd >or= 15% induced by volume expansion and norepinephrine introduction/increase (area under ROC curves, 0.564 (0.398 to 0.720) and 0.541 (0.377 to 0.700, respectively, both not significantly different from versus 0.500).
The CIpc was reliable and accurate for assessing the CI changes induced by volume expansion and norepinephrine. By contrast, the CIpw poorly tracked the trends in CI induced by those therapeutic interventions.
我们比较了两种设备通过动脉压力曲线分析来估算心输出量的能力，以跟踪感染性休克患者中容量扩张和去甲肾上腺素引起的经肺温度稀释法测量的心输出量变化。
在 80 例感染性循环衰竭患者中，我们给予容量扩张（40 例）或引入/增加去甲肾上腺素（40 例）。我们在治疗干预前后测量脉搏轮廓衍生的心指数（CIpc）、由动脉压力波形衍生的 CI 提供的 Vigileo 设备（CIpw）和经肺温度稀释 CI（CItd）。
CIpc 的变化准确地跟踪了容量扩张引起的 CItd 的变化（偏倚，-0.20 +/- 0.63 L/min/m2），以及去甲肾上腺素引起的变化（偏倚，-0.05 +/- 0.74 L/min/m2）。CIpc 的变化准确地检测到容量扩张和去甲肾上腺素引入/增加引起的 CItd 增加>or=15%（ROC 曲线下面积，分别为 0.878（0.736 至 0.960）和 0.924（0.795 至 0.983）；均<0.05 与 0.500 相比）。CIpw 的变化对于跟踪容量引起的 CItd 的变化（偏倚，-0.23 +/- 0.95 L/min/m2）和去甲肾上腺素引起的 CItd 的变化不太可靠（偏倚，-0.01 +/- 1.75 L/min/m2）。CIpw 的变化无法检测到容量扩张和去甲肾上腺素引入/增加引起的 CItd 增加>or=15%（ROC 曲线下面积，分别为 0.564（0.398 至 0.720）和 0.541（0.377 至 0.700），均与 0.500 无显著差异）。
CIpc 可靠且准确地评估容量扩张和去甲肾上腺素引起的 CI 变化。相比之下，CIpw 对这些治疗干预引起的 CI 趋势跟踪不佳。
