Thornton Hospital, University of California San Diego, La Jolla, CA 92093-7770, USA.
J Cardiothorac Vasc Anesth. 2011 Oct;25(5):770-5. doi: 10.1053/j.jvca.2010.12.017. Epub 2011 Feb 26.
To evaluate the accuracy, precision, and trending of a new endotracheally sourced impedance cardiography-based cardiac output (CO) monitor (ECOM; ConMed Corp, Irvine, CA).
Two university hospitals.
Thirty patients scheduled for elective coronary artery bypass graft (CABG) surgery.
All patients received a pulmonary artery catheter (PAC), arterial catheter, endotracheal CO monitor (ECOM), endotracheal intubation, and transesophageal echocardiographic monitoring. ECOM CO was compared with CO measured with pulmonary artery thermodilution, and left ventricular CO measured with transesophageal echocardiography.
One hundred forty-five pairs of triplicate CO measurements using intermittent bolus pulmonary artery thermodilution (TD) and ECOM were compared at 5 distinct time points: postinduction, postinduction passive leg raise, poststernotomy, post-CABG completion, and post-chest closure. Eighty-seven pairs of triplicate CO measurements using transesophageal echocardiography were obtained at 3 time points: postinduction, post-CABG completion, and post-chest closure and compared with ECOM- and PA-derived CO measurements. The measurements at each time point were compared by using Bland-Altman and polar plot analyses.
The mean CO ranged from 2.16 to 9.41 L/min. ECOM CO, compared with TD CO, revealed a bias of 0.02 L/min, 95% limits of agreement of -2.26 to 2.30 L/min, and a percent error of 50%. ECOM CO showed trending with TD CO with 91% and 99% of values within 0.5L/min and 1 L/min limits of agreement, respectively. ECOM CO, compared with TEE CO, revealed a bias of -0.25 L/min, 95% limits of agreement of -2.41 to 1.92 L/min, and a percent error of 48%. ECOM CO showed trending with TEE CO with 83% and 95% of values within 0.5L/min and 1 L/min limits of agreement, respectively.
ECOM CO shows an acceptable bias with wide limits of agreement and a large percent error when compared with TD CO or TEE CO; however, it shows acceptable trending of CO to both modalities in patients undergoing cardiac surgery. Further studies are required to evaluate ECOM in other patient populations and clinical situations.
评估一种新的经气管源阻抗心排量（CO）监测仪（ECOM；康美公司，欧文，CA）的准确性、精密度和趋势。
两所大学医院。
30 名拟行择期冠状动脉旁路移植术（CABG）的患者。
所有患者均接受肺动脉导管（PAC）、动脉导管、经气管 CO 监测仪（ECOM）、气管插管和经食管超声心动图监测。ECOM CO 与肺动脉热稀释法测量的 CO 以及经食管超声心动图测量的左心室 CO 进行比较。
在 5 个不同时间点，用间歇性肺动脉热稀释（TD）和 ECOM 进行了 145 对三重复测量 CO：诱导后、诱导后被动抬腿、开胸后、CABG 完成后和关胸后。在 3 个时间点（诱导后、CABG 完成后和关胸后）获得了 87 对三重复测量的经食管超声心动图 CO，并与 ECOM 和 PA 衍生的 CO 测量值进行比较。在每个时间点，通过 Bland-Altman 和极坐标图分析进行比较。
平均 CO 范围为 2.16 至 9.41 L/min。与 TD CO 相比，ECOM CO 的偏差为 0.02 L/min，95%的一致性界限为-2.26 至 2.30 L/min，百分比误差为 50%。ECOM CO 与 TD CO 呈趋势变化，91%和 99%的数值在 0.5L/min 和 1 L/min 的一致性界限内。与 TEE CO 相比，ECOM CO 的偏差为-0.25 L/min，95%的一致性界限为-2.41 至 1.92 L/min，百分比误差为 48%。ECOM CO 与 TEE CO 呈趋势变化，83%和 95%的数值在 0.5L/min 和 1 L/min 的一致性界限内。
与 TD CO 或 TEE CO 相比，ECOM CO 的 CO 显示出可接受的偏差、较宽的一致性界限和较大的百分比误差；然而，它在接受心脏手术的患者中显示出对两种模式的可接受的 CO 趋势。需要进一步的研究来评估 ECOM 在其他患者人群和临床情况下的应用。
