Division of Critical Care, Department of Pediatrics, The Children's Hospital, Aurora, CO, USA.
Intensive Care Med. 2011 Aug;37(8):1297-301. doi: 10.1007/s00134-011-2252-y. Epub 2011 May 31.
A continuous cardiac output monitor based on arterial pressure waveform (FloTrac/Vigileo; Edwards Lifesciences, Irvine, CA) is now approved for use in adults but not in children. This device is minimally invasive, calculates cardiac output continuously and in real time, and is easy to use. Our study sought to validate the FloTrac with the pulmonary artery catheter (PAC) intermittent thermodilution technique in pediatric cardiac patients.
This was a prospective pilot study comparing cardiac output measurements obtained via the FloTrac and arterial pressure waveform analysis with intermittent thermodilution. Subjects carried the diagnosis of pulmonary hypertension or cardiomyopathy, or were in the postoperative course after orthotopic heart transplantation.
Enrolled in the study were 31 subjects, and 136 data points were obtained. The age range was 8 months to 16 years. The mean body surface area (BSA) was 1.1 m(2). Bland-Altman plots for the mean cardiac outputs of all subjects with a BSA ≥ 1 m(2) showed limits of agreement of -2.7 to 8.0 l/min (± 5.4 l/min). Patients with a BSA ≤ 1 m(2) demonstrated even wider limits of agreement (± 8.5 l/min). The intraclass correlation for the PAC was 0.929 and 0.992 for the FloTrac.
There was poor agreement between the PAC and FloTrac in measuring cardiac output in a population of children with pulmonary hypertension or cardiomyopathy, or after cardiac transplantation. This is in contrast to adult studies published thus far. This suggests that the utility of the FloTrac and measurements obtained from arterial pulse wave analysis in children is uncertain at this time.
一种基于动脉压力波形的连续心输出量监测仪（FloTrac/Vigileo；爱德华生命科学公司，欧文，加利福尼亚州）现已获准用于成人，但不适用于儿童。该设备微创、连续实时计算心输出量，使用方便。我们的研究旨在验证 FloTrac 与肺动脉导管（PAC）间歇性热稀释技术在儿科心脏患者中的应用。
这是一项前瞻性试点研究，比较了通过 FloTrac 和动脉压力波形分析与间歇性热稀释获得的心输出量测量值。研究对象患有肺动脉高压或心肌病，或在原位心脏移植后处于术后阶段。
该研究共纳入 31 例患者，获得了 136 个数据点。年龄范围为 8 个月至 16 岁。平均体表面积（BSA）为 1.1m2。所有 BSA≥1m2 的受试者的平均心输出量的 Bland-Altman 图显示，一致性限为-2.7 至 8.0l/min（±5.4l/min）。BSA≤1m2 的患者显示出更宽的一致性限（±8.5l/min）。PAC 的组内相关系数为 0.929，FloTrac 的组内相关系数为 0.992。
在患有肺动脉高压或心肌病或心脏移植后的儿童人群中，PAC 和 FloTrac 在测量心输出量方面存在较差的一致性。这与迄今为止发表的成人研究结果形成对比。这表明，目前尚不确定在儿童中使用 FloTrac 和从动脉脉搏波分析获得的测量值的实用性。
