Department of Emergency Medicine, Henry Ford Health System, Detroit, MI 48202, USA.
Am J Emerg Med. 2012 Jul;30(6):954-60. doi: 10.1016/j.ajem.2011.05.021. Epub 2011 Jul 29.
Emergency physicians (EPs) estimate the underlying hemodynamics of acutely ill patients and use them to help both diagnose and formulate a treatment plan. This trial compared the EP clinically derived estimates of cardiac output (CO) and systemic vascular resistance (SVR) to those measured noninvasively.
Forty acutely ill emergency department patients with a broad range of diagnosis and blood pressure (BP) and pulse were monitored for 2 hours using novel noninvasive finger cuff technology (Nexfin; BMEYE, Amsterdam, The Netherlands). The Nexfin device provides continuous BP monitoring and, from the resulting pulse pressure waveform, calculates beat-to-beat CO and SVR. At baseline assessment and after 2 hours of testing and therapy, treating EPs were asked to estimate the CO and SVR (low, normal, or high), and these were compared with Nexfin measurements.
Twenty-five men and 15 women were enrolled with a mean age of 62.2 years (SD, 12.6 years). Eighteen had acute shortness of breath; 11, with probable stroke syndrome; 3, with suspected sepsis; and 8, with a systolic BP greater than 180 or less than 100 mm Hg. Concordance tables showed that there was very little agreement (κ values) between either the compared initial CO (-0.0873) and SVR (-0.0645) or the 2-hour values (-0.0645 and -0.1949, respectively).
Emergency physicians cannot accurately estimate the underlying hemodynamic profiles of acutely ill patients when compared with more objective measurements. This inaccuracy may have important clinical ramifications. Further study is needed to determine how to use these measured continuous CO and SVR monitoring values.
急诊医师（EP）评估急性病患者的潜在血液动力学，并利用这些信息帮助诊断和制定治疗计划。本试验比较了 EP 临床估计的心输出量（CO）和全身血管阻力（SVR）与非侵入性测量值。
40 名患有广泛诊断和血压（BP）和脉搏的急性急诊科患者使用新型无创指套技术（Nexfin；BMEYE，阿姆斯特丹，荷兰）监测 2 小时。Nexfin 设备提供连续血压监测，并从所得的脉搏压力波形计算出逐搏 CO 和 SVR。在基线评估和 2 小时的测试和治疗后，要求治疗 EP 估计 CO 和 SVR（低、正常或高），并将其与 Nexfin 测量值进行比较。
纳入 25 名男性和 15 名女性，平均年龄为 62.2 岁（SD，12.6 岁）。18 例有急性呼吸急促；11 例有疑似中风综合征；3 例有疑似脓毒症；8 例有收缩压大于 180 或小于 100mmHg。一致性表格显示，初始 CO（-0.0873）和 SVR（-0.0645）或 2 小时值（分别为-0.0645 和-0.1949）之间的一致性非常小（κ 值）。
与更客观的测量值相比，急诊医师无法准确估计急性病患者的潜在血液动力学特征。这种不准确性可能具有重要的临床意义。需要进一步研究如何使用这些测量的连续 CO 和 SVR 监测值。
