AP-HP, Hôpitaux Universitaires Paris-Sud, Service de Réanimation Médicale, Le Kremlin-Bicêtre F-94270, France.
Crit Care. 2011 Aug 27;15(4):R204. doi: 10.1186/cc10421.
We wanted to determine the number of cold bolus injections that are necessary for achieving an acceptable level of precision for measuring cardiac index (CI), indexed global end-diastolic volume (GEDVi) and indexed extravascular lung water (EVLWi) by transpulmonary thermodilution.
We included 91 hemodynamically stable patients (age 59 (25% to 75% interquartile range: 39 to 79) years, simplified acute physiologic score (SAPS)II 59 (53 to 65), 56% under norepinephrine) who were monitored by a PiCCO2 device. We performed five successive cold saline (15 mL, 6 °C) injections and recorded the measurements of CI, GEDVi and EVLWi.
Considering five boluses, the coefficient of variation (CV, calculated as standard deviation divided by the mean of the five measurements) was 7 (5 to 11)%, 7 (5 to 12)% and 7 (6 to 12)% for CI, GEDVi and EVLWi, respectively. If the results of two bolus injections were averaged, the precision (2 × CV/√ number of boluses) was 10 (7 to 15)%, 10 (7 to 17)% and 8 (7 to 14)% for CI, GEDVi and EVLWi, respectively. If the results of three bolus injections were averaged, the precision dropped below 10%, that is, the cut-off that is generally considered as acceptable (8 (6 to 12)%, 8 (6 to 14)% and 8 (7 to 14)% for CI, GEDVi and EVLWi, respectively). If two injections were performed, the least significant change, that is, the minimal change in value that could be trusted to be significant, was 14 (10 to 21)%, 14 (10 to 24)% and 14 (11 to 23)% for CI, GEDVi and EVLWi, respectively. If three injections were performed, the least significant change was 12 (8 to 17)%, 12 (8 to 19)% and 12 (9 to 19)% for CI, GEDVi and EVLWi, respectively, that is, below the 15% cut-off that is usually considered as clinically relevant.
These results support the injection of at least three cold boluses for obtaining an acceptable precision when transpulmonary thermodilution is used for measuring CI, GEDVi and EVLWi.
我们旨在确定通过经肺热稀释法测量心指数（CI）、指数化全心舒张末期容积（GEDVi）和指数化血管外肺水（EVLWi）时，需要进行多少次冷盐水推注才能达到可接受的精度。
我们纳入了 91 例血流动力学稳定的患者（年龄 59 岁（25%至 75%四分位间距：39 至 79），简化急性生理学评分（SAPS）II 59 分（53 至 65），56%患者接受去甲肾上腺素治疗），这些患者使用 PiCCO2 设备进行监测。我们进行了五次连续的冷生理盐水（15 mL，6°C）注射，并记录了 CI、GEDVi 和 EVLWi 的测量值。
考虑到五次推注，变异系数（CV，定义为标准差除以五次测量的平均值）分别为 7%（5%至 11%）、7%（5%至 12%）和 7%（6%至 12%），用于 CI、GEDVi 和 EVLWi。如果将两次推注的结果平均，则精度（2×CV/√推注次数）分别为 10%（7%至 15%）、10%（7%至 17%）和 8%（7%至 14%），用于 CI、GEDVi 和 EVLWi。如果将三次推注的结果平均，则精度低于 10%，即通常认为可接受的截止值（分别用于 CI、GEDVi 和 EVLWi 的 8%（6%至 12%）、8%（6%至 14%）和 8%（7%至 14%））。如果进行两次推注，则最小有意义变化，即可以认为有显著意义的最小变化值为 14%（10%至 21%）、14%（10%至 24%）和 14%（11%至 23%），用于 CI、GEDVi 和 EVLWi。如果进行三次推注，则最小有意义变化分别为 12%（8%至 17%）、12%（8%至 19%）和 12%（9%至 19%），用于 CI、GEDVi 和 EVLWi，即低于通常认为具有临床意义的 15%截止值。
这些结果支持在使用经肺热稀释法测量 CI、GEDVi 和 EVLWi 时，至少进行三次冷盐水推注，以获得可接受的精度。
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