Kiefer Nicholas, Hofer Christoph K, Marx Gernot, Geisen Martin, Giraud Raphaël, Siegenthaler Nils, Hoeft Andreas, Bendjelid Karim, Rex Steffen
Crit Care. 2012 May 30;16(3):R98. doi: 10.1186/cc11366.
Transpulmonary thermodilution is used to measure cardiac output (CO), global end-diastolic volume (GEDV) and extravascular lung water (EVLW). A system has been introduced (VolumeView/EV1000™ system, Edwards Lifesciences, Irvine CA, USA) that employs a novel algorithm for the mathematical analysis of the thermodilution curve. Our aim was to evaluate the agreement of this method with the established PiCCO™ method (Pulsion Medical Systems SE, Munich, Germany, clinicaltrials.gov identifier: NCT01405040) METHODS: Seventy-two critically ill patients with clinical indication for advanced hemodynamic monitoring were included in this prospective, multicenter, observational study. During a 72-hour observation period, 443 sets of thermodilution measurements were performed with the new system. These measurements were electronically recorded, converted into an analog resistance signal and then re-analyzed by a PiCCO2™ device (Pulsion Medical Systems SE).
For CO, GEDV, and EVLW, the systems showed a high correlation (r(2) = 0.981, 0.926 and 0.971, respectively), minimal bias (0.2 L/minute, 29.4 ml and 36.8 ml), and a low percentage error (9.7%, 11.5% and 12.2%). Changes in CO, GEDV and EVLW were tracked with a high concordance between the two systems, with a traditional concordance for CO, GEDV, and EVLW of 98.5%, 95.1%, and 97.7% and a polar plot concordance of 100%, 99.8% and 99.8% for CO, GEDV, and EVLW, respectively. Radial limits of agreement for CO, GEDV and EVLW were 0.31 ml/minute, 81 ml and 40 ml, respectively. The precision of GEDV measurements was significantly better using the VolumeView™ algorithm compared to the PiCCO™ algorithm (0.033 (0.03) versus 0.040 (0.03; median (interquartile range), P = 0.000049).
For CO, GEDV, and EVLW, the agreement of both the individual measurements as well as measurements of change showed the interchangeability of the two methods. For the VolumeView method, the higher precision may indicate a more robust GEDV algorithm.
clinicaltrials.gov NCT01405040.
经肺热稀释法用于测量心输出量（CO）、全心舒张末期容积（GEDV）和血管外肺水（EVLW）。已推出一种系统（VolumeView/EV1000™系统，美国爱德华生命科学公司，加利福尼亚州欧文市），该系统采用一种新颖的算法对热稀释曲线进行数学分析。我们的目的是评估该方法与已确立的PiCCO™方法（德国慕尼黑普ulsion医疗系统公司，clinicaltrials.gov标识符：NCT01405040）的一致性。方法：本前瞻性、多中心、观察性研究纳入了72例有高级血流动力学监测临床指征的危重症患者。在72小时观察期内，使用新系统进行了443组热稀释测量。这些测量结果被电子记录，转换为模拟电阻信号，然后由PiCCO2™设备（普ulsion医疗系统公司）重新分析。
对于CO、GEDV和EVLW，两种系统显示出高度相关性（r(2)分别为0.981、0.926和0.971），偏差极小（分别为0.2升/分钟、29.4毫升和36.8毫升），且百分比误差较低（分别为9.7%、11.5%和12.2%）。两种系统对CO、GEDV和EVLW变化的跟踪具有高度一致性，CO、GEDV和EVLW的传统一致性分别为98.5%、95.1%和97.7%，极坐标图一致性分别为100%、99.8%和99.8%。CO、GEDV和EVLW的径向一致性界限分别为0.31毫升/分钟、81毫升和40毫升。与PiCCO™算法相比，使用VolumeView™算法测量GEDV的精度显著更高（中位数（四分位间距）为0.033（0.03）对0.040（0.03），P = 0.000049）。
对于CO、GEDV和EVLW，单次测量以及变化测量的一致性均表明两种方法具有互换性。对于VolumeView方法，更高的精度可能表明GEDV算法更稳健。
clinicaltrials.gov NCT01405040。
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