Seckeler Michael D, Hirsch Russel, Beekman Robert H, Goldstein Bryan H
The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Congenit Heart Dis. 2014 Jul-Aug;9(4):307-15. doi: 10.1111/chd.12140. Epub 2013 Sep 19.
To validate a method for determination of cardiac index (CI) using real-time measurement of oxygen consumption (VO2 ) in young children undergoing cardiac catheterization.
Retrospective review comparing thermodilution cardiac index (TDCI) to CI calculated by the Fick equation using real-time measured VO2 (RT-VO2 ) and VO2 derived from 2 published predictive equations. Paired t-test and Bland-Altman analysis were used to compare TDCI to Fick CI. A survey to ascertain pediatric cardiac catheterization practices regarding VO2 determination was also conducted.
Quaternary care children's hospital cardiac catheterization laboratory.
Children <3 years old with structurally normal hearts undergoing cardiac catheterization under general anesthesia with at least one set of contemporaneous TDCI and RT-VO2 measurements.
Thirty-six paired measurements of TDCI and RT-VO2 were made in 27 patients over a 2-year period. Indications for catheterization included congenital diaphragmatic hernia postrepair (n = 13), heart disease post-orthotopic heart transplant (n = 13), and suspected cardiomyopathy (n = 1). Mean age was 21.5 ± 8 months; median weight was 9.9 kg (IQR 8.57, 12.2). RT-VO2 was higher than VO2 predicted by the LaFarge equation (190 ± 31 vs. 173.8 ± 12.8 mL/min/m(2), P < .001), but there was no difference between TDCI and Fick CI calculated using VO2 from any method. Bland-Altman analysis showed excellent agreement between TDCI and Fick CI using RT-VO2 and VO2 predicted by the Lundell equation; Fick CI using VO2 predicted by the LaFarge equation showed fair agreement with TDCI.
In children <3 years with a structurally normal heart, RT-VO2 generates highly accurate determinations of Fick CI as compared with TDCI. Additionally, in this population, VO2 derived from the LaFarge and Lundell equations generates accurate Fick CI compared with TDCI. Future studies are needed to identify factors associated with inaccurate VO2 generated from these predictive equations.
验证一种通过实时测量接受心导管检查的幼儿耗氧量（VO2）来测定心脏指数（CI）的方法。
回顾性研究，比较热稀释法心脏指数（TDCI）与使用实时测量的VO2（RT-VO2）以及从2个已发表的预测方程得出的VO2通过菲克方程计算出的CI。采用配对t检验和布兰德-奥特曼分析来比较TDCI与菲克CI。还进行了一项调查，以确定儿科心导管检查中关于VO2测定的实践情况。
四级护理儿童医院的心导管检查实验室。
年龄小于3岁、心脏结构正常且在全身麻醉下接受心导管检查的儿童，至少有一组同步的TDCI和RT-VO2测量值。
在2年期间，对27例患者进行了36对TDCI和RT-VO2测量。心导管检查的适应证包括先天性膈疝修补术后（n = 13）、原位心脏移植术后心脏病（n = 13）以及疑似心肌病（n = 1）。平均年龄为21.5±8个月；中位数体重为9.9 kg（四分位间距8.57，12.2）。RT-VO2高于拉法热方程预测的VO2（190±31对173.8±12.8 mL/min/m²，P <.001），但使用任何方法得出的VO2计算的TDCI与菲克CI之间无差异。布兰德-奥特曼分析显示，使用RT-VO2和伦德尔方程预测的VO2时，TDCI与菲克CI之间具有极好的一致性；使用拉法热方程预测的VO2计算的菲克CI与TDCI显示出一般的一致性。
对于年龄小于3岁、心脏结构正常的儿童，与TDCI相比，RT-VO2能高度准确地测定菲克CI。此外，在该人群中，与TDCI相比，从拉法热方程和伦德尔方程得出的VO2能准确计算菲克CI。未来需要开展研究，以确定与这些预测方程得出的VO2不准确相关的因素。
