Department of Anesthesiology and Critical Care Medicine and INSERM U1088, Jules Verne University of Picardy, Amiens, France
Department of Anesthesiology and Critical Care Medicine and INSERM U1088, Jules Verne University of Picardy, Amiens, France.
Br J Anaesth. 2014 Oct;113(4):596-602. doi: 10.1093/bja/aeu136. Epub 2014 May 28.
Impedance cardiography (ICG) enables continuous, beat-by-beat, non-invasive, operator-independent, and inexpensive cardiac output (CO) monitoring. We compared CO values and variations obtained by ICG (Niccomo™, Medis) and oesophageal Doppler monitoring (ODM) (CardioQ™, Deltex Medical) in surgical patients.
This prospective, observational, single-centre study included 32 subjects undergoing surgery with general anaesthesia. CO was measured simultaneously with ICG and ODM before and after events likely to modify CO (vasopressor administration and volume expansion). One hundred and twenty pairs of CO measurements and 94 pairs of CO variation measurements were recorded.
The CO variations measured by ICG correlated with those measured by ODM [r=0.88 (0.82-0.94), P<0.001]. Trending ability was good for a four-quadrant plot analysis with exclusion of the central zone (<10%) [95% confidence interval (CI) for concordance (0.86; 1.00)]. Moderate to good trending ability was observed with a polar plot analysis (angular bias: -7.2°; 95% CI -12.3°; -2.5°; with radial limits of agreement -38°; 24°). After excluding subjects with chronic obstructive pulmonary disease, a Bland-Altman plot showed a mean bias of 0.47 litre min(-1), limits of agreements between -1.24 and 2.11 litre min(-1), and a percentage error of 35%.
ICG appears to be a reliable method for the non-invasive monitoring of CO in patients undergoing general surgery.
阻抗心动图（ICG）可实现连续、逐拍、非侵入性、操作员独立且经济实惠的心输出量（CO）监测。我们比较了阻抗心动图（Niccomo™，Medis）和食道多普勒监测（ODM）（CardioQ™，Deltex Medical）在外科患者中获得的 CO 值和变化。
这是一项前瞻性、观察性、单中心研究，纳入了 32 名接受全身麻醉手术的患者。在可能改变 CO（血管加压药给药和容量扩张）的事件前后，同时使用 ICG 和 ODM 测量 CO。记录了 120 对 CO 测量值和 94 对 CO 变化测量值。
ICG 测量的 CO 变化与 ODM 测量的 CO 变化相关[r=0.88（0.82-0.94），P<0.001]。通过排除中央区域（<10%）的四象限图分析，趋势判断能力良好[一致性的 95%置信区间（0.86；1.00）]。极坐标图分析显示，趋势判断能力为中度至良好（角偏差：-7.2°；95%置信区间-12.3°；-2.5°；径向界限为-38°；24°）。在排除慢性阻塞性肺疾病患者后，Bland-Altman 图显示平均偏差为 0.47 升/分钟，一致性界限为-1.24 至 2.11 升/分钟，百分比误差为 35%。
ICG 似乎是一种可靠的方法，可用于监测接受普通外科手术的患者的 CO。
