Suehiro Koichi, Tanaka Katsuaki, Yamada Tokuhiro, Matsuura Tadashi, Mori Takashi, Funao Tomoharu, Nishikawa Kiyonobu
Department of Anesthesiology, Osaka City University Graduate School of Medicine, 1-5-7 Asahimachi, Abenoku, Osaka City, Osaka, 545-8586, Japan,
J Clin Monit Comput. 2015 Jun;29(3):333-9. doi: 10.1007/s10877-014-9609-z. Epub 2014 Sep 12.
This study was aimed at comparing the cardiac output (CO) measured by the Vigileo™-FloTrac™ system with that estimated by the thermodilution pulmonary artery catheter (PAC) during one-lung ventilation (OLV) and determining the reliability of this system in tracking phenylephrine-induced CO changes during OLV. Sixteen patients scheduled for descending aorta replacement were enrolled. The study was performed 30 min after starting OLV under stable hemodynamic conditions. We recorded hemodynamic variables, CO measured by PAC thermodilution (ICO), CO measured by Vigileo™-FloTrac™ system (Version 3.02, Edwards Lifesciences, Irvine, CA, USA) (APCO), and systemic vascular resistance index (SVRI) before (T0) and after (T1) phenylephrine (100 μg) administration. We used Bland-Altman analysis to compare ICO and APCO. Polar plot and four-quadrant plot were used to assess the tracking ability of the Vigileo™-FloTrac™ system against ICO after administration of phenylephrine. Ninety hemodynamic interventions were performed. Bland-Altman analysis revealed that the mean bias between APCO and ICO was 0.05 L/min and the percentage error, 46.9 %. Four-quadrant plot analysis showed a concordance rate of 24.7 %, while polar plot analysis showed that the concordance rate was 13.3 %; the angular bias, -45.9°; radial limit of agreement, 85.3°. The bias between APCO and ICO was significantly correlated with the SVRI value (p < 0.001, r(2) = 0.822). The reliability of the Vigileo™-FloTrac™ system during OLV to estimate CO and track phenylephrine-induced CO changes was not acceptable.
本研究旨在比较在单肺通气（OLV）期间，Vigileo™-FloTrac™系统测量的心输出量（CO）与热稀释肺动脉导管（PAC）估算的心输出量，并确定该系统在追踪苯肾上腺素诱导的OLV期间CO变化的可靠性。纳入了16例计划进行降主动脉置换的患者。在稳定的血流动力学条件下，于OLV开始30分钟后进行该研究。我们记录了苯肾上腺素（100μg）给药前（T0）和给药后（T1）的血流动力学变量、通过PAC热稀释法测量的CO（ICO）、通过Vigileo™-FloTrac™系统（版本3.02，美国加利福尼亚州尔湾市爱德华兹生命科学公司）测量的CO（APCO）以及全身血管阻力指数（SVRI）。我们使用Bland-Altman分析比较ICO和APCO。使用极坐标图和四象限图评估苯肾上腺素给药后Vigileo™-FloTrac™系统相对于ICO的追踪能力。共进行了90次血流动力学干预。Bland-Altman分析显示，APCO与ICO之间的平均偏差为0.05L/min，百分比误差为46.9%。四象限图分析显示一致性率为24.7%，而极坐标图分析显示一致性率为13.3%；角度偏差为-45.9°；径向一致限为85.3°。APCO与ICO之间的偏差与SVRI值显著相关（p<0.001，r(2)=0.822）。Vigileo™-FloTrac™系统在OLV期间估算CO以及追踪苯肾上腺素诱导的CO变化的可靠性不可接受。
