1Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 2Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 3Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 4Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany.
Crit Care Med. 2015 Jul;43(7):1423-8. doi: 10.1097/CCM.0000000000000979.
Radial artery applanation tonometry allows completely noninvasive continuous cardiac output estimation. The aim of the present study was to compare cardiac output measurements obtained with applanation tonometry (AT-CO) using the T-Line system (Tensys Medical, San Diego, CA) with cardiac output measured by intermittent pulmonary artery thermodilution using a pulmonary artery catheter (PAC-CO) with regard to accuracy, precision of agreement, and trending ability.
A prospective method comparison study.
The study was conducted in a cardiosurgical ICU of a German university hospital.
We performed cardiac output measurements in 50 patients after cardiothoracic surgery.
None.
Three independent sets of three consecutive thermodilution measurements (i.e., PAC-CO) each were performed per patient, and AT-CO was measured simultaneously. The average of the three thermodilution cardiac output measurements was compared with the average of the corresponding three AT-CO values resulting in 150 paired cardiac output measurements. In 13 patients, cardiac output-modifying maneuvers performed for clinical reasons additionally allowed to evaluate trending ability. For statistical analysis, we used Bland-Altman analysis, the percentage error, four-quadrant plot, and concordance analysis. Mean PAC-CO was 4.7 ± 1.2 L/min and mean AT-CO was 4.9 ± 1.1 L/min. The mean of differences was -0.2 L/min with 95% limits of agreement of -1.8 to + 1.4 L/min. The percentage error was 34%. The concordance rate was 95%.
Continuous cardiac output measurement using the noninvasive applanation tonometry technology is basically feasible in ICU patients after cardiothoracic surgery. The applanation tonometry technology provides cardiac output values with reasonable accuracy and precision of agreement compared with intermittent pulmonary artery thermodilution measurements in a clinical study setting and is able to reliably track cardiac output changes induced by cardiac output-modifying maneuvers.
桡动脉平面张力测量法可实现完全无创的连续心输出量估测。本研究旨在比较 T-Line 系统（Tensys Medical，圣地亚哥，CA）下的平面张力测量法（AT-CO）与肺动脉导管（PAC）下的间断肺动脉热稀释法（PAC-CO）测量心输出量的准确性、一致性精度和趋势能力。
前瞻性方法比较研究。
该研究在德国大学医院的心胸外科重症监护病房进行。
我们对 50 例心胸手术后的患者进行了心输出量测量。
无。
每位患者均进行三组连续三次热稀释测量（即 PAC-CO），同时进行 AT-CO 测量。将三组热稀释心输出量测量的平均值与相应的三组 AT-CO 值的平均值进行比较，得出 150 对配对心输出量测量值。在 13 例患者中，为临床原因进行的改变心输出量的操作，另外允许评估趋势能力。进行统计分析时，我们使用 Bland-Altman 分析、百分比误差、四象限图和一致性分析。平均 PAC-CO 为 4.7±1.2 L/min，平均 AT-CO 为 4.9±1.1 L/min。差值的平均值为-0.2 L/min，95%一致性界限为-1.8 至+1.4 L/min。百分比误差为 34%。一致性率为 95%。
在心胸手术后的 ICU 患者中，使用非侵入性平面张力测量技术进行连续心输出量测量基本可行。在临床研究环境中，与间断肺动脉热稀释测量相比，平面张力测量技术提供的心脏输出值具有合理的准确性和一致性精度，并且能够可靠地跟踪心脏输出量改变诱导的心脏输出量修改操作。
