Grindheim Guro, Eidet Jo, Bentsen Gunnar
Division of Emergencies and Critical Care, Oslo University Hospital - Rikshospitalet, Oslo, Norway.
Paediatr Anaesth. 2016 Apr;26(4):418-24. doi: 10.1111/pan.12859. Epub 2016 Feb 9.
The PiCCO system, based on transpulmonary thermodilution, is one of the few tools available for continuous hemodynamic monitoring in children. However, published data for some of the derived variables reveal indexed values that seem questionable.
The aim of this study was to collect data from hemodynamically normal children and compare these to existing reference values. Furthermore, we sought to explore if indexing some of the variables differently could improve the clinical application of the obtained values.
This is a prospective observational study in a tertiary university hospital including 31 children without cardiopulmonary disease scheduled for major neurosurgery. Measurements were performed after induction of general anesthesia.
Median age was 8 months. PiCCO-derived median Cardiac Index (CI) was 3.8 l · min(-1) · m(-2) (range 2.6-6.6), reference range 3.0-5.0, median Global End-Diastolic Volume Index (GEDVI) was 366 ml · m(-2) (range 269-685), reference range 680-800, whereas median Extravascular Lung Water Index (EVLWI) was 12 ml · kg(-1) (range 7-31), reference range 3-7. All measured variables had a high interindividual variation, especially in children weighing less than 15 kg.
Values obtained by the PiCCO system in children have a wide range, and should therefore be interpreted with caution. Current reference values published for GEDVI and EVLWI are not applicable in children; the former is too high and the latter too low, and should not guide clinical practice. Indexing by other physiological indices may reduce this problem. Using current variables, we find GEDVI 280-590 ml · m(-2) and ELWI 7-27 ml · kg(-1) to be typical ranges for children.
基于经肺热稀释技术的脉搏指示连续心输出量（PiCCO）系统是少数可用于儿童连续血流动力学监测的工具之一。然而，一些派生变量的已发表数据显示其指数值似乎存在问题。
本研究的目的是收集血流动力学正常儿童的数据，并将其与现有的参考值进行比较。此外，我们试图探讨对某些变量进行不同的指数计算是否可以改善所获数值的临床应用。
这是一项在三级大学医院进行的前瞻性观察性研究，纳入了31例计划进行重大神经外科手术且无心肺疾病的儿童。在全身麻醉诱导后进行测量。
中位年龄为八个月。PiCCO得出的中位心脏指数（CI）为3.8升·分钟⁻¹·米⁻²（范围2.6 - 6.6），参考范围3.0 - 5.0；中位全心舒张末期容积指数（GEDVI）为366毫升·米⁻²（范围269 - 685），参考范围680 - 800；而中位血管外肺水指数（EVLWI）为12毫升·千克⁻¹（范围7 - 31），参考范围3 - 7。所有测量变量均存在较大的个体间差异，尤其是体重小于15千克的儿童。
PiCCO系统在儿童中获得的值范围较宽，因此应谨慎解释。目前公布的GEDVI和EVLWI参考值不适用于儿童；前者过高，后者过低，不应指导临床实践。通过其他生理指标进行指数计算可能会减少这个问题。使用当前变量，我们发现儿童的GEDVI典型范围为280 - 590毫升·米⁻²，ELWI为7 - 27毫升·千克⁻¹。
