多普勒超声心动图与未校准脉搏轮廓法测量心输出量的比较：一项多中心观察性研究

Comparison Between Doppler-Echocardiography and Uncalibrated Pulse Contour Method for Cardiac Output Measurement: A Multicenter Observational Study.

作者信息

Scolletta Sabino, Franchi Federico, Romagnoli Stefano, Carlà Rossella, Donati Abele, Fabbri Lea P, Forfori Francesco, Alonso-Iñigo José M, Laviola Silvia, Mangani Valerio, Maj Giulia, Martinelli Giampaolo, Mirabella Lucia, Morelli Andrea, Persona Paolo, Payen Didier

机构信息

1Department of Medical Biotechnologies, Anesthesiology and Intensive Care, University Hospital of Siena, Siena, Italy. 2Department of Anesthesiology and Critical Care, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy. 3Department of Health Science, University of Florence, Florence, Italy. 4Department of Emergency and Critical Medicine, Anesthesiology and Intensive Care, Mugello Hospital, Florence, Italy. 5Dipartimento di Scienze Biomediche e Sanità Pubblica, Università Politecnica delle Marche, AOU Ospedali Riuniti di Ancona, Clinica di Anestesia e Rianimazione, Torrette di Ancona, Italy. 6Dipartimento di Emergenza-Urgenza, Azienda Sanitaria Massa Carrara, Ospedale di Pontremoli, Pontremoli, Italy. 7Department of Surgery, Intensive Care Unit IV, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy. 8Department of Anesthesia and Surgical Critical Care, Hospital Universitari i Politécnic La Fe, Valencia, Spain. 9Department of Emergency and Critical Medicine, Anesthesiology and Intensive Care, Santa Maria Annunziata Hospital, Florence, Italy. 10Department of Emergency and Critical Medicine, Anesthesiology and Intensive Care, San Giovanni di Dio Hospital, Florence, Italy. 11Department of Cardiothoracic Anesthesia and Intensive Care, San Raffaele Hospital, Istituto Scientifico San Raffaele, Milan, Italy. 12Department of Anaesthesia, Heart and Lung Centre, Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom. 13Department of Anesthesiology and Intensive Care, University of Foggia, Foggia, Italy. 14Department of Cardiovascular, Respiratory, Nephrologic, Anesthesiologic and Geriatric Sciences, University of Rome "La Sapienza," Rome, Italy. 15Emergency Department, Istituto di Anestesia e Rianimazione, Azienda Ospedaliera Universitaria di Padova, Padova, Italy. 16Department of Anesthesiology and Critical Care, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris and UMR INSERM 1160: Alloimmunité, Autoimmunité, Transpla

出版信息

Crit Care Med. 2016 Jul;44(7):1370-9. doi: 10.1097/CCM.0000000000001663.

DOI:10.1097/CCM.0000000000001663

PMID:27097293

Abstract

OBJECTIVES

Echocardiography and pulse contour methods allow, respectively, noninvasive and less invasive cardiac output estimation. The aim of the present study was to compare Doppler echocardiography with the pulse contour method MostCare for cardiac output estimation in a large and nonselected critically ill population.

DESIGN

A prospective multicenter observational comparison study.

SETTING

The study was conducted in 15 European medicosurgical ICUs.

PATIENTS

We assessed cardiac output in 400 patients in whom an echocardiographic evaluation was performed as a routine need or for cardiocirculatory assessment.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

One echocardiographic cardiac output measurement was compared with the corresponding MostCare cardiac output value per patient, considering different ICU admission categories and clinical conditions. For statistical analysis, we used Bland-Altman and linear regression analyses. To assess heterogeneity in results of individual centers, Cochran Q, and the I statistics were applied. A total of 400 paired echocardiographic cardiac output and MostCare cardiac output measures were compared. MostCare cardiac output values ranged from 1.95 to 9.90 L/min, and echocardiographic cardiac output ranged from 1.82 to 9.75 L/min. A significant correlation was found between echocardiographic cardiac output and MostCare cardiac output (r = 0.85; p < 0.0001). Among the different ICUs, the mean bias between echocardiographic cardiac output and MostCare cardiac output ranged from -0.40 to 0.45 L/min, and the percentage error ranged from 13.2% to 47.2%. Overall, the mean bias was -0.03 L/min, with 95% limits of agreement of -1.54 to 1.47 L/min and a relative percentage error of 30.1%. The percentage error was 24% in the sepsis category, 26% in the trauma category, 30% in the surgical category, and 33% in the medical admission category. The final overall percentage error was 27.3% with a 95% CI of 22.2-32.4%.

CONCLUSIONS

Our results suggest that MostCare could be an alternative to echocardiography to assess cardiac output in ICU patients with a large spectrum of clinical conditions.

摘要

目的

超声心动图和脉搏轮廓法分别可实现无创和微创的心输出量估计。本研究的目的是在大量未经过筛选的危重症人群中，比较多普勒超声心动图与脉搏轮廓法MostCare在心输出量估计方面的差异。

设计

一项前瞻性多中心观察性比较研究。

地点

该研究在15家欧洲内科和外科重症监护病房进行。

患者

我们对400例患者的心输出量进行了评估，这些患者因常规需要或进行心脏循环评估而接受了超声心动图检查。

干预措施

无。

测量指标及主要结果

将每位患者的一次超声心动图心输出量测量值与相应的MostCare心输出量值进行比较，同时考虑不同的重症监护病房入院类别和临床状况。对于统计分析，我们使用了Bland-Altman分析和线性回归分析。为评估各个中心结果的异质性，应用了Cochran Q检验和I统计量。总共比较了400对超声心动图心输出量和MostCare心输出量测量值。MostCare心输出量值范围为1.95至9.90升/分钟，超声心动图心输出量范围为1.82至9.75升/分钟。超声心动图心输出量与MostCare心输出量之间存在显著相关性（r = 0.85；p < 0.0001）。在不同的重症监护病房中，超声心动图心输出量与MostCare心输出量之间的平均偏差范围为-0.40至0.45升/分钟，百分比误差范围为13.2%至47.2%。总体而言，平均偏差为-0.03升/分钟，95%一致性界限为-1.54至1.47升/分钟，相对百分比误差为30.1%。脓毒症类别中的百分比误差为24%，创伤类别为26%，手术类别为30%，内科入院类别为33%。最终总体百分比误差为27.3%，95%置信区间为22.2 - 32.4%。