Biais Matthieu, Mazocky Elodie, Stecken Laurent, Pereira Bruno, Sesay Musa, Roullet Stéphanie, Quinart Alice, Sztark François
From the *CHU de Bordeaux, Service d'Anesthésie Réanimation 3, Bordeaux, France; †INSERM and ‡University Bordeaux, Adaptation cardiovasculaire à l'ischémie, U1034, Pessac, France; §CHU de Bordeaux, Service d'Anesthésie réanimation 1, Bordeaux, France; and ‖Biostatistics Unit (DRCI), Délégation Recherche Clinique and Innovation, CHU de Clermont-Ferrand, Villa annexe IFSI, Rue Montalembert, Clermont-Ferrand Cedex, France.
Anesth Analg. 2017 Feb;124(2):487-493. doi: 10.1213/ANE.0000000000001591.
The accuracy of currently available devices using pulse contour analysis without external calibration for cardiac index (CI) estimation is negatively impacted by hyperdynamic states, low systemic vascular resistance (SVR), and abrupt changes in SVR. The aim of this study was to evaluate the accuracy of a new device, the Pulsioflex (Pulsion Medical System), in patients undergoing liver transplantation.
Thirty consecutive patients scheduled for liver transplantation were included. CI was monitored using pulmonary arterial catheter (CI-PAC) and Pulsioflex (CI-Pulsio). Simultaneous CI measurements were made intraoperatively at 9 different stages of the procedure.
Two hundred seventy pairs of measurements were analyzed. The median CI-Pulsio values (3.3; interquartile range, 2.8-3.8 L·min·m) were significantly different from the median CI-PAC (4.1; interquartile range, 3.1-5.0 L·min·m; P < .0001). Bland and Altman analysis showed a mean bias of 0.8 L·min·m and 95% limit of agreement from -2.5 to 4.1 L·min·m. Percentage error was 65% (95% confidence interval, 60%-71%). Considering the variations in CI between 2 stages, the comparison between changes in CI-PAC and changes in CI-Pulsio showed a mean bias of 0.1 L·min·m and 95% limit of agreement of -2.1 to 2.2 L·min·m. When excluding changes in CI <0.5 L·min·m (154 paired analyzed), the concordance rate was 62% (95% confidence interval, 54%-70%). The bias between CI-PAC and CI-Pulsio was negatively correlated with SVR (r = -0.67, P < .0001). The bias between changes in CI-PAC and changes in CI-Pulsio was also negatively correlated with changes in SVR (r = -0.52, P < .0001).
In patients undergoing liver transplantation, Pulsioflex does not accurately estimate CI. Its accuracy is highly impacted by SVR, and it is not able to track changes in CI when large variations in SVR occur.
目前可用的不进行外部校准的采用脉搏轮廓分析来估计心脏指数（CI）的设备的准确性，会受到高动力状态、低全身血管阻力（SVR）以及SVR突然变化的负面影响。本研究的目的是评估一种新设备Pulsioflex（普升医疗系统公司）在肝移植患者中的准确性。
纳入30例计划进行肝移植的连续患者。使用肺动脉导管（CI-PAC）和Pulsioflex（CI-Pulsio）监测CI。在手术的9个不同阶段术中同时进行CI测量。
分析了270对测量值。CI-Pulsio的中位数（3.3；四分位间距，2.8 - 3.8L·min·m²）与CI-PAC的中位数（4.1；四分位间距，3.1 - 5.0L·min·m²；P <.0001）有显著差异。Bland和Altman分析显示平均偏差为0.8L·min·m²，95%一致性界限为 - 2.5至4.1L·min·m²。百分比误差为65%（95%置信区间，60% - 71%）。考虑两个阶段之间CI的变化，CI-PAC变化与CI-Pulsio变化之间的比较显示平均偏差为0.1L·min·m²，95%一致性界限为 - 2.1至2.2L·min·m²。当排除CI <0.5L·min·m²的变化（分析了154对）时，一致率为62%（95%置信区间，54% - 70%）。CI-PAC与CI-Pulsio之间的偏差与SVR呈负相关（r = - 0.67，P <.0001）。CI-PAC变化与CI-Pulsio变化之间的偏差也与SVR变化呈负相关（r = - 0.52，P <.0001）。
在肝移植患者中，Pulsioflex不能准确估计CI。其准确性受SVR的影响很大，并且当SVR发生较大变化时，它无法追踪CI的变化。
