Broch Ole, Bein Berthold, Gruenewald Matthias, Masing Sarah, Huenges Katharina, Haneya Assad, Steinfath Markus, Renner Jochen
Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Schleswig-Holstein, Germany.
Department of Anesthesiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg, Germany.
Biomed Res Int. 2016;2016:3468015. doi: 10.1155/2016/3468015. Epub 2016 Dec 28.
Today, there exist several different pulse contour algorithms for calculation of cardiac output (CO). The aim of the present study was to compare the accuracy of nine different pulse contour algorithms with transpulmonary thermodilution before and after cardiopulmonary bypass (CPB). Thirty patients scheduled for elective coronary surgery were studied before and after CPB. A passive leg raising maneuver was also performed. Measurements included CO obtained by transpulmonary thermodilution (CO) and by nine pulse contour algorithms (CO). Calibration of pulse contour algorithms was performed by esophageal Doppler ultrasound after induction of anesthesia and 15 min after CPB. Correlations, Bland-Altman analysis, four-quadrant, and polar analysis were also calculated. There was only a poor correlation between CO and CO during passive leg raising and in the period before and after CPB. Percentage error exceeded the required 30% limit. Four-quadrant and polar analysis revealed poor trending ability for most algorithms before and after CPB. The Liljestrand-Zander algorithm revealed the best reliability. Estimation of CO by nine different pulse contour algorithms revealed poor accuracy compared with transpulmonary thermodilution. Furthermore, the less-invasive algorithms showed an insufficient capability for trending hemodynamic changes before and after CPB. The Liljestrand-Zander algorithm demonstrated the highest reliability. This trial is registered with NCT02438228 (ClinicalTrials.gov).
如今，存在几种不同的用于计算心输出量（CO）的脉搏轮廓算法。本研究的目的是比较九种不同脉搏轮廓算法与体外循环（CPB）前后经肺热稀释法在心输出量计算方面的准确性。对30例计划进行择期冠状动脉手术的患者在CPB前后进行了研究。还进行了被动抬腿动作。测量包括通过经肺热稀释法获得的心输出量（CO）以及通过九种脉搏轮廓算法获得的心输出量（CO）。脉搏轮廓算法的校准在麻醉诱导后和CPB后15分钟通过食管多普勒超声进行。还计算了相关性、Bland-Altman分析、四象限分析和极坐标分析。在被动抬腿期间以及CPB前后，CO与CO之间的相关性较差。百分比误差超过了所需的30%的限值。四象限分析和极坐标分析显示，大多数算法在CPB前后的趋势分析能力较差。Liljestrand-Zander算法显示出最佳的可靠性。与经肺热稀释法相比，九种不同脉搏轮廓算法在心输出量估计方面显示出较差的准确性。此外，侵入性较小的算法在CPB前后对血流动力学变化的趋势分析能力不足。Liljestrand-Zander算法表现出最高的可靠性。本试验已在ClinicalTrials.gov上注册，注册号为NCT02438228。
