Hsu Kai-Hsiang, Wu Tai-Wei, Wu I-Hsyuan, Lai Mei-Yin, Hsu Shih-Yun, Huang Hsiao-Wen, Mok Tze-Yee, Lien Reyin
Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital Linkou Branch and School of Medicine, Chang Gung University, Taoyuan, Taiwan.
Neonatology. 2017;112(3):231-237. doi: 10.1159/000475774. Epub 2017 Jul 14.
Electrical cardiometry (EC) is an impedance-based monitoring that provides noninvasive cardiac output (CO) assessment. Through comparison to transthoracic echocardiography (Echo), the accuracy of EC has been verified. However, left-to-right patent ductus arteriosus (PDA) shunting is a concern because PDA shunts aortic flow to the pulmonary artery and may interfere with EC in measuring CO.
To determine the agreement between EC and Echo in preterm infants with a hemodynamically significant PDA (hsPDA).
We reviewed our hemodynamic database in which simultaneous CO measurements by Echo and EC (Aesculon®) were recorded. Preterm infants with left-to-right shunting hsPDA were enrolled.
A total of 105 paired measurements in 36 preterm infants were compared. Infants' median (range) age and weight at measurement were 27+2 weeks (24+0-33+1) and 1,015 g (518-1,880), with mean (95% CI) ductal diameter 2.11 mm (1.99-2.22) or 2.15 mm/kg (2.00-2.30). Mean COEC and COEcho were 252 ± 32 and 258 ± 45 mL/kg/min, respectively, which demonstrated a moderate correlation and without a significant between-measurement difference. Bland-Altman analysis showed a bias, limits of agreement, and error percentage of -5.3 mL/kg/min, -78.3 to 67.7 mL/kg/min, and 28.6%, respectively. There was a trend of increased bias and error percentage of infants with high CO ≥280 mL/kg/min and supported with high-frequency ventilator.
EC and Echo have a wide but clinically acceptable agreement in measuring CO in preterm infants with hsPDA. However, for infants with high CO or ventilated by high-frequency ventilation, interpretation of COEC should be approached with caution.
心电描记法（EC）是一种基于阻抗的监测方法，可提供无创心输出量（CO）评估。通过与经胸超声心动图（Echo）比较，已验证了EC的准确性。然而，动脉导管未闭（PDA）从左向右分流是一个问题，因为PDA会将主动脉血流分流至肺动脉，可能会干扰EC测量CO。
确定血流动力学显著的PDA（hsPDA）早产儿中EC与Echo之间的一致性。
我们回顾了血流动力学数据库，其中记录了通过Echo和EC（Aesculon®）同时测量的CO。纳入有从左向右分流的hsPDA的早产儿。
比较了36例早产儿的105对测量值。测量时婴儿的中位（范围）年龄和体重分别为27+2周（24+0-33+1）和1015 g（518-1880），平均（95%CI）导管直径为2.11 mm（1.99-2.22）或2.15 mm/kg（2.00-2.30）。平均COEC和COEcho分别为252±32和258±45 mL/kg/min，显示出中度相关性且测量间无显著差异。Bland-Altman分析显示偏差、一致性界限和误差百分比分别为-5.3 mL/kg/min、-78.3至67.7 mL/kg/min和28.6%。CO≥280 mL/kg/min且使用高频通气支持的婴儿存在偏差和误差百分比增加的趋势。
在测量hsPDA早产儿的CO时，EC和Echo有广泛但临床上可接受的一致性。然而，对于CO高或使用高频通气的婴儿，应谨慎解释COEC。
Zotero 插件