From the Department of Intensive Care Medicine, Centre of Anaesthesiology and Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg (JG), Department of Anaesthesiology and Operative Intensive Care Medicine, University Witten/Herdecke, Medical Centre Cologne-Merheim, Köln (JG, JMD, US, FW, SGS), and University Witten/Herdecke, Witten, Germany (MW).
Eur J Anaesthesiol. 2017 Nov;34(11):723-731. doi: 10.1097/EJA.0000000000000699.
Because of their simplicity, uncalibrated pulse contour (UPC) methods have been introduced into clinical practice in critical care but are often validated with a femoral arterial waveform.
We aimed to test the accuracy of cardiac index (CI) measurements and trending ability from a radial artery with one UPC.
An observational study.
Tertiary care mixed-surgical ICU. Data were obtained from April 2015 to July 2016.
We studied 20 critically ill mechanically ventilated patients monitored by UPC (PulsioFlex; Pulsion Medical Systems SE, Feldkirchen, Germany). We used transpulmonary thermodilution (PiCCO2) as a reference.
Bland-Altman-analyses with percentage errors were calculated to assess the accuracy of CI values from radial pulse contour analysis (CIRAD), autocalibration (CIAC) and femoral pulse contour analysis (CIFEM). All were compared with a reference (CITD) at 4-h intervals for 24 h. Trending ability was assessed by polar-plots and four-quadrant-plots. CI is given in l min m.
Bland-Altman-analyses: for CIRAD, the mean bias was -0.1 with limits of agreement (LOA) of -2.9 to 2.7 and a percentage error of 70%; for CIAC, the mean bias was 0 with LOA -2.8 to 2.7 and a percentage error of 70%; for CIFEM, the mean bias was 0 with LOA -1.2 to 1.2 and a percentage error of 30%, respectively. Polar plots for trending: for CIRAD, the angular bias was 12° with radial LOA of 39°, a polar concordance rate of 73% and a concordance rate of 67% in the four-quadrant-plot; for CIAC, the angular bias was 4° with radial LOA of 41°, polar concordance rate of 79% and a concordance rate of 74% in the four quadrant plot; for CIFEM, the angular bias was -2° with radial LOA of 50°, polar concordance rate of 74% and a concordance rate of 81%.
In critically ill patients, the PulsioFlex system connected to a radial arterial catheter is inaccurate for CI measurements and does not track changes in CI adequately. We therefore recommend using validated thermodilution techniques for monitoring in the critical care setting.
由于其简单性，未经校准的脉搏轮廓（UPC）方法已被引入重症监护的临床实践中，但通常使用股动脉波形进行验证。
我们旨在测试使用一个 UPC 从桡动脉测量心指数（CI）测量值和趋势的准确性。
观察性研究。
三级混合外科重症监护病房。数据于 2015 年 4 月至 2016 年 7 月获得。
我们研究了 20 名接受 UPC（PulsioFlex；Pulsion Medical Systems SE，Feldkirchen，德国）监测的机械通气危重症患者。我们使用经肺热稀释法（PiCCO2）作为参考。
计算 Bland-Altman 分析的百分比误差，以评估从桡动脉脉搏轮廓分析（CIRAD）、自动校准（CIAC）和股动脉脉搏轮廓分析（CIFEM）获得的 CI 值的准确性。在 24 小时内，每隔 4 小时将所有值与参考值（CITD）进行比较。通过极坐标图和四象限图评估趋势能力。CI 以 l/min/m 表示。
Bland-Altman 分析：对于 CIRAD，平均偏差为 0.1，一致性界限（LOA）为-2.9 至 2.7，百分比误差为 70%；对于 CIAC，平均偏差为 0，LOA 为-2.8 至 2.7，百分比误差为 70%；对于 CIFEM，平均偏差为 0，LOA 为-1.2 至 1.2，百分比误差为 30%。趋势的极坐标图：对于 CIRAD，角度偏差为 12°，径向 LOA 为 39°，极一致性率为 73%，四象限图的一致性率为 67%；对于 CIAC，角度偏差为 4°，径向 LOA 为 41°，极一致性率为 79%，四象限图的一致性率为 74%；对于 CIFEM，角度偏差为-2°，径向 LOA 为 50°，极一致性率为 74%，四象限图的一致性率为 81%。
在危重症患者中，连接到桡动脉导管的 PulsioFlex 系统用于 CI 测量不准确，并且不能充分跟踪 CI 的变化。因此，我们建议在重症监护环境中使用经过验证的热稀释技术进行监测。
