Tecson Kristen M, Vasudevan Anupama, Bindra Amarinder, Joseph Susan M, Felius Joost, Hall Shelley A, Kale Parag
Baylor Heart and Vascular Institute, Baylor Scott & White Research Institute, Dallas, Texas; Department of Internal Medicine, Texas A&M University College of Medicine Health Science Center, Dallas, Texas.
Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, Texas.
Am J Cardiol. 2018 Jan 1;121(1):50-54. doi: 10.1016/j.amjcard.2017.09.020. Epub 2017 Oct 10.
The pulmonary artery catheter (PAC) remains the gold standard to calculate Fick cardiac outputs (FCOs) in patients with heart failure admitted to the intensive care unit (ICU). The peripherally inserted central catheter (PICC) provides long-term intravenous access and is used outside the ICU; however, there is scant literature validating venous oxygen saturations (VOSs) from PICC lines. Heart failure patients in the ICU with an existing PAC requiring a PICC line to transition were enrolled. Three blood samples were taken per person (1 at PICC, 1 at central venous pressure [CVP], and 1 at distal PAC). We performed repeated measures analysis of variance, as well as reliability analysis on 31 subjects (77% male, 71% Caucasian, mean ± standard deviation age 60 ± 8 years, 80% on inotropes). The average VOSs were 62 ± 11%, 62 ± 12%, and 61 ± 9% for the PICC line, CVP, and distal port, respectively (p = 0.66); there was excellent reliability (0.79). The median FCOs were 5 [4, 6], 5 [4, 6], and 5 [4, 6] L/min at the PICC, CVP, and distal port, respectively (p = 0.91); there was fair-to-good reliability (0.67). In conclusion, VOS and FCO did not differ by location, on average. Reliable data may be obtained through the PICC line, after evaluation from the PAC. The PICC may provide longer-term hemodynamic assessment while improving patient comfort.
肺动脉导管（PAC）仍是重症监护病房（ICU）收治的心力衰竭患者计算菲克心输出量（FCO）的金标准。经外周静脉穿刺中心静脉导管（PICC）可提供长期静脉通路，常用于ICU以外的情况；然而，验证PICC导管测得的静脉血氧饱和度（VOS）的文献却很少。纳入了ICU中已有PAC且需要置入PICC导管以便过渡治疗的心力衰竭患者。每人采集三份血样（一份来自PICC导管处，一份来自中心静脉压[CVP]处，一份来自PAC远端）。我们对31名受试者（77%为男性，71%为白种人，平均年龄±标准差为60±8岁，80%使用了血管活性药物）进行了重复测量方差分析以及可靠性分析。PICC导管处、CVP处和远端端口处的平均VOS分别为62±11%、62±12%和61±9%（p = 0.66）；可靠性极佳（0.79）。PICC导管处、CVP处和远端端口处的FCO中位数分别为5[4, 6]、5[4, 6]和5[4, 6]L/min（p = 0.91）；可靠性为中等到良好（0.67）。总之，平均而言，VOS和FCO在不同位置并无差异。经PAC评估后，通过PICC导管可获得可靠数据。PICC导管可提供更长期的血流动力学评估，同时提高患者舒适度。
