Burtman David T M, Stolze Annick, Genaamd Dengler Selma E Kaffka, Vonk Alexander B A, Boer Christa
Department of Anaesthesiology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands.
Department of Anaesthesiology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands; Department of Cardio-thoracic Surgery, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands.
J Cardiothorac Vasc Anesth. 2018 Jun;32(3):1266-1272. doi: 10.1053/j.jvca.2017.06.042. Epub 2017 Jun 27.
Evaluate minimally invasive assessment of oxygen delivery (DO) and oxygen consumption (VO) and determine its level of agreement with the gold standard approach of those measurements in patients undergoing cardiac surgery.
Observational study.
Single center, VU University Medical Center (Amsterdam, The Netherlands).
The study comprised 29 adult patients.
Parallel measurements of invasive and minimally invasive parameters required for the calculation of DO and VO.
Measurements were performed after anesthesia induction (T1) and before sternal closure (T2) in adult cardiac surgery. The invasive approach included arterial and pulmonary artery catheter-derived blood sampling and cardiac output measurements. The minimally invasive approach included pulse oximetry, point-of-care hemoglobin, Nexfin-based cardiac output, and central venous catheter-derived blood sampling. Level of agreement was determined using Bland-Altman analysis and percentage error. DO and VO levels were determined in patients 71 ± 8 years old. DO measurements showed a level of agreement of -17 ± 57 L/min/m and -18 ± 72 L/min/m with percentage errors of 35% and 38% at T1 and T2, respectively. VO assessment showed a level of agreement of -5 ± 18 L/min/m and -12 ± 22 L/min/m, with percentage errors of 47% at T1 and T2. The highest percentage errors were for cardiac output measurements, 33% and 28% at T1 and T2, respectively.
Agreement between minimally invasive and invasive DO and VO determinations is, moderate and poor, respectively. These findings may be explained by the poor agreement between minimally invasive and invasive cardiac output measurements.
评估心脏手术患者氧输送（DO）和氧消耗（VO）的微创评估方法，并确定其与这些测量的金标准方法的一致性水平。
观察性研究。
单中心，荷兰阿姆斯特丹VU大学医学中心。
该研究包括29名成年患者。
对计算DO和VO所需的有创和微创参数进行平行测量。
在成年心脏手术中，于麻醉诱导后（T1）和胸骨关闭前（T2）进行测量。有创方法包括通过动脉和肺动脉导管采集血样以及测量心输出量。微创方法包括脉搏血氧饱和度测定、即时血红蛋白检测、基于Nexfin的心输出量测量以及通过中心静脉导管采集血样。使用Bland-Altman分析和百分比误差来确定一致性水平。在71±8岁的患者中测定了DO和VO水平。DO测量在T1和T2时的一致性水平分别为-17±57 L/min/m和-18±72 L/min/m，百分比误差分别为35%和38%。VO评估的一致性水平为-5±18 L/min/m和-12±22 L/min/m，在T1和T2时的百分比误差均为47%。最高百分比误差出现在心输出量测量中，T1和T2时分别为33%和28%。
微创和有创DO及VO测定之间的一致性分别为中等和较差。这些发现可能是由于微创和有创心输出量测量之间的一致性较差所致。
