Blancas R, Martínez-González Ó, Ballesteros D, Núñez A, Luján J, Rodríguez-Serrano D, Hernández A, Martínez-Díaz C, Parra C M, Matamala B L, Alonso M A, Chana M
Critical Care Department, Hospital Universitario del Tajo, Alfonso X El Sabio University, Eco Club Madrid, Aranjuez, Spain.
Critical Care Department, Hospital Universitario del Tajo, Alfonso X El Sabio University, Aranjuez, Spain.
Med Intensiva (Engl Ed). 2019 Mar;43(2):73-78. doi: 10.1016/j.medin.2017.11.012. Epub 2018 Feb 7.
To assess the correlation between left ventricular outflow tract velocity time integral (LVOT VTI) and stroke volume index (SVI) calculated by thermodilution methods in ventilated critically ill patients.
A prospective, descriptive, multicenter study was performed.
Five intensive care units from university hospitals.
Patients older than 17 years needing mechanical ventilation and invasive hemodynamic monitoring were included.
LVOT VTI was measured by pulsatile Doppler echocardiography. Calculations of SVI were performed through a floating pulmonary artery catheter (PAC) or a Pulse index Contour Cardiac Output (PiCCO) thermodilution methods.
The relation between LVOT VTI and SVI was tested by linear regression analysis.
One hundred and fifty-six paired measurements were compared. Mean LVOT VTI was 20.83±4.86cm and mean SVI was 41.55±9.55mL/m. Pearson correlation index for these variables was r=0.644, p<0.001; ICC was 0.52 (CI 95% 0.4-0.63). When maximum LVOT VTI was correlated with SVI, Pearson correlation index was r=0.62, p<0.001. Correlation worsened for extreme values, especially for those with higher LVOT VTI.
LVOT VTI could be a complementary hemodynamic evaluation in selected patients, but does not eliminate the need for invasive monitoring at the present time. The weak correlation between LVOT VTI and invasive monitoring deserves additional assessment to identify the factors affecting this disagreement.
评估机械通气的危重症患者左心室流出道速度时间积分（LVOT VTI）与热稀释法计算的每搏输出量指数（SVI）之间的相关性。
进行一项前瞻性、描述性、多中心研究。
来自大学医院的五个重症监护病房。
纳入年龄大于17岁、需要机械通气和有创血流动力学监测的患者。
通过脉冲多普勒超声心动图测量LVOT VTI。通过漂浮肺动脉导管（PAC）或脉搏指示连续心输出量（PiCCO）热稀释法计算SVI。
通过线性回归分析测试LVOT VTI与SVI之间的关系。
比较了156对测量值。平均LVOT VTI为20.83±4.86cm，平均SVI为41.55±9.55mL/m²。这些变量的Pearson相关指数为r = 0.644，p < 0.001；组内相关系数（ICC）为0.52（95%CI 0.4 - 0.63）。当最大LVOT VTI与SVI相关时，Pearson相关指数为r = 0.62，p < 0.001。对于极端值，相关性变差，尤其是LVOT VTI较高者。
LVOT VTI可作为特定患者血流动力学评估的补充，但目前不能替代有创监测。LVOT VTI与有创监测之间的弱相关性值得进一步评估，以确定影响这种差异的因素。
