Institute of Development, Aging and Cancer, Tohoku University.
Research Institute for Brain and Blood Vessels-AKITA, Akita, Japan.
J Neurosurg Anesthesiol. 2019 Oct;31(4):422-427. doi: 10.1097/ANA.0000000000000519.
Fluid therapy guided by cardiac output measurements is of particular importance for adequate cerebral perfusion and oxygenation in neurosurgical patients. We examined the usefulness of a noninvasive electrical velocimetry (EV) device based on the thoracic bioimpedance method for perioperative hemodynamic monitoring in patients after aneurysmal subarachnoid hemorrhage.
In total, 18 patients who underwent surgical clipping or endovascular coiling for ruptured aneurysms were examined prospectively. Simultaneous cardiac index (CI) measurements obtained with EV (CIEV) and reference transpulmonary thermodilution (CITPTD) were compared. A total of 223 pairs of data were collected.
A significant correlation was found between CIEV and CITPTD (r=0.86; P<0.001). Bland and Altman analysis revealed a bias between CIEV and CITPTD of -0.06 L/min/m, with limits of agreement of ±1.14 L/min/m and a percentage error of 33%. Although the percentage error for overall data was higher than the acceptable limit of 30%, subgroup analysis during the postoperative phase showed better agreement (23% vs. 42% during the intraprocedure phase). Four-quadrant plot and polar plot analyses showed fair-to-poor trending abilities (concordance rate of 90% to 91%, angular bias of +17 degrees, radial limits of agreement between ±37 and ±40 degrees, and polar concordance rate of 72% to 75%), including the subgroup analysis.
Absolute CI values obtained from EV and TPTD are not interchangeable with TPTD for perioperative use in subarachnoid hemorrhage patients. However, considering the moderate levels of agreement with marginal trending ability during the early postoperative phase, this user-friendly device can provide an attractive monitoring option during neurocritical care.
在神经外科患者中，通过心输出量测量指导的液体治疗对于充分的脑灌注和氧合尤为重要。我们研究了一种基于胸部生物阻抗法的非侵入性电速度计（EV）设备在蛛网膜下腔出血后患者围手术期血流动力学监测中的有效性。
共前瞻性检查了 18 例接受手术夹闭或血管内栓塞治疗破裂动脉瘤的患者。比较了 EV（CIEV）和参考经肺热稀释（CITPTD）获得的同时心指数（CI）测量值。共收集了 223 对数据。
CIEV 与 CITPTD 之间存在显著相关性（r=0.86；P<0.001）。Bland 和 Altman 分析显示 CIEV 和 CITPTD 之间存在 -0.06 L/min/m 的偏差，一致性界限为±1.14 L/min/m，百分比误差为 33%。尽管总体数据的百分比误差高于可接受的 30%限制，但术后阶段的亚组分析显示出更好的一致性（术中阶段为 42%，术后阶段为 23%）。四象限图和极坐标图分析显示出尚可至不佳的趋势能力（一致性率为 90%至 91%，角偏差为+17 度，径向一致性界限为±37 和±40 度，极一致性率为 72%至 75%），包括亚组分析。
EV 和 TPTD 获得的绝对 CI 值不能与 TPTD 互换，不能用于蛛网膜下腔出血患者的围手术期。然而，考虑到术后早期阶段具有适度的一致性和边缘趋势能力，这种易于使用的设备可为神经危重症患者的监测提供有吸引力的选择。
