Department of Anesthesiology, National Cerebral and Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka, 565-8565, Japan.
Division of Transfusion Medicine, National Cerebral and Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka, 565-8565, Japan.
J Clin Monit Comput. 2019 Oct;33(5):767-776. doi: 10.1007/s10877-018-0217-1. Epub 2018 Nov 7.
To compare the accuracy and trending ability of the cardiac index (CI) measured by FloTrac/Vigileo™ (CI) or derived by the Fick equation (CI) using E-CAiOVX (enables continuous monitoring of oxygen consumption) with that measured by thermodilution (CI) in patients with off-pump coronary artery bypass surgery. Twenty-two patients undergoing elective off-pump coronary artery bypass surgery were included. CI and CI were determined simultaneously at six time-points during off-pump coronary artery bypass surgery. At each time-point, phenylephrine (50 µg) was administered to increase systematic vascular resistance, with CI measured before and after administration (CI used as reference method). Agreement of each method was evaluated by Bland-Altman analysis, while trending ability was evaluated by four-quadrant plot analysis and polar plot analysis. By Bland-Altman analysis, CI and CI showed percentage errors of 49.5% and 78.6%, respectively, compared with CI. Subgroup analysis showed a percentage error between CO and CO of 28.9% in patients with a CI ≥ 2.4 L/min/m, and 78.1% in patients with a CI ≥ 2.4 L/min/m. The concordance rate of four-quadrant plot analysis was 93.3% for CI and 66.7% for CI in datasets where CI ≥ 2.4 L/min/m before and after phenylephrine administration were included. CI and CI had wide limits of agreement with CI, and were below acceptable limits for tracking phenylephrine-induced CI changes. However, subgroup analysis showed improved accuracy and trending ability of CI when only points where CI ≥ 2.4 L/min/m were included, while there was no improvement in CI accuracy or trending ability.
比较非体外循环冠状动脉旁路移植术中使用 E-CAiOVX（可连续监测氧耗量）的 FloTrac/Vigileo™（CI）或 Fick 方程（CI）测量的心脏指数（CI）与热稀释法（CI）测量的心脏指数的准确性和趋势能力。纳入 22 例行择期非体外循环冠状动脉旁路移植术的患者。在非体外循环冠状动脉旁路移植术期间的六个时间点同时测定 CI 和 CI。在每个时间点，给予去氧肾上腺素（50µg）以增加全身血管阻力，在给予去氧肾上腺素前后测量 CI（CI 用作参考方法）。通过 Bland-Altman 分析评估每种方法的一致性，通过四象限图分析和极坐标图分析评估趋势能力。通过 Bland-Altman 分析，与 CI 相比，CI 和 CI 的百分比误差分别为 49.5%和 78.6%。亚组分析显示，CI 和 CO 的百分比误差在 CI≥2.4L/min/m 的患者中为 28.9%，在 CI≥2.4L/min/m 的患者中为 78.1%。在包括去氧肾上腺素前后 CI≥2.4L/min/m 的数据集，四象限图分析的一致性率为 CI 的 93.3%和 CI 的 66.7%。CI 和 CI 与 CI 的一致性范围较宽，无法跟踪去氧肾上腺素诱导的 CI 变化。然而，亚组分析显示，仅当 CI≥2.4L/min/m 时，CI 的准确性和趋势能力得到改善，而 CI 的准确性或趋势能力没有提高。
