From the Department of Anaesthesia, Burn, and Critical Care, Saint-Louis Lariboisière University Hospital (RB, FD, MR, JS, AM, BGC), Department of Anaesthesia and Critical Care, European Hospital Georges-Pompidou, APHP (AN, DD, RP), Paris Diderot University, Sorbonne Paris Cité (AM, BGC), Inserm U942 (AM), Paris Descartes University, Sorbonne Paris Cité (RP), Inserm U1153 (RP) and Inserm U1160, Paris, France (BGC).
Eur J Anaesthesiol. 2019 Feb;36(2):135-143. doi: 10.1097/EJA.0000000000000924.
The ability of the pressure recording analytical method (PRAM) in tracking change in cardiac output (ΔCO) after a fluid challenge in ICU needs to be evaluated with the most contemporary comparison methods recommended by experts.
Our objective was to report the trending ability of PRAM in tracking ΔCO after a fluid challenge in ICU and to compare this with oesophageal Doppler monitoring (ODM).
Prospective, observational study.
Hôpital Lariboisière and Hôpital Européen George Pompidou, Paris, France, from April 2016 to December 2017.
Critically ill patients admitted to ICU with monitoring of CO monitored by ODM and invasive arterial pressure.
ΔCO after fluid challenge was simultaneously registered with ODM and PRAM connected to the arterial line.
Polar statistics (mean angular bias, radial limits of agreement and polar concordance rate) and clinical concordance evaluation (error grid and clinical concordance rate). Predictors of bias were determined.
Sixty-eight fluid challenge were administered in 49 patients. At the time of fluid challenge, almost all were mechanically ventilated (99%), with 85% receiving norepinephrine. Admission diagnosis was septic shock in 70% of patients. Patients had a Sequential Organ Failure Assessment score of 10 [7 to 12] and a median Simplified Acute Physiology Score II of 61 [49 to 69]. Relative ΔCO bias was 7.8° (6.3°) with radial limits of agreement of ±41.7°, polar concordance rate 80% and clinical concordance rate 74%. ΔCO bias was associated with baseline bias (P = 0.007). Baseline bias was associated with radial location of the arterial line (P = 0.03).
When compared with ODM, PRAM has insufficient performance to track ΔCO induced by fluid challenge in ICU patients. Baseline bias is an independent predictor of trending bias.
IRB 00010254-2016-033.
压力记录分析方法（PRAM）在 ICU 中通过液体挑战来跟踪心输出量（ΔCO）变化的能力，需要使用专家推荐的最新比较方法进行评估。
本研究旨在报告 PRAM 在 ICU 液体挑战后跟踪 ΔCO 的趋势能力，并与食道多普勒监测（ODM）进行比较。
前瞻性观察性研究。
法国巴黎拉罗什医院和欧洲乔治蓬皮杜医院，2016 年 4 月至 2017 年 12 月。
入住 ICU 并通过 ODM 监测 CO 且有创动脉压的危重症患者。
同时用 ODM 和连接动脉线的 PRAM 记录液体挑战后的 ΔCO。
极坐标统计（平均角偏差、径向一致性界限和极一致性率）和临床一致性评估（误差网格和临床一致性率）。确定偏差的预测因素。
49 名患者共进行了 68 次液体挑战。在进行液体挑战时，几乎所有患者都在接受机械通气（99%），其中 85%接受去甲肾上腺素治疗。患者的入院诊断为感染性休克（70%）。患者的序贯器官衰竭评估（SOFA）评分为 10 分[7-12 分]，简化急性生理学评分Ⅱ为 61 分[49-69 分]。相对 ΔCO 偏差为 7.8°（6.3°），径向一致性界限为±41.7°，极坐标一致性率为 80%，临床一致性率为 74%。ΔCO 偏差与基线偏差相关（P = 0.007）。基线偏差与动脉线的径向位置相关（P = 0.03）。
与 ODM 相比，PRAM 在心输出量诱导的 ICU 患者液体挑战中跟踪 ΔCO 的性能不足。基线偏差是趋势偏差的独立预测因素。
IRB 00010254-2016-033。
