Queen Mary University London and Barts Health NHS Trust, London, UK.
University of Western Australia School of Medicine and Pharmacology, Perth, Australia.
Scand J Trauma Resusc Emerg Med. 2019 Mar 11;27(1):30. doi: 10.1186/s13049-019-0586-6.
There is little published data investigating non-invasive cardiac output monitoring in the emergency department (ED). We assessed six non-invasive fluid responsiveness monitoring methods which measure cardiac output directly or indirectly for their feasibility and repeatability of measurements in the ED: (1) left ventricular outflow tract echocardiography derived velocity time integral, (2) common carotid artery blood flow, (3) suprasternal aortic Doppler, (4) bioreactance, (5) plethysmography with digital vascular unloading method, and (6) inferior vena cava collapsibility index.
This is a prospective observational study of non-invasive methods of assessing fluid responsiveness in the ED. Participants were non-ventilated ED adult patients requiring intravenous fluid resuscitation. Feasibility of each method was determined by the proportion of clinically interpretable measurements from the number of measurement attempts. Repeatability was determined by comparing the mean difference of two paired measurements in a fluid steady state (after participants received an intravenous fluid bolus).
76 patients were recruited in the study. A total of 207 fluid responsiveness measurement sets were analysed. Feasibility rates were 97.6% for bioreactance, 91.3% for vascular unloading method with plethysmography, 87.4% for common carotid artery blood flow, 84.1% for inferior vena cava collapsibility index, 78.7% for LVOT VTI, and 76.8% for suprasternal aortic Doppler. The feasibility rates difference between bioreactance and all other methods was statistically significant.
Our study shows that non-invasive fluid responsiveness monitoring in the emergency department may be feasible with selected methods. Higher repeatability of measurements were observed in non-ultrasound methods. These findings have implications for further studies specifically assessing the accuracy of such non-invasive cardiac output methods and their effect on patient outcome in the ED in fluid depleted states such as sepsis.
关于在急诊科（ED）进行非侵入性心输出量监测的研究数据很少。我们评估了六种非侵入性的液体反应性监测方法，这些方法直接或间接测量心输出量，以评估其在 ED 中的可行性和测量的可重复性：（1）左心室流出道超声心动图衍生的速度时间积分，（2）颈总动脉血流，（3）胸骨上主动脉多普勒，（4）生物电抗，（5）容积描记法伴数字血管卸载法，和（6）下腔静脉塌陷指数。
这是一项在 ED 中评估液体反应性的非侵入性方法的前瞻性观察性研究。参与者为需要静脉补液复苏的非机械通气的 ED 成年患者。每种方法的可行性通过有临床意义的测量数量与测量尝试数量的比例来确定。可重复性通过比较两个液体稳定状态（患者接受静脉补液冲击后）的配对测量的平均值差异来确定。
本研究共纳入 76 例患者，共分析了 207 组液体反应性测量数据。生物电抗的可行性率为 97.6%，容积描记法伴血管卸载法为 91.3%，颈总动脉血流为 87.4%，下腔静脉塌陷指数为 84.1%，左心室流出道 VTI 为 78.7%，胸骨上主动脉多普勒为 76.8%。生物电抗的可行性率与所有其他方法之间的差异具有统计学意义。
我们的研究表明，选择合适的方法，ED 中的非侵入性液体反应性监测可能是可行的。非超声方法的测量重复性更高。这些发现对进一步研究具有重要意义，特别是评估这些非侵入性心输出量方法的准确性及其在 ED 中液体耗竭状态（如脓毒症）下对患者结局的影响。
