Department of Anesthesiology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
Department of Anesthesiology, National Cerebral and Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka, 565-8565, Japan.
J Anesth. 2019 Jun;33(3):364-371. doi: 10.1007/s00540-019-02632-6. Epub 2019 Mar 23.
The ClearSight™ device monitors continuous pressure and cardiac output via pulse contour analysis. ClearSight™, however, may not be reliable in patients with reduced peripheral perfusion caused by high peripheral resistance. This study aimed to elucidate the accuracy and trending ability of ClearSight™ in patients undergoing abdominal aortic aneurysm (AAA) surgery by comparing the ClearSight-derived cardiac index (CI) with that measured using three-dimensional echocardiography (CI).
The study included 20 patients who underwent elective AAA surgery. CI and CI were measured simultaneously at eight time points during the surgery. Trending ability was investigated after aortic clamping and unclamping. We used CI as the reference method.
Bland-Altman analysis showed a wide limit of agreement between CI and CI (percentage error 41.3%). Subgroup analysis showed a lower percentage error (33.2%) in patients with CI ≥ 2.5 L/min/m. The cubic splines related to the CI and CI discrepancy were negatively sloped, indicating that CI had significant influence on the CI discrepancy (p < 0.001). Four-quadrant plot analysis showed that the tracking ability of ClearSight™ after aortic clamping and declamping were clinically unacceptable (81.3% and 78.6%, respectively). Also, the polar plot analysis showed that the concordance rate of ClearSight™ after aortic clamping and declamping were clinically unacceptable (58.3% and 66.7%, respectively).
ClearSight™ was not sufficiently accurate in patients undergoing AAA surgery. The tracking ability of ClearSight™ after aortic clamping was below the acceptable limit.
ClearSight™ 设备通过脉搏轮廓分析监测连续压力和心输出量。然而，当外周灌注由于外周阻力增加而减少时，ClearSight™ 可能不可靠。本研究旨在通过比较 ClearSight™ 衍生的心指数 (CI) 与三维超声心动图 (CI) 测量的 CI，阐明 ClearSight™ 在接受腹主动脉瘤 (AAA) 手术的患者中的准确性和趋势能力。
本研究纳入了 20 名接受择期 AAA 手术的患者。在手术期间的八个时间点同时测量 CI 和 CI。在主动脉夹闭和解夹后，研究了趋势能力。我们使用 CI 作为参考方法。
Bland-Altman 分析显示 CI 和 CI 之间的一致性界限很宽（百分比误差 41.3%）。亚组分析显示 CI≥2.5 L/min/m 的患者的百分比误差较低（33.2%）。与 CI 和 CI 差异相关的三次样条呈负斜率，表明 CI 对 CI 差异有显著影响（p<0.001）。四象限图分析表明，主动脉夹闭和解夹后 ClearSight™ 的跟踪能力临床不可接受（分别为 81.3%和 78.6%）。此外，极坐标图分析表明，主动脉夹闭和解夹后 ClearSight™ 的一致性率临床不可接受（分别为 58.3%和 66.7%）。
在接受 AAA 手术的患者中，ClearSight™ 不够准确。主动脉夹闭后 ClearSight™ 的跟踪能力低于可接受的极限。
