Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
Institute of Medical Informatics, Statistics and Epidemiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
J Clin Monit Comput. 2020 Aug;34(4):643-648. doi: 10.1007/s10877-019-00374-0. Epub 2019 Aug 27.
Cardiac output (CO) is a key hemodynamic variable that can be minimally invasively estimated by pulse wave analysis. Multi-beat analysis is a novel pulse wave analysis method. In this prospective observational clinical method comparison study, we compared CO estimations by multi-beat analysis with CO measured by intermittent pulmonary artery thermodilution (PATD) in adult patients treated in the intensive care unit (ICU) after off-pump coronary artery bypass surgery (OPCAB). We included patients after planned admission to the ICU after elective OPCAB who were monitored with a radial arterial catheter and a pulmonary artery catheter. At seven time points, we determined CO using intermittent PATD (PATD-CO; reference method) and simultaneously recorded the radial arterial blood pressure waveform that we later used to estimate CO using multi-beat analysis (MBA-CO; test method) with the Argos monitor (Retia Medical; Valhalla, NY, USA). Blood pressure waveforms impaired by inappropriate damping properties or artifacts were excluded. We compared PATD-CO and MBA-CO using Bland-Altman analysis accounting for repeated measurements, the percentage error, and the concordance rate derived from four-quadrant plot analysis (15% exclusion zone). We analyzed 167 CO values of 31 patients. Mean PATD-CO was 5.30 ± 1.22 L/min and mean MBA-CO was 5.55 ± 1.82 L/min. The mean of the differences between PATD-CO and MBA-CO was 0.08 ± 1.10 L/min (95% limits of agreement: - 2.13 L/min to + 2.29 L/min). The percentage error was 40.7%. The four-quadrant plot-derived concordance rate was 88%. CO estimation by multi-beat analysis of the radial arterial blood pressure waveform (Argos monitor) shows reasonable agreement compared with CO measured by intermittent PATD in adult patients treated in the ICU after OPCAB.
心输出量（CO）是一个关键的血流动力学变量，可以通过脉搏波分析进行微创估计。多拍分析是一种新的脉搏波分析方法。在这项前瞻性观察性临床方法比较研究中，我们比较了多拍分析和间歇肺动脉热稀释法（PATD）对非体外循环冠状动脉旁路移植术（OPCAB）后 ICU 成人患者 CO 的估计。我们纳入了计划在 OPCAB 后入住 ICU 的患者，这些患者接受了桡动脉导管和肺动脉导管监测。在七个时间点，我们使用间歇 PATD（PATD-CO；参考方法）确定 CO，并同时记录桡动脉血压波形，我们随后使用 Argos 监测仪（Retia Medical；Valhalla，NY，USA）对该波形进行多拍分析（MBA-CO；测试方法）。排除了阻尼特性或伪影导致的血压波形异常。我们使用 Bland-Altman 分析比较了 PATD-CO 和 MBA-CO，该分析考虑了重复测量、百分比误差和来自四象限图分析的一致性率（15%排除区）。我们分析了 31 名患者的 167 个 CO 值。平均 PATD-CO 为 5.30±1.22 L/min，平均 MBA-CO 为 5.55±1.82 L/min。PATD-CO 和 MBA-CO 之间差值的平均值为 0.08±1.10 L/min（95%置信区间：-2.13 L/min 至 +2.29 L/min）。百分比误差为 40.7%。四象限图分析的一致性率为 88%。与间歇 PATD 测量相比，OPCAB 后 ICU 成人患者桡动脉血压波形的多拍分析（Argos 监测仪）CO 估计具有合理的一致性。
