Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Outcomes Research Consortium, Cleveland, OH, USA.
Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Br J Anaesth. 2020 Jul;125(1):25-37. doi: 10.1016/j.bja.2020.03.013. Epub 2020 May 29.
Finger cuff technologies allow continuous noninvasive arterial blood pressure (AP) and cardiac output/index (CO/CI) monitoring.
We performed a meta-analysis of studies comparing finger cuff-derived AP and CO/CI measurements with invasive measurements in surgical or critically ill patients. We calculated overall random effects model-derived pooled estimates of the mean of the differences and of the percentage error (PE; CO/CI studies) with 95%-confidence intervals (95%-CI), pooled 95%-limits of agreement (95%-LOA), Cochran's Q and I (for heterogeneity).
The pooled mean of the differences (95%-CI) was 4.2 (2.8 to 5.62) mm Hg with pooled 95%-LOA of -14.0 to 22.5 mm Hg for mean AP (Q=230.4 [P<0.001], I=91%). For mean AP, the mean of the differences between finger cuff technologies and the reference method was ≤5±8 mm Hg in 9/27 data sets (33%). The pooled mean of the differences (95%-CI) was -0.13 (-0.43 to 0.18) L min with pooled 95%-LOA of -2.56 to 2.23 L min for CO (Q=66.7 [P<0.001], I=90%) and 0.07 (0.01 to 0.13) L min m with pooled 95%-LOA of -1.20 to 1.15 L min m for CI (Q=5.8 [P=0.326], I=0%). The overall random effects model-derived pooled estimate of the PE (95%-CI) was 43 (37 to 49)% (Q=48.6 [P<0.001], I=63%). In 4/19 data sets (21%) the PE was ≤30%, and in 10/19 data sets (53%) it was ≤45%.
Study heterogeneity was high. Several studies showed interchangeability between AP and CO/CI measurements using finger cuff technologies and reference methods. However, the pooled results of this meta-analysis indicate that AP and CO/CI measurements using finger cuff technologies and reference methods are not interchangeable in surgical or critically ill patients.
PROSPERO registration number: CRD42019119266.
手指套技术可实现连续无创动脉血压（AP）和心输出量/指数（CO/CI）监测。
我们对比较手指套衍生的 AP 和 CO/CI 测量值与手术或危重症患者的有创测量值的研究进行了荟萃分析。我们计算了总体随机效应模型得出的差异平均值和百分比误差（PE；CO/CI 研究）的汇总估计值，以及 95%-置信区间（95%-CI）、汇总 95%-一致性界限（95%-LOA）、Cochran's Q 和 I（用于异质性）。
AP 的平均差异（95%-CI）汇总平均值为 4.2（2.8 至 5.62）mmHg，AP 的汇总 95%-LOA 为 -14.0 至 22.5 mmHg（Q=230.4[P<0.001]，I=91%）。对于平均 AP，在 27 个数据集（33%）中的 9 个数据集中，手指套技术与参考方法之间的差异平均值小于等于 5±8 mmHg。CO 的差异平均值（95%-CI）为 -0.13（-0.43 至 0.18）L min，CO 的汇总 95%-LOA 为 -2.56 至 2.23 L min（Q=66.7[P<0.001]，I=90%），CI 的差异平均值（95%-CI）为 0.07（0.01 至 0.13）L min m，CI 的汇总 95%-LOA 为 -1.20 至 1.15 L min m（Q=5.8[P=0.326]，I=0%）。PE（95%-CI）的总体随机效应模型汇总估计值为 43（37 至 49）%（Q=48.6[P<0.001]，I=63%）。在 19 个数据集（21%）中的 4 个数据集中，PE 小于等于 30%，在 19 个数据集（53%）中的 10 个数据集中，PE 小于等于 45%。
研究的异质性很高。一些研究表明，使用手指套技术和参考方法测量 AP 和 CO/CI 是可以互换的。然而，本荟萃分析的汇总结果表明，在手术或危重症患者中，使用手指套技术和参考方法测量 AP 和 CO/CI 是不可互换的。
PROSPERO 注册号：CRD42019119266。
