Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
Department of Anesthesiology, CUB Erasme University Hospital, Université Libre de Bruxelles, 808 Route de Lennik, 1070, Brussels, Belgium.
J Clin Monit Comput. 2021 Oct;35(5):1203-1209. doi: 10.1007/s10877-020-00572-1. Epub 2020 Aug 4.
Pulse pressure variation (PPV) and cardiac output (CO) can guide perioperative fluid management. Capstesia (Galenic App, Vitoria-Gasteiz, Spain) is a mobile application for snapshot pulse wave analysis (PWAsnap) and estimates PPV and CO using pulse wave analysis of a snapshot of the arterial blood pressure waveform displayed on any patient monitor. We evaluated the PPV and CO measurement performance of PWAsnap in adults having major abdominal surgery. In a prospective study, we simultaneously measured PPV and CO using PWAsnap installed on a tablet computer (PPV, CO) and using invasive internally calibrated pulse wave analysis (ProAQT; Pulsion Medical Systems, Feldkirchen, Germany; PPV, CO). We determined the diagnostic accuracy of PPV in comparison to PPV according to three predefined PPV categories and by computing Cohen's kappa coefficient. We compared CO and CO using Bland-Altman analysis, the percentage error, and four quadrant plot/concordance rate analysis to determine trending ability. We analyzed 190 paired PPV and CO measurements from 38 patients. The overall diagnostic agreement between PPV and PPV across the three predefined PPV categories was 64.7% with a Cohen's kappa coefficient of 0.45. The mean (± standard deviation) of the differences between CO and CO was 0.6 ± 1.3 L min (95% limits of agreement 3.1 to - 1.9 L min) with a percentage error of 48.7% and a concordance rate of 45.1%. In adults having major abdominal surgery, PPV moderately agrees with PPV. The absolute and trending agreement between CO with CO is poor. Technical improvements are needed before PWAsnap can be recommended for hemodynamic monitoring.
脉搏压变异度（PPV）和心输出量（CO）可以指导围手术期液体管理。Capstesia（Galenic App，西班牙维多利亚-加斯泰兹）是一种用于快照脉搏波分析（PWAsnap）的移动应用程序，它使用在任何患者监护仪上显示的动脉血压波形快照的脉搏波分析来估计 PPV 和 CO。我们评估了 PWAsnap 在接受大型腹部手术的成年人中的 PPV 和 CO 测量性能。在一项前瞻性研究中，我们同时使用安装在平板电脑上的 PWAsnap（PPV、CO）和使用内部校准的侵入性脉搏波分析（ProAQT；Pulsion Medical Systems，德国费尔德基兴；PPV、CO）同时测量 PPV 和 CO。我们根据三个预设的 PPV 类别和通过计算 Cohen's kappa 系数来确定 PPV 的诊断准确性。我们通过 Bland-Altman 分析、百分比误差和四象限图/一致性率分析比较 CO 和 CO，以确定趋势能力。我们分析了 38 名患者的 190 对 PPV 和 CO 测量值。在三个预设的 PPV 类别中，PPV 和 PPV 的总体诊断一致性为 64.7%，Cohen's kappa 系数为 0.45。CO 和 CO 之间的平均（±标准差）差值为 0.6±1.3 L min（95% 一致性区间为 3.1 至-1.9 L min），百分比误差为 48.7%，一致性率为 45.1%。在接受大型腹部手术的成年人中，PPV 与 PPV 中度一致。CO 与 CO 之间的绝对和趋势一致性较差。在推荐 PWAsnap 用于血流动力学监测之前，需要进行技术改进。
