Ehlers Ulrike, Erlebach Rolf, Brandi Giovanna, Stretti Federica, Valek Richard, Klinzing Stephanie, Schuepbach Reto
Institute of Intensive Care, University Hospital of Zurich, Raemistasse 100 CH-8091, Zurich, Switzerland.
Intensive Care Unit, Kantonsspital Glarus, Burgstrasse 99, CH-8750, Glarus, Switzerland.
Crit Care Res Pract. 2020 Jul 20;2020:8956372. doi: 10.1155/2020/8956372. eCollection 2020.
Estimation of cardiac output (CO) and evaluation of change in CO as a result of therapeutic interventions are essential in critical care medicine. Whether noninvasive tools estimating CO, such as continuous cardiac output (esCCOTM) methods, are sufficiently accurate and precise to guide therapy needs further evaluation. We compared esCCOTM with an established method, namely, transpulmonary thermodilution (TPTD). . In a single center mixed ICU, esCCOTM was compared with the TPTD method in 38 patients. The primary endpoint was accuracy and precision. The cardiac output was assessed by two investigators at baseline and after eight hours.
In 38 critically ill patients, the two methods correlated significantly ( = 0.742). The Bland-Altman analysis showed a bias of 1.6 l/min with limits of agreement of -1.76 l/min and +4.98 l/min. The percentage error for CO was 47%. The correlation of trends in cardiac output after eight hours was significant ( = 0.442), with a concordance of 74%. The performance of CO could not be linked to the patient's condition.
The accuracy and precision of the esCCOTM method were not clinically acceptable for our critical patients. EsCCOTM also failed to reliably detect changes in cardiac output.
在重症监护医学中，估计心输出量（CO）以及评估治疗干预导致的CO变化至关重要。诸如连续心输出量（esCCOTM）方法等非侵入性估计CO的工具是否足够准确和精确以指导治疗，需要进一步评估。我们将esCCOTM与一种既定方法，即经肺热稀释法（TPTD）进行了比较。在一个单中心混合重症监护病房中，对38例患者的esCCOTM与TPTD方法进行了比较。主要终点是准确性和精密度。两名研究人员在基线和八小时后评估心输出量。
在38例危重症患者中，两种方法显著相关（=0.742）。Bland-Altman分析显示偏差为1.6升/分钟，一致性界限为-1.76升/分钟和+4.98升/分钟。CO的百分比误差为47%。八小时后心输出量趋势的相关性显著（=0.442），一致性为74%。CO的表现与患者病情无关。
对于我们的危重症患者，esCCOTM方法的准确性和精密度在临床上不可接受。esCCOTM也未能可靠地检测到心输出量的变化。
