Department of Emergency Medicine, University of New Mexico School of Medicine, Albuquerque, NM.
Department of Emergency Medicine, University of New Mexico School of Medicine, Albuquerque, NM.
Air Med J. 2020 Sep-Oct;39(5):389-392. doi: 10.1016/j.amj.2020.05.015. Epub 2020 Jun 19.
Arterial catheterization is a commonly performed procedure in intensive care units to guide the management of critically ill patients who require precise hemodynamic monitoring; however, this technology is not always available in the transport setting because of cumbersome and expensive equipment requirements. We compared the accuracy and reliability of a disposable vascular pressure device (DVPD) with the gold standard (ie, the transducer pressure bag invasive arterial monitoring system) used in intensive care units to determine if the DVPD can be reliably used in place of the traditional pressure transducer setup.
This study was a single-center, prospective, observational study performed in the adult intensive care unit of a large academic university hospital. A convenience cohort of hemodynamically stable, adult critically ill patients with femoral, brachial, or radial arterial catheters was recruited for this study. The Compass pressure device (Centurion Medical Products, Williamston, MI) is a disposable vascular pressure-sensing device used to assure venous access versus inadvertent arterial access during central line placement. The DVPD was attached to an in situ arterial catheter and measures the mean intravascular pressure via an embedded sensor and displays the pressure via the integrated LCD screen. Using a 3-way stopcock, the DVPD was compared with the standard arterial setup. We compared the mean arterial pressure (MAP) in the standard setup with the DVPD using Bland-Altman plots and methods that accounted for repeated measures in the same subject.
Data were collected on 14 of the 15 subjects enrolled. Five measurements were obtained on each patient comparing the DVPD with the standard arterial setup at 1-minute intervals over the course of 5 minutes. A total of 70 observations were made. Among the 15 subjects, most (10 [67%]) were radial or brachial sites. The average MAP scores and standard deviation values obtained by the standard setup were 83.5 mm Hg (14.8) and 81.1 mm Hg (19.3) using the DVPD. Just over half (51.4%) of the measurements were within a ± 5-mm Hg difference. Using Bland-Altman plotting methods, standard arterial measurements were 2.4 mm Hg higher (95% confidence interval, 0.60-4.1) than with the DVPD. Differences between the 2 devices varied significantly across MAP values. The standard arterial line measurements were significantly higher than the DVPD at low MAP values, whereas the DVPD measurements were significantly higher than the standard arterial line at high MAP values.
The DVPD provides a reasonable estimate of MAP and may be suitable for arterial pressure monitoring in settings where standard monitoring setups are not available. The DVPD appears to provide "worst-case" values because it underestimates low arterial blood pressure and overestimates high arterial blood pressure. Future trials should investigate the DVPD under different physiological conditions (eg, hypotensive patients, patients with ventricular assist devices, and patients on extracorporeal membrane oxygenation), different patient populations (such as pediatric patients), and in different environments (prehospital, air medical transport, and austere locations).
动脉置管术是重症监护病房中常用的一种操作，用于指导需要精确血流动力学监测的危重病患者的治疗；然而，由于设备要求繁琐且昂贵，该技术在转运环境中并不总是可行。我们比较了一次性血管压力装置（DVPD）与重症监护病房中使用的金标准（即传感器压力袋有创动脉监测系统）的准确性和可靠性，以确定 DVPD 是否可以可靠地替代传统的压力传感器设置。
这是一项单中心、前瞻性、观察性研究，在一所大型学术大学医院的成人重症监护病房进行。本研究纳入了血流动力学稳定的成年危重病患者，他们有股动脉、肱动脉或桡动脉导管。Compass 压力装置（Centurion Medical Products，Williamston，MI）是一种一次性血管压力感应装置，用于在中心静脉置管过程中确保静脉通路而不是意外动脉通路。DVPD 连接到原位动脉导管上，并通过嵌入式传感器测量平均血管内压力，并通过集成的 LCD 屏幕显示压力。使用三通阀，将 DVPD 与标准动脉设置进行比较。我们使用 Bland-Altman 图和考虑同一受试者重复测量的方法，比较标准设置中的平均动脉压（MAP）与 DVPD。
在纳入的 15 名受试者中，有 14 名完成了数据收集。在 5 分钟的过程中，每隔 1 分钟对每位患者进行 5 次测量，比较 DVPD 与标准动脉设置。共进行了 70 次观察。在 15 名受试者中，大多数（10 [67%]）为桡动脉或肱动脉部位。标准设置获得的平均 MAP 评分和标准偏差值分别为 83.5mmHg（14.8）和 81.1mmHg（19.3）使用 DVPD。超过一半（51.4%）的测量值在±5mmHg 的差异范围内。使用 Bland-Altman 绘图方法，标准动脉测量值比 DVPD 高 2.4mmHg（95%置信区间，0.60-4.1）。两种设备之间的差异随 MAP 值显著变化。在 MAP 值较低时，标准动脉线测量值明显高于 DVPD，而在 MAP 值较高时，DVPD 测量值明显高于标准动脉线。
DVPD 可提供 MAP 的合理估计值，在无法使用标准监测设置的情况下，可能适合用于动脉压监测。DVPD 似乎提供了“最坏情况”的值，因为它低估了低动脉血压并高估了高动脉血压。未来的试验应在不同的生理条件（例如低血压患者、心室辅助设备患者和体外膜氧合患者）、不同的患者人群（如儿科患者）和不同的环境（院前、空中医疗转运和恶劣环境）下研究 DVPD。
