无创心排血量监测在危重症患者血流动力学监测中的准确性评估。

Accuracy assessment of noninvasive cardiac output monitoring in the hemodynamic monitoring in critically ill patients.

机构信息

Department of Critical Care Medicine, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China.

出版信息

Ann Palliat Med. 2020 Sep;9(5):3506-3512. doi: 10.21037/apm-20-1731.

DOI:10.21037/apm-20-1731

PMID:33065801

Abstract

BACKGROUND

The consistency of cardiac output (CO) measured by noninvasive cardiac output monitoring (NICOM), pulse index continuous cardiac output (PiCCO), and ultrasound in the hemodynamic monitoring of critically ill patients was studied. Using the NICOM built-in passive leg raising (PLR) test, stroke volume index variation (∆SVI) was calculated and was used to predict volume responsiveness in patients with circulatory shock (excluding cardiogenic shock).

METHODS

Critically ill patients requiring hemodynamic monitoring were admitted during the study period. The CO of each included patient under hemodynamic monitoring was measured by NICOM plus PiCCO or ultrasound, and the consistency of the measured COs was analyzed. By the NICOM built-in PLR test, ∆SVI was calculated and was used to predict volume responsiveness.

RESULTS

The CO of 58 patients was measured by NICOM and ultrasound, and the COs measured by these two methods were consistent. The CO of 40 patients was measured by NICOM and PiCCO, and the COs measured by these two methods were consistent. The volume responsiveness of all 98 patients was assessed by the NICOM built-in PLR test. A total of 60 patients had ∆SVI >10%, so they underwent the fluid challenge. Among them, 43 patients were positive by both the NICOM built-in PLR and fluid challenge. When using ∆SVI to predict volume responsiveness in patients with circulatory shock (excluding cardiogenic shock), the area under the receiver operating characteristic curve was 0.754 (95% confidence interval, 0.626-0.856), and the cut-off value was 18% (sensitivity: 88.37%, specificity: 52.94%), indicating that ∆SVI has value in predicting the volume responsiveness of patients with noncardiogenic circulatory shock.

CONCLUSIONS

NICOM had good consistency with ultrasound and PiCCO in the hemodynamic monitoring of critically ill patients and can be for hemodynamic monitoring and evaluation in critically ill patients. The ∆SVI obtained by the NICOM built-in PLR test has certain clinical value in predicting the volume responsiveness of patients with circulatory shock (excluding cardiac shock) and provides a method for evaluating the volume responsiveness of critically ill patients.

摘要

背景

本研究旨在探讨无创心输出量监测（NICOM）、脉搏指示连续心输出量（PiCCO）和超声在危重症患者血流动力学监测中的一致性。利用 NICOM 内置被动抬腿（PLR）试验，计算每搏量指数变化（∆SVI），并用于预测循环休克（不包括心源性休克）患者的容量反应性。

方法

研究期间，收入需要血流动力学监测的危重症患者。对接受血流动力学监测的每位患者，使用 NICOM 加 PiCCO 或超声测量心输出量，分析测量心输出量的一致性。通过 NICOM 内置 PLR 试验，计算 ∆SVI 并用于预测容量反应性。

结果

58 例患者使用 NICOM 和超声测量心输出量，两种方法测量的心输出量一致。40 例患者使用 NICOM 和 PiCCO 测量心输出量，两种方法测量的心输出量一致。98 例患者均采用 NICOM 内置 PLR 试验评估容量反应性。共 60 例患者 ∆SVI＞10%，行容量负荷试验。其中，43 例患者 NICOM 内置 PLR 试验和容量负荷试验均阳性。在预测循环休克（不包括心源性休克）患者的容量反应性时，∆SVI 的受试者工作特征曲线下面积为 0.754（95%置信区间，0.626-0.856），截断值为 18%（敏感度：88.37%，特异度：52.94%），提示 ∆SVI 对预测非心源性循环休克患者的容量反应性有一定价值。