单腔5Fr和三腔6Fr经外周中心静脉导管（PICC）是否适用于经肺热稀释法进行血流动力学评估？一项初步研究。

Are single-lumen 5Fr and triple-lumen 6Fr PICCs suitable for hemodynamic assessment by trans-pulmonary thermodilution? A pilot study.

作者信息

D'Arrigo Sonia, Sandroni Claudio, Cacciola Sofia, Dell'Anna Antonio Maria, Pittiruti Mauro, Annetta Maria Giuseppina, Colosimo Cesare, Antonelli Massimo

机构信息

Department of Intensive Care, Emergency Medicine and Anesthesiology, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Largo Agostino Gemelli, 8, 00168, Rome, Italy.

Institute of Anesthesiology and Intensive Care Medicine, Università Cattolica del Sacro Cuore, Rome, Italy.

出版信息

Ann Intensive Care. 2020 Dec 7;10(1):165. doi: 10.1186/s13613-020-00785-2.

DOI:10.1186/s13613-020-00785-2

PMID:33284392

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7720030/

Abstract

BACKGROUND

Single-lumen 4Fr or double-lumen 5Fr power injectable peripherally inserted central catheters (PICCs) are not accurate for trans-pulmonary thermodilution (TPTD), since they overestimate cardiac index and other TPTD-derived parameters when compared with centrally inserted central catheters (CICCs) because of the smaller size of their lumen. We hypothesize that PICCs with larger lumen size may be reliable for the cardiac index assessment using the TPTD.

METHODS

This is a single-centre, prospective method-comparison study that included adult patients admitted in ICU who required a calibrated Pulse Contour hemodynamic monitoring system (VolumeView/EV1000™) for circulatory shock and had both PICC and CICC in place. We compared TPTD measurements via single-lumen 5Fr or triple-lumen 6Fr polyurethane power injectable PICCs with triple-lumen 7Fr CICC (reference standard). To rule out biases related to manual injection, measurements were repeated using an automated rapid injection system. We performed Bland-Altman analysis accounting for multiple observations per patient.

RESULTS

A total of 320 measurements were performed in 15 patients. During the manual phase, the cardiac index measured with either single-lumen 5Fr or triple-lumen 6Fr PICCs were comparable with cardiac index measured with triple-lumen 7Fr CICC (3.2 ± 1.04 vs. 3.2 ± 1.06 L/min/m, bias 2.2% and 3.3 ± 0.8 vs. 3.0 ± 0.7 L/min/m, bias 8.5%, respectively). During the automated phase, triple-lumen 6Fr PICC slightly overestimated the cardiac index when compared to triple-lumen 7Fr CICC (CI 3.4 ± 0.7 vs. 3.0 ± 0.7 L/min/m, bias 12.5%; p = 0.012). For both single-lumen 5Fr and triple-lumen 6Fr PICCs, percentage error vs. triple-lumen 7Fr CICC was below 20% (14.7% and 19% during the manual phase and 14.4% and 13.8% during the automated phase, respectively). Similar results were observed for TPTD-derived parameters.

CONCLUSIONS

During hemodynamic monitoring with TPTD, both single-lumen 5Fr PICCs and triple-lumen 6Fr PICCs can be used for cold fluid bolus injection as an alternative to CICC (ClinicalTrials.gov NCT04241926).

摘要

背景

单腔4Fr或双腔5Fr的动力注射式外周静脉中心导管（PICC）用于经肺热稀释法（TPTD）时不准确，因为与中心静脉中心导管（CICC）相比，其管腔尺寸较小，会高估心脏指数及其他TPTD衍生参数。我们推测管腔尺寸更大的PICC可能可用于通过TPTD评估心脏指数。

方法

这是一项单中心前瞻性方法比较研究，纳入了入住重症监护病房（ICU）、因循环性休克需要校准的脉搏轮廓血流动力学监测系统（VolumeView/EV1000™）且同时留置了PICC和CICC的成年患者。我们将通过单腔5Fr或三腔6Fr聚氨酯动力注射式PICC进行的TPTD测量结果与三腔7Fr CICC（参考标准）进行比较。为排除与手动注射相关的偏差，使用自动快速注射系统重复测量。我们进行了Bland-Altman分析，并考虑了每位患者的多次观察结果。

结果

15例患者共进行了320次测量。在手动阶段，单腔5Fr或三腔6Fr PICC测得的心脏指数与三腔7Fr CICC测得的心脏指数相当（分别为3.2±1.04与3.2±1.06 L/min/m²，偏差2.2%；以及3.3±0.8与3.0±0.7 L/min/m²，偏差8.5%）。在自动阶段，与三腔7Fr CICC相比，三腔6Fr PICC略微高估了心脏指数（CI 3.4±0.7与3.0±0.7 L/min/m²，偏差12.5%；p = 0.012）。对于单腔5Fr和三腔6Fr PICC，与三腔7Fr CICC相比的百分比误差均低于20%（手动阶段分别为14.7%和19%，自动阶段分别为14.4%和13.8%）。TPTD衍生参数也观察到类似结果。