Le Gall Arthur, Vallée Fabrice, Joachim Jona, Hong Alex, Matéo Joaquim, Mebazaa Alexandre, Gayat Etienne
Inria Paris-Saclay, 01, avenue Honoré d'Estienne d'Orves, 91120, Palaiseau, France.
LMS, École Polytechnique, 91128, Palaiseau Cedex, France.
J Clin Monit Comput. 2022 Apr;36(2):501-510. doi: 10.1007/s10877-021-00679-z. Epub 2021 Mar 9.
Multi-beat analysis (MBA) of the radial arterial pressure (AP) waveform is a new method that may improve cardiac output (CO) estimation via modelling of the confounding arterial wave reflection. We evaluated the precision and accuracy using the trending ability of the MBA method to estimate absolute CO and variations (ΔCO) during hemodynamic challenges. We reviewed the hemodynamic challenges (fluid challenge or vasopressors) performed when intra-operative hypotension occurred during non-cardiac surgery. The CO was calculated offline using transesophageal Doppler (TED) waveform (CO) or via application of the MBA algorithm onto the AP waveform (CO) before and after hemodynamic challenges. We evaluated the precision and the accuracy according to the Bland & Altman method. We also assessed the trending ability of the MBA by evaluating the percentage of concordance with 15% exclusion zone between ΔCO and ΔCO. A non-inferiority margin was set at 87.5%. Among the 58 patients included, 23 (40%) received at least 1 fluid challenge, and 46 (81%) received at least 1 bolus of vasopressors. Before treatment, the CO was 5.3 (IQR [4.1-8.1]) l min, and the CO was 4.1 (IQR [3-5.4]) l min. The agreement between CO and CO was poor with a 70% percentage error. The bias and lower and upper limits of agreement between CO and CO were 0.9 (CI = 0.82 to 1.07) l min, -2.8 (CI = -2.71 to-2.96) l min and 4.7 (CI = 4.61 to 4.86) l min, respectively. After hemodynamic challenge, the percentage of concordance (PC) with 15% exclusion zone for ΔCO was 93 (CI = 90 to 97)%. In this retrospective offline analysis, the accuracy, limits of agreements and percentage error between TED and MBA for the absolute estimation of CO were poor, but the MBA could adequately track induced CO variations measured by TED. The MBA needs further evaluation in prospective studies to confirm those results in clinical practice conditions.
桡动脉压力（AP）波形的多搏分析（MBA）是一种新方法，它可能通过对混杂的动脉波反射进行建模来改善心输出量（CO）估计。我们利用MBA方法在血流动力学挑战期间估计绝对CO和变化量（ΔCO）的趋势能力来评估其精密度和准确性。我们回顾了非心脏手术期间发生术中低血压时进行的血流动力学挑战（液体挑战或血管升压药）。在血流动力学挑战前后，使用经食管多普勒（TED）波形（CO）或通过将MBA算法应用于AP波形（CO）离线计算CO。我们根据Bland & Altman方法评估精密度和准确性。我们还通过评估ΔCO与ΔCO之间15%排除区的一致性百分比来评估MBA的趋势能力。非劣效性界限设定为87.5%。在纳入的58例患者中，23例（40%）接受了至少1次液体挑战，46例（81%）接受了至少1次血管升压药推注。治疗前，CO为5.3（IQR[4.1 - 8.1]）l/min，CO为4.1（IQR[3 - 5.4]）l/min。CO与CO之间的一致性较差，误差百分比为70%。CO与CO之间的偏差以及一致性的下限和上限分别为0.9（CI = 0.82至1.07）l/min、-2.8（CI = -2.71至 - 2.96）l/min和4.7（CI = 4.61至4.86）l/min。血流动力学挑战后，ΔCO的15%排除区的一致性百分比（PC）为93（CI = 90至97）%。在这项回顾性离线分析中，TED和MBA在绝对CO估计方面的准确性、一致性界限和误差百分比较差，但MBA能够充分跟踪TED测量的诱导CO变化。MBA需要在前瞻性研究中进一步评估，以在临床实践条件下证实这些结果。
