Department of Anesthesiology, Perioperative and Pain Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.
Curr Opin Crit Care. 2022 Jun 1;28(3):340-347. doi: 10.1097/MCC.0000000000000937. Epub 2022 Mar 11.
The purpose of this article is to review various contemporary cardiac output (CO) measurement technologies available and their utility in critically ill patients.
CO measurement devices can be invasive, minimally invasive, or noninvasive depending upon their method of CO measurement. All devices have pros and cons, with pulmonary artery catheter (PAC) being the gold standard. The invasive techniques are more accurate; however, their invasiveness can cause more complications. The noninvasive devices predict CO via mathematical modeling with several assumptions and are thus prone to errors in clinical situations. Recently, PAC has made a comeback into clinical practice especially in cardiac intensive care units (ICUs). Critical care echocardiography (CCE) is an upcoming tool that not only provides CO but also helps in differential diagnosis. Lack of proper training and nonavailability of equipment are the main hindrances to the wide adoption of CCE.
PAC thermodilution for CO measurement is still gold standard and most suitable in patients with cardiac pathology and with experienced user. CCE offers an alternative to thermodilution and is suitable for all ICUs; however, structural training is required.
本文旨在回顾各种现有的心输出量（CO）测量技术及其在危重症患者中的应用。
根据 CO 测量方法的不同，CO 测量设备可分为有创、微创和无创。所有设备都有优缺点，肺动脉导管（PAC）是金标准。有创技术更准确；然而，它们的侵入性会导致更多的并发症。无创设备通过数学模型预测 CO，并基于一些假设，因此在临床情况下容易出现误差。最近，PAC 在心脏重症监护病房（ICU）的临床实践中重新流行起来。心脏超声（CCE）是一种新兴的工具，不仅可以提供 CO，还可以帮助进行鉴别诊断。缺乏适当的培训和设备的不可用是广泛采用 CCE 的主要障碍。
PAC 热稀释法测量 CO 仍然是金标准，在有心脏病理的患者和有经验的使用者中最适用。CCE 提供了热稀释法的替代方法，适用于所有 ICU；然而，需要进行结构性培训。
