Department of Anesthesiology, Hospital Privado de Comunidad, Mar del Plata, Argentina.
Karolinska Institute Department of Physiology and Pharmacology, Section of Anesthesiology and Intensive Care, Stockholm, Sweden; Maquet Critical Care, Solna, Sweden.
J Cardiothorac Vasc Anesth. 2022 Aug;36(8 Pt B):2900-2907. doi: 10.1053/j.jvca.2022.02.002. Epub 2022 Feb 6.
To test the clinical performance of a novel continuous noninvasive cardiac output (CO) monitoring based on expired carbon dioxide kinetics in cardiac surgery patients.
A prospective feasibility pragmatic clinical study.
A single-center, large community hospital.
Thirty-two patients undergoing cardiac surgery were studied during the intraoperative (before cardiopulmonary bypass) and postoperative (in the intensive care unit before extubation) periods.
CO was measured simultaneously by the continuous capnodynamic method and by transpulmonary thermodilution during changes in the patient's hemodynamic and/or respiratory conditions.
The current recommended comparative statistics for CO measurement methods were analyzed, including bias, precision, and percentage error obtained from Bland-Altman analysis, and concordance between methods obtained from the four-quadrant plot analysis to evaluate the trending ability. Bias ± limits of agreement and percentage error were -0.6 (-1.9 to +0.8; 95% CI of 3.73-5.25) L/min and 31% (n = 147 measurements) for the intraoperative period, -0.8 (-2.4 to +0.9; 95% CI of 3.03-5.21) L/min and 41% (n = 66) for the postoperative period, and -0.6 (-2.1 to +0.8; 95% CI of 3.74-5.00) L/min and 34% (n = 213) for the pooled data. The trending analysis obtained a concordance of 82% (n = 65) for the intraoperative and 71% (n = 24) for the early postoperative periods. Aggregation of both data sets gave a concordance of 79% (n = 89).
The continuous capnodynamic method was reliable and in good agreement with the reference method, and had an accuracy and trending ability good enough to make it a possible future alternative for hemodynamic monitoring in the studied population of elective adult cardiac surgery patients.
测试一种基于呼气末二氧化碳动力学的新型连续无创心输出量（CO）监测在心脏手术患者中的临床性能。
前瞻性可行性实用临床研究。
一家单中心、大型社区医院。
32 名接受心脏手术的患者在术中（体外循环前）和术后（拔管前重症监护病房）期间进行了研究。
在患者的血流动力学和/或呼吸状况发生变化时，通过连续的呼吸动力学方法和经肺热稀释法同时测量 CO。
分析了当前推荐的 CO 测量方法的比较统计数据，包括通过 Bland-Altman 分析获得的偏倚、精度和百分比误差，以及通过四象限图分析获得的方法之间的一致性，以评估趋势能力。术中期间的偏倚±一致性界限和百分比误差分别为-0.6（-1.9 至 +0.8；95%置信区间为 3.73-5.25）L/min 和 31%（n=147 次测量），术后期间为-0.8（-2.4 至 +0.9；95%置信区间为 3.03-5.21）L/min 和 41%（n=66），合并数据为-0.6（-2.1 至 +0.8；95%置信区间为 3.74-5.00）L/min 和 34%（n=213）。趋势分析术中获得了 82%（n=65）的一致性，术后早期获得了 71%（n=24）的一致性。两组数据的汇总得到了 79%（n=89）的一致性。
连续呼吸动力学方法可靠，与参考方法具有良好的一致性，并且具有足够的准确性和趋势能力，可以成为研究人群中择期成年心脏手术患者血流动力学监测的一种可能的替代方法。
