Halemani Kusuma, Kumar Lakshmi, Narayanan Bhadrinath, Rajan Sunil, Ramamurthi Pavithra, Sudhakar Abish
Department of Anaesthesia, Amrita Institute of Medical Sciences, Kochi, Kerala, India.
Department of Pediatric Cardiology, Amrita Institute of Medical Sciences, Kochi, Kerala, India.
Turk J Anaesthesiol Reanim. 2022 Apr;50(2):135-141. doi: 10.5152/TJAR.2021.1356.
Arterial pulse-derived cardiac output monitors are routinely employed to guide hemodynamic management during liver transplant surgery. In this study, we sought to assess the reliability by evaluating the agreement of the cardiac output measured by the FloTrac Vigileo versus pulmonary artery catheter (continuous cardiac output) at specified times during liver transplant.
Liver transplant database with cardiac output values measured by FloTrac Vigileo and continuous cardiac output was analyzed retrospectively at a tertiary care hospital. Data were compared at T0: baseline, T1: 1 hour in dissection phase, T2: anhepatic phase, T3: portosystemic shunt, T4: reperfusion, T5: 1 hour after reperfusion, and T6: skin closure. Statistical analysis was done using Bland-Altman analysis and percentage error (<30%) to assess the agreement between cardiac output measured by 2 techniques, Lin's concordance correlation coefficient for quantifying the agreement and 4-quadrant plots to compare the trends of cardiac output.
Bland-Altman analysis showed mean cardiac output ± standard deviation L min-1 (95% CI) at T0: 0.2 ± 2.09 (-3.9 to 4.3), T1: 0.53 ± 3.0 (-5.4 to 6.4), T2: 0.47 ± 2.1(-3.7 to 4.6), T3: 0.31 ± 1.9 (-3.4 to 4.0), T4: 0.44 ± 2.15 (-3.8 to 4.7), T 5:0.69 ± 1.9. (-2.9 to 4.3), and at T6: 0.43 ± 2.25 (-4.0 to 4.8). Percentage error was 44%-72% and concordance correlation coefficient was poor (<0.65) at all points.
There is poor agreement between the cardiac output measured by FloTrac and pulmonary artery catheter among liver transplant recipients. The need for superior hemodynamic monitoring is mandated in liver transplant.
动脉脉搏衍生的心输出量监测仪常用于指导肝移植手术期间的血流动力学管理。在本研究中，我们试图通过评估在肝移植特定时间点，FloTrac Vigileo测量的心输出量与肺动脉导管（连续心输出量）测量结果的一致性，来评估其可靠性。
在一家三级医疗机构对肝移植数据库进行回顾性分析，该数据库包含FloTrac Vigileo测量的心输出量值和连续心输出量。在T0：基线、T1：解剖阶段1小时、T2：无肝期、T3：门体分流、T4：再灌注、T5：再灌注后1小时以及T6：皮肤缝合时对数据进行比较。使用Bland - Altman分析和百分比误差（<30%）来评估两种技术测量的心输出量之间的一致性，使用Lin一致性相关系数来量化一致性，并使用四象限图来比较心输出量的趋势。
Bland - Altman分析显示，在T0时平均心输出量±标准差L min-1（95%可信区间）为0.2 ± 2.09（-3.9至4.3），T1时为0.53 ± 3.0（-5.4至6.4），T2时为0.47 ± 2.1（-3.7至4.6），T3时为0.31 ± 1.9（-3.4至4.0），T4时为0.44 ± 2.15（-3.8至4.7），T5时为0.69 ± 1.9（-2.9至4.3），T6时为0.43 ± 2.25（-4.0至4.8）。在所有时间点，百分比误差为44% - 72%，一致性相关系数较差（<0.65）。
肝移植受者中，FloTrac测量的心输出量与肺动脉导管测量的心输出量之间一致性较差。肝移植中需要更高级的血流动力学监测。
