脉搏波分析应用压力记录分析法与经胸超声心动图测量心输出量在静脉-静脉体外膜肺氧合治疗患者中的一致性：观察方法比较。

Agreement between cardiac output measurements by pulse wave analysis using the Pressure Recording Analytical Method and transthoracic echocardiography in patients with veno-venous extracorporeal membrane oxygenation therapy: An observational method comparison.

机构信息

From the Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (GG, MF, RN, BS), the Institute of General Practice and Health Services Research, School of Medicine, Technical University of Munich, Munich, Germany (AH), the Institute of AI and Informatics in Medicine, School of Medicine, Technical University of Munich, Munich, Germany (AH), the Department of Anesthesiology and Intensive Care, University Medical Center Göttingen, Göttingen, Germany (MSW), the Department of Intensive Care Medicine, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (DF), the Outcomes Research Consortium, Cleveland, Ohio, USA (BS).

出版信息

Eur J Anaesthesiol. 2023 Jun 1;40(6):436-441. doi: 10.1097/EJA.0000000000001828. Epub 2023 Apr 12.

DOI:10.1097/EJA.0000000000001828

PMID:37052059

Abstract

BACKGROUND

Measuring cardiac output (CO) is important in patients treated with veno-venous extracorporeal membrane oxygenation (vvECMO) because vvECMO flow and CO need to be balanced. Uncalibrated pulse wave analysis with the Pressure Recording Analytical Method (PRAM) may be suitable to measure CO in patients with vvECMO therapy.

OBJECTIVE

To assess the agreement between CO measured by PRAM (PRAM-CO; test method) and CO measured by transthoracic echocardiography (TTE-CO; reference method).

DESIGN

A prospective observational method comparison study.

SETTING

The ICU of a German university hospital between March and December 2021.

PATIENTS

Thirty one adult patients with respiratory failure requiring vvECMO therapy: 29 of the 31 patients (94%) were treated for COVID-19 related respiratory failure.

MAIN OUTCOME MEASURES

PRAM-CO and TTE-CO were measured simultaneously at two time points in each patient with at least 20 min between measurements. A radial or femoral arterial catheter-derived blood pressure waveform was used for PRAM-CO measurements. TTE-CO measurements were conducted using the pulsed wave Doppler-derived velocity time integral of the left ventricular outflow tract (LVOT) and the corresponding LVOT diameter. PRAM-CO and TTE-CO were compared using Bland-Altman analysis and the percentage error (PE). We defined a PE of <30% as clinically acceptable.

RESULTS

Mean ± SD PRAM-CO was 6.86 ± 1.49 l min -1 and mean TTE-CO was 6.94 ± 1.58 l min -1 . The mean of the differences between PRAM-CO and TTE-CO was 0.09 ± 0.73 l min -1 with a lower 95% limit of agreement of -1.34 l min -1 and an upper 95% limit of agreement of 1.51 l min -1 . The PE was 21%.

CONCLUSIONS

The agreement between PRAM-CO and TTE-CO is clinically acceptable in adult patients with vvECMO therapy.

摘要

背景

在接受静脉-静脉体外膜肺氧合（vvECMO）治疗的患者中，测量心输出量（CO）非常重要，因为 vvECMO 流量和 CO 需要平衡。未经校准的脉搏波分析与压力记录分析方法（PRAM）可能适合测量 vvECMO 治疗患者的 CO。

目的

评估 PRAM（PRAM-CO；测试方法）测量的 CO 与经胸超声心动图（TTE-CO；参考方法）测量的 CO 之间的一致性。

设计

前瞻性观察方法比较研究。

地点

德国一所大学医院的 ICU，时间为 2021 年 3 月至 12 月。

患者

31 名患有需要 vvECMO 治疗的呼吸衰竭的成年患者：31 名患者中有 29 名（94%）因 COVID-19 相关呼吸衰竭而接受治疗。

主要观察指标

在每个患者的两个时间点同时测量 PRAM-CO 和 TTE-CO，两次测量之间至少间隔 20 分钟。使用源自桡动脉或股动脉的动脉导管的血压波形进行 PRAM-CO 测量。使用脉冲波多普勒测量左心室流出道（LVOT）的速度时间积分和相应的 LVOT 直径来测量 TTE-CO。使用 Bland-Altman 分析和百分比误差（PE）比较 PRAM-CO 和 TTE-CO。我们将 <30%的 PE 定义为临床可接受的范围。

结果

平均±标准差 PRAM-CO 为 6.86±1.49 l min-1，平均 TTE-CO 为 6.94±1.58 l min-1。PRAM-CO 和 TTE-CO 之间差异的平均值为 0.09±0.73 l min-1，下 95%限为-1.34 l min-1，上 95%限为 1.51 l min-1。PE 为 21%。