Departments of Anesthesiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Departments of Anesthesiology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
BMC Anesthesiol. 2024 Jun 6;24(1):201. doi: 10.1186/s12871-024-02582-x.
Significant hemodynamic changes occur during liver transplantation, emphasizing the importance of precious and continuous monitoring of cardiac output, cardiac index, and other parameters. Although the monitoring of cardiac output by pulse indicator continuous cardiac output (PiCCO) was statistically homogeneous compared to the clinical gold standard pulmonary artery catheterization (PAC) in previous studies of liver transplantation, there are fewer statistical methods for the assessment of its conclusions, and a lack of comparisons of other hemodynamic parameters (e.g., SVRI, systemic vascular resistance index). Some studies have also concluded that the agreement between PiCCO and PAC is not good enough. Overall, there are no uniform conclusions regarding the agreement between PiCCO and PAC in previous studies. This study evaluates the agreement and trending ability of relevant hemodynamic parameters obtained with PiCCO compared to the clinical gold standard PAC from multiple perspectives, employing various statistical methods.
Fifty-two liver transplantation patients were included. Cardiac output (CO), cardiac index (CI), SVRI and stroke volume index (SVI) values were monitored at eight time points using both PiCCO and PAC. The results were analyzed by Bland-Altman analysis, Passing-bablok regression, intra-class correlation coefficient (ICC), 4-quadrant plot, polar plot, and trend interchangeability method (TIM).
The Bland-Altman analysis revealed high percentage errors for PiCCO: 54.06% for CO, 52.70% for CI, 62.18% for SVRI, and 51.97% for SVI, indicating poor accuracy. While Passing-Bablok plots showed favorable agreement for SVRI overall and during various phases, the agreement for other parameters was less satisfactory. The ICC results confirmed good overall agreement between the two devices across most parameters, except for SVRI during the new liver phase, which showed poor agreement. Additionally, four-quadrant and polar plot analyses indicated that all agreement rate values fell below the clinically acceptable threshold of over 90%, and all angular deviation values exceeded ± 5°, demonstrating that PiCCO is unable to meet the acceptable trends. Using the TIM, the interchangeability rates were found to be quite low: 20% for CO and CI, 16% for SVRI, and 13% for SVI.
Our study revealed notable disparities in absolute values of CO, CI, SVRI and SVI between PiCCO and PAC in intraoperative liver transplant settings, notably during the neohepatic phase where errors were particularly pronounced. Consequently, these findings highlight the need for careful consideration of PiCCO's advantages and disadvantages in liver transplantation scenarios, including its multiple parameters (such as the encompassing extravascular lung water index), against its limited correlation with PAC.
肝移植过程中会发生显著的血流动力学变化，强调了连续监测心输出量、心指数和其他参数的重要性。虽然脉冲指示剂连续心输出量（PiCCO）监测与之前的肝移植研究中的临床金标准肺动脉导管（PAC）相比，在心脏输出方面具有统计学上的一致性，但对于其结论的评估，统计方法较少，并且缺乏对其他血流动力学参数（例如，SVRI、全身血管阻力指数）的比较。一些研究还得出结论，PiCCO 与 PAC 的一致性不够好。总的来说，在之前的研究中，关于 PiCCO 与 PAC 的一致性没有统一的结论。本研究从多个角度评估了 PiCCO 与临床金标准 PAC 获得的相关血流动力学参数的一致性和趋势能力，采用了各种统计方法。
纳入 52 例肝移植患者。使用 PiCCO 和 PAC 在八个时间点监测心输出量（CO）、心指数（CI）、SVRI 和每搏量指数（SVI）。结果采用 Bland-Altman 分析、Passing-bablok 回归、组内相关系数（ICC）、四象限图、极坐标图和趋势可互换性方法（TIM）进行分析。
Bland-Altman 分析显示 PiCCO 的百分比误差较高：CO 为 54.06%，CI 为 52.70%，SVRI 为 62.18%，SVI 为 51.97%，表明准确性较差。虽然 Passing-Bablok 图总体上显示了 SVRI 的良好一致性，但对于其他参数的一致性较差。ICC 结果证实了两种设备在大多数参数上具有良好的总体一致性，但在新肝期的 SVRI 上一致性较差。此外，四象限和极坐标图分析表明，所有的一致性率值均低于临床可接受的阈值（超过 90%），所有的角度偏差值均超过±5°，表明 PiCCO 无法满足可接受的趋势。使用 TIM 发现，可互换率相当低：CO 和 CI 为 20%，SVRI 为 16%，SVI 为 13%。
我们的研究表明，在肝移植手术中，PiCCO 与 PAC 之间的 CO、CI、SVRI 和 SVI 的绝对值存在明显差异，尤其是在新肝期，误差更为明显。因此，这些发现强调了在肝移植情况下需要仔细考虑 PiCCO 的优势和劣势，包括其多个参数（如包含的血管外肺水指数），以及其与 PAC 的有限相关性。
