Bitker Laurent, Noirot Inès, Chauvelot Louis, Mezidi Mehdi, Dhelft François, Gaillet Maxime, Yonis Hodane, Deniel Guillaume, Richard Jean-Christophe
Service de Médecine Intensive - Réanimation, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France.
Univ Lyon, Université Claude Bernard Lyon 1, INSA-Lyon, CNRS, INSERM, CREATIS UMR 5220, U1294, Villeurbanne, France.
Crit Care Resusc. 2024 Jun 21;26(2):108-115. doi: 10.1016/j.ccrj.2024.04.003. eCollection 2024 Jun.
To evaluate the accuracy of non-calibrated multi-beat analysis continuous cardiac output (CCO), against calibrated pulse-contour analysis continuous cardiac output (CCO) during a passive leg raise (PLR) and/or a fluid challenge (FC).
Observational, single-centre, prospective study.
Tertiary academic medical intensive care unit, Lyon, France.
Adult patients receiving norepinephrine, monitored by CCO, and in which a PLR and/or a FC was indicated.
CCO and CCO were recorded prior to and during the PLR/FC to evaluate bias and evaluate changes in CCO and CCO (∆%CCO and ∆%CCO). Fluid responsiveness was identified by an increase >15% in calibrated cardiac output after FC, to identify the optimal ∆%CCO threshold during PLR to predict fluid responsiveness.
29 patients (median age 68 [IQR: 57-74]) performed 28 PLR and 16 FC. The bias between methods increased with higher CCO values, with a percentage error of 64% (confidence interval: 52%-77%). ∆%CCO adequately tracked changes in ∆%CCO with an angular bias of 2 ± 29°. ∆%CCO during PLR had an AUROC of 0.92 ( < 0.05), with an optimal threshold >14% to predict fluid responsiveness (sensitivity: 0.99, specificity: 0.87).
CCO showed a non-constant bias and a percentage error >30% against calibrated CCO, but an adequate ability to track changes in CCO and to predict fluid responsiveness.
评估在被动抬腿（PLR）和/或液体负荷试验（FC）期间，非校准多搏分析连续心输出量（CCO）相对于校准脉搏轮廓分析连续心输出量（CCO）的准确性。
观察性、单中心、前瞻性研究。
法国里昂的三级学术医疗重症监护病房。
接受去甲肾上腺素治疗、采用CCO监测且有PLR和/或FC指征的成年患者。
在PLR/FC之前和期间记录CCO和CCO，以评估偏差并评估CCO和CCO的变化（∆%CCO和∆%CCO）。通过FC后校准心输出量增加>15%来确定液体反应性，以确定PLR期间预测液体反应性的最佳∆%CCO阈值。
29例患者（中位年龄68岁[四分位间距：57 - 74岁]）进行了28次PLR和16次FC。方法之间的偏差随CCO值升高而增加，百分比误差为64%（置信区间：52% - 77%）。∆%CCO能充分跟踪∆%CCO的变化，角度偏差为2±29°。PLR期间的∆%CCO曲线下面积为0.92（<0.05），预测液体反应性的最佳阈值>14%（敏感性：0.99，特异性：0.87）。
与校准后的CCO相比，CCO显示出非恒定偏差且百分比误差>30%，但在跟踪CCO变化和预测液体反应性方面具有足够能力。
