胸段食管癌手术中无创连续心输出量监测：校准脉搏轮廓分析与胸部生物反应技术的比较研究

Non-invasive continuous cardiac output monitoring in thoracic cancer surgery: A comparative study between calibrated pulse contour analysis and chest bioreactance.

作者信息

Fellahi Jean-Luc, Abraham Paul, Tiberghien Nicolas, Coelembier Clément, Maury Jean-Michel, Bendjelid Karim

机构信息

From the Service d'Anesthésie-Réanimation, Hôpital Louis Pradel, Hospices Civils de Lyon (J-LF, NT, CC), Laboratoire CarMeN, Inserm UMR 1060, Université Claude Bernard Lyon 1, Lyon, France (J-LF), Service de Médecine Intensive Adulte, Centre Hospitalier Universitaire du Vaud, Lausanne, Switzerland (PA), Service de Chirurgie Thoracique, Hôpital Louis Pradel, Hospices Civils de Lyon, Lyon, France (J-MM), Département d'Anesthésiologie et de Soins Intensifs, Hôpitaux Universitaires de Genève, Genève, Switzerland (KB).

出版信息

Eur J Anaesthesiol Intensive Care. 2022 Sep 15;1(4):e006. doi: 10.1097/EA9.0000000000000006. eCollection 2022 Aug.

DOI:10.1097/EA9.0000000000000006

PMID:39917369

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11783632/

Abstract

BACKGROUND

Patients scheduled for thoracic cancer surgery are eligible for goal-directed fluid therapy, but cardiac output monitoring remains challenging in that specific setting.

OBJECTIVE

We aimed to compare cardiac output as measured with chest bioreactance with that measured by calibrated pulse contour analysis; the hypothesis being that both methods would be interchangeable.

DESIGN

A prospective monocentre observational study.

SETTING

A tertiary university hospital.

PATIENTS

Fifty adult patients undergoing thoracic cancer surgery over a one year period.

MAIN OUTCOME MEASURES

Simultaneous measurements of cardiac index (CI) with bioreactance (CI-NICOM) and arterial pulse contour analysis calibrated by transthoracic echocardiography (CI-PCA) were performed at eight pre-specified intra-operative time points and following fluid challenge and/or vasoactive agents. Relationships between absolute values and changes in CI were assessed by linear regression. Interchangeability was tested with Bland-Altman analysis and percentage error calculation. A four quadrant plot was used to evaluate trending ability.

RESULTS

There was a significant difference between CI-PCA and CI-NICOM: 2.4 ± 0.8 (range: 0.9 to 5.8) l min m vs. 2.9 ± 0.9 (range: 0.9 to 7.2) l min m, respectively ( < 0.001). A positive relationship was found between both techniques: y = 0.29x + 2.19; = 0.08 ( < 0.001). Taking CI-PCA as the reference method, there was a systematic overestimation of CI-NICOM by 21% (0.5 l min m) and limits of agreement were large: -2.49 to 1.47 l min m. The percentage error was 77% and concordance rates were 75 and 70% with and without an exclusion zone of 0.5 l min m.

CONCLUSION

Chest bioreactance is feasible and well tolerated in patients undergoing thoracic surgery for cancer. When compared with calibrated PCA over a wide range of CI values, the technique is moderately correlated, not interchangeable, and provides moderate trending ability.

TRIAL REGISTRATION

NCT04251637.

摘要

背景

计划进行胸段癌症手术的患者适合进行目标导向液体治疗，但在这种特定情况下，心输出量监测仍然具有挑战性。

目的

我们旨在比较胸部生物电阻抗法测量的心输出量与校准脉搏轮廓分析法测量的心输出量；假设两种方法可以互换。

设计

一项前瞻性单中心观察性研究。

地点

一家三级大学医院。

患者

50例成年患者在一年时间内接受胸段癌症手术。

主要观察指标

在八个预先指定的术中时间点以及液体冲击和/或使用血管活性药物后，同时使用生物电阻抗法（CI-NICOM）和经胸超声心动图校准的动脉脉搏轮廓分析法（CI-PCA）测量心脏指数（CI）。通过线性回归评估CI绝对值与变化之间的关系。使用Bland-Altman分析和百分比误差计算来测试互换性。使用四象限图评估趋势能力。

结果

CI-PCA和CI-NICOM之间存在显著差异：分别为2.4±0.8（范围：0.9至5.8）l·min·m²和2.9±0.9（范围：0.9至7.2）l·min·m²（P<0.001）。两种技术之间存在正相关关系：y = 0.29x + 2.19；R² = 0.08（P<0.001）。以CI-PCA作为参考方法，CI-NICOM存在系统性高估21%（0.5 l·min·m²），一致性界限较大：-2.49至1.47 l·min·m²。百分比误差为77%，有和没有0.5 l·min·m²排除区时的一致性率分别为75%和70%。