Perrino A C, O'Connor T, Luther M
Department of Anesthesiology, Yale University School of Medicine, New Haven, CT 06510.
Anesth Analg. 1994 Jun;78(6):1060-6. doi: 10.1213/00000539-199406000-00005.
The validity of transtracheal Doppler (TTD) cardiac output (CO) monitoring during noncardiac surgery has not been established. A prospective evaluation was undertaken in 30 patients undergoing noncardiac surgery to assess the agreement between TTD and thermodilution measurements of CO. Linear regression, Bland-Altman analysis, and receiver operator characteristic (ROC) techniques were employed to evaluate the accuracy, reliability, and trending capability of TTD monitoring. A total of 250 simultaneous TTD and thermodilution CO values were compared. TTD and thermodilution CO measurements were highly correlated (P < 0.005, r = 0.84) and Bland-Altman analysis revealed a small systematic underestimation of thermodilution CO (mean bias = -0.25 L/min) with a SD of the bias of 0.88 L/min and a mean percent error of 12.4%. TTD performed particularly well in patients in whom the Doppler signal was stable throughout surgery and required minimal manipulation. In these patients, linear regression yielded the relation TTD CO = 0.96 thermodilution CO + 0.15 with a correlation coefficient r = 0.92. Mean percent error was 10.0% with a mean bias of -0.02 L/min and a SD of the bias of 0.58 L/min. The ability of TTD to track directional changes in thermodilution CO was evaluated by regression analysis and a ROC plot. Changes in TTD CO were highly correlated to changes in thermodilution CO (r = 0.81). ROC plots showed that changes in TTD CO reliably identified large (greater than 15%) changes in thermodilution CO with a sensitivity of 92% and a specificity of 87%. Clinical experience with the TTD device is needed to obtain accurate measurements.(ABSTRACT TRUNCATED AT 250 WORDS)
非心脏手术期间经气管多普勒（TTD）心输出量（CO）监测的有效性尚未确立。对30例接受非心脏手术的患者进行了一项前瞻性评估，以评估TTD与热稀释法测量CO之间的一致性。采用线性回归、布兰德-奥特曼分析和受试者工作特征（ROC）技术来评估TTD监测的准确性、可靠性和趋势追踪能力。共比较了250组同时进行的TTD和热稀释法CO值。TTD与热稀释法CO测量值高度相关（P < 0.005，r = 0.84），布兰德-奥特曼分析显示热稀释法CO存在轻微的系统性低估（平均偏差 = -0.25 L/分钟），偏差标准差为0.88 L/分钟，平均百分比误差为12.4%。在整个手术过程中多普勒信号稳定且只需最少操作的患者中，TTD表现特别出色。在这些患者中，线性回归得出关系TTD CO = 0.96×热稀释法CO + 0.15，相关系数r = 0.92。平均百分比误差为10.0%，平均偏差为 -0.02 L/分钟，偏差标准差为0.58 L/分钟。通过回归分析和ROC曲线评估TTD追踪热稀释法CO方向变化的能力。TTD CO的变化与热稀释法CO的变化高度相关（r = 0.81）。ROC曲线显示，TTD CO的变化能够可靠地识别热稀释法CO大于15%的大变化，灵敏度为92%，特异性为87%。需要TTD设备的临床经验来获得准确测量值。（摘要截短于250字）
