非校准多搏动分析连续心输出量监测仪的偏差、趋势分析能力和诊断性能，用于识别重症患者的液体反应性

IF 1.4 4区医学 Q3 CRITICAL CARE MEDICINE

Critical Care and Resuscitation Pub Date : 2024-06-01 DOI:10.1016/j.ccrj.2024.04.003

Laurent Bitker MD, PhD , Inès Noirot MD , Louis Chauvelot MD , Mehdi Mezidi MD, MSc , François Dhelft MD, MSc , Maxime Gaillet MD , Hodane Yonis MD , Guillaume Deniel MD, MSc , Jean-Christophe Richard MD, PhD

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引用次数: 0

摘要

目的评估在被动抬腿（PLR）和/或液体挑战（FC）期间，非校准多搏动分析连续心输出量（CCOMBA）与校准脉搏轮廓分析连续心输出量（CCOPCA）的准确性。主要结果测量在 PLR/FC 之前和过程中记录 CCOMBA 和 CCOPCA，以评估偏差并评价 CCOMBA 和 CCOPCA 的变化（∆%CCOMBA 和 ∆%CCOPCA）。结果 29 名患者（中位年龄 68 [IQR：57-74]）进行了 28 次 PLR 和 16 次 FC。CCOPCA 值越高，方法之间的偏差越大，误差百分比为 64%（95% 置信区间：52%-77%）。∆%CCOMBA 可以充分跟踪 ∆%CCOPCA 的变化，角度偏差为 2 ± 29°。结论 ∆%CCOMBA 在 PLR 期间的 AUROC 为 0.92（P <0.05），预测液体反应性的最佳阈值为 14%（灵敏度：0.99，特异性：0.87）。

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Bias, trending ability and diagnostic performance of a non-calibrated multi-beat analysis continuous cardiac output monitor to identify fluid responsiveness in critically ill patients

Objective

To evaluate the accuracy of non-calibrated multi-beat analysis continuous cardiac output (CCO_MBA), against calibrated pulse-contour analysis continuous cardiac output (CCO_PCA) during a passive leg raise (PLR) and/or a fluid challenge (FC).

Design

Observational, single-centre, prospective study.

Setting

Tertiary academic medical intensive care unit, Lyon, France.

Participants

Adult patients receiving norepinephrine, monitored by CCO_PCA, and in which a PLR and/or a FC was indicated.

Main outcome measures

CCO_MBA and CCO_PCA were recorded prior to and during the PLR/FC to evaluate bias and evaluate changes in CCO_MBA and CCO_PCA (∆%CCO_MBA and ∆%CCO_PCA). Fluid responsiveness was identified by an increase >15% in calibrated cardiac output after FC, to identify the optimal ∆%CCO_MBA threshold during PLR to predict fluid responsiveness.

Results

29 patients (median age 68 [IQR: 57–74]) performed 28 PLR and 16 FC. The bias between methods increased with higher CCO_PCA values, with a percentage error of 64% (_95%confidence interval: 52%–77%). ∆%CCO_MBA adequately tracked changes in ∆%CCO_PCA with an angular bias of 2 ± 29°. ∆%CCO_MBA during PLR had an AUROC of 0.92 (P < 0.05), with an optimal threshold >14% to predict fluid responsiveness (sensitivity: 0.99, specificity: 0.87).

Conclusions

CCO_MBA showed a non-constant bias and a percentage error >30% against calibrated CCO_PCA, but an adequate ability to track changes in CCO_PCA and to predict fluid responsiveness.

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来源期刊

Critical Care and Resuscitation CRITICAL CARE MEDICINE-

CiteScore

7.70

自引率

3.40%

发文量

审稿时长

>12 weeks

期刊介绍： ritical Care and Resuscitation (CC&R) is the official scientific journal of the College of Intensive Care Medicine (CICM). The Journal is a quarterly publication (ISSN 1441-2772) with original articles of scientific and clinical interest in the specialities of Critical Care, Intensive Care, Anaesthesia, Emergency Medicine and related disciplines. The Journal is received by all Fellows and trainees, along with an increasing number of subscribers from around the world. The CC&R Journal currently has an impact factor of 3.3, placing it in 8th position in world critical care journals and in first position in the world outside the USA and Europe.