围手术期医学无创心输出量监测装置的准确性和精密度:一项系统综述和荟萃分析

A. Joosten, O. Desebbe, K. Suehiro, L. Murphy, M. Essiet, B. Alexander, M. Fischer, L. Barvais, L. Obbergh, D. Maucort-Boulch, M. Cannesson
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引用次数: 1

摘要

本文的主要目的是对所有医学文献(37项研究;1543例患者)比较了在各种临床环境(如重症监护室、急诊科和手术室)使用市售的完全无创CO监测装置测量的心输出量(CO)和大剂量热稀释(TD)。此外,作者对从系统综述中提取的数据进行了荟萃分析,通过汇总估计来计算围手术期使用这些无创CO监测装置的精度。作者从系统评价中收集数据,以计算以下4个变量:(1)bolus TD测试方法与无创参考方法(bias)的平均差的合并估计,(2)偏差的标准差(precision)的合并估计,(3)偏差95%置信区间的合并估计,(4)误差百分比(PE)的合并估计。被测试方法和参考方法之间可接受的一致性定义为汇总估计(PE)为30%或更高。尽管它在重症监护管理中至关重要,但一氧化碳作为测量终末器官氧输送的基础,在临床环境中明显监测不足。新的无创技术和旧的监测方法有很多,包括脉搏波传递时间(PWTT)、无创脉搏廓线分析(niPCA)、部分CO2再呼吸(CO2r)和胸电生物阻抗(TEB),但在临床环境中“首选”的是传统的有创技术——大剂量TD。两种方法的平均CO为4.78 L/min。总体随机效应合并偏倚为- 0.13 L/min (- 2.38 ~ 2.12 L/min), PE为47%,具有较高的研究间敏感性异质性(I = 83%, P < 0.001)。尽管自21世纪初以来医疗技术取得了许多进步,但与大剂量TD相比,TEB和CO2r并没有显示出显著增加的一致性(在该荟萃分析中,TEB的PE在1999年为37%,2010年为43%,2016年为42%;CO2r PE与2010年相似:44.5%对40%)。最近的技术,如PWTT和niPCA, PWTT的PE为62%,niPCA为45%。完全无创的CO测量技术没有达到可接受的一致水平。所有无创技术的pe均高于30%的预设阈值
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Accuracy and Precision of Non-invasive Cardiac Output Monitoring Devices in Perioperative Medicine: A Systematic Review and Meta-analysis
The main purpose of this article is to provide a systematic review of all medical literature (37 studies; 1543 patients) comparing cardiac output (CO) measured with a commercially available completely noninvasive CO monitoring device against bolus thermodilution (TD) in various clinical settings such as the intensive care unit, emergency department, and the operating room. In addition, the authors provide a meta-analysis of the data extracted from the systematic review to calculate the precision of these noninvasive CO monitoring devices when used perioperatively by following pooled estimates. The authors gathered data from the systematic review in order to calculate the following 4 variables: (1) the pooled estimate of the mean difference between the tested method of bolus TD and the noninvasive reference method (bias), (2) the pooled estimate of the standard deviation (precision) of the bias, (3) the pooled estimate of the 95% confidence intervals of the bias, and (4) the pooled estimate of the percentage of error (PE). An acceptable agreement between the tested and the reference method was defined as a pooled estimate (PE) of 30% or greater. Despite it being crucial in critical care management, CO, the basis of measuring oxygen delivery to end organs, has been demonstrably undermonitored in clinical settings. New noninvasive techniques and older methods abound for monitoring CO including pulse wave transit time (PWTT), noninvasive pulse contour analysis (niPCA), partial CO2 rebreathing (CO2r), and thoracic electrical bioimpedance (TEB), yet the “go-to” in the clinical setting is the traditional invasive technique of bolus TD. Mean CO was 4.78 L/min in both methods. The overall random-effects pooled bias was −0.13 L/min (−2.38 to 2.12 L/min) and PE 47% with high interstudy sensitivity heterogeneity (I = 83%, P < 0.001). Despite the many advances in medical technology since the early 2000s, both TEB and CO2r have not shown significantly increased agreement when compared with bolus TD (PE for TEB was 37% in 1999, 43% in 2010, and 42% in 2016 in this metaanalysis; CO2r PE was similar to 2010: 44.5% against 40% in this meta-analysis). Recent techniques, such as PWTTand the niPCA, have a PE of 62% for PWTT and 45% for niPCA. Completely noninvasive technologies for the measurement of CO did not reach an acceptable level of agreement. The PEs of all noninvasive techniques were above the preset threshold of 30%, and the
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