Bradford H Ralston, Andrew T Waberski, Joshua P Kanter, Jacob W Schick, Tacy E Downing
{"title":"小儿心脏导管术中的实测耗氧量比假定耗氧量更准确。","authors":"Bradford H Ralston, Andrew T Waberski, Joshua P Kanter, Jacob W Schick, Tacy E Downing","doi":"10.1007/s00246-023-03186-x","DOIUrl":null,"url":null,"abstract":"<p><p>When calculating cardiac index (C.I.) by the Fick method, oxygen consumption (VO<sub>2</sub>) is often unknown, so assumed values are typically used. This practice introduces a known source of inaccuracy into the calculation. Using a measured VO<sub>2</sub> (mVO<sub>2</sub>) from the CARESCAPE E-sCAiOVX module provides an alternative that may improve accuracy of C.I. calculations. Our aim is to validate this measurement in a general pediatric catheterization population and compare its accuracy with assumed VO<sub>2</sub> (aVO<sub>2</sub>). mVO<sub>2</sub> was recorded for all patients undergoing cardiac catheterization with general anesthesia and controlled ventilation during the study period. mVO<sub>2</sub> was compared to the reference VO<sub>2</sub> (refVO<sub>2</sub>) determined by the reverse Fick method using cardiac MRI (cMRI) or thermodilution (TD) as a reference standard for measurement of C.I. when available. 193 VO<sub>2</sub> measurements were obtained, including 71 with a corresponding cMRI or TD measure of cardiac index for validation. mVO<sub>2</sub> demonstrated satisfactory concordance and correlation with the TD- or cMRI-derived refVO<sub>2</sub> (ρ<sub>c</sub> = 0.73, r<sup>2</sup> = 0.63) with a mean bias of - 3.2% (SD ± 17.3%). Assumed VO<sub>2</sub> demonstrated much weaker concordance and correlation with refVO<sub>2</sub> (ρ<sub>c</sub> = 0.28, r<sup>2</sup> = 0.31) with a mean bias of + 27.5% (SD ± 30.0%). Subgroup analysis of patients < 36 months of age demonstrated that error in mVO<sub>2</sub> was not significantly different from that observed in older patients. Many previously reported prediction models for assuming VO<sub>2</sub> performed poorly in this younger age range. Measured oxygen consumption using the E-sCAiOVX module is significantly more accurate than assumed VO<sub>2</sub> when compared to TD- or cMRI-derived VO<sub>2</sub> in a pediatric catheterization lab.</p>","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":null,"pages":null},"PeriodicalIF":1.5000,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Measured Oxygen Consumption During Pediatric Cardiac Catheterization is More Accurate than Assumed Oxygen Consumption.\",\"authors\":\"Bradford H Ralston, Andrew T Waberski, Joshua P Kanter, Jacob W Schick, Tacy E Downing\",\"doi\":\"10.1007/s00246-023-03186-x\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>When calculating cardiac index (C.I.) by the Fick method, oxygen consumption (VO<sub>2</sub>) is often unknown, so assumed values are typically used. This practice introduces a known source of inaccuracy into the calculation. Using a measured VO<sub>2</sub> (mVO<sub>2</sub>) from the CARESCAPE E-sCAiOVX module provides an alternative that may improve accuracy of C.I. calculations. Our aim is to validate this measurement in a general pediatric catheterization population and compare its accuracy with assumed VO<sub>2</sub> (aVO<sub>2</sub>). mVO<sub>2</sub> was recorded for all patients undergoing cardiac catheterization with general anesthesia and controlled ventilation during the study period. mVO<sub>2</sub> was compared to the reference VO<sub>2</sub> (refVO<sub>2</sub>) determined by the reverse Fick method using cardiac MRI (cMRI) or thermodilution (TD) as a reference standard for measurement of C.I. when available. 193 VO<sub>2</sub> measurements were obtained, including 71 with a corresponding cMRI or TD measure of cardiac index for validation. mVO<sub>2</sub> demonstrated satisfactory concordance and correlation with the TD- or cMRI-derived refVO<sub>2</sub> (ρ<sub>c</sub> = 0.73, r<sup>2</sup> = 0.63) with a mean bias of - 3.2% (SD ± 17.3%). Assumed VO<sub>2</sub> demonstrated much weaker concordance and correlation with refVO<sub>2</sub> (ρ<sub>c</sub> = 0.28, r<sup>2</sup> = 0.31) with a mean bias of + 27.5% (SD ± 30.0%). Subgroup analysis of patients < 36 months of age demonstrated that error in mVO<sub>2</sub> was not significantly different from that observed in older patients. Many previously reported prediction models for assuming VO<sub>2</sub> performed poorly in this younger age range. Measured oxygen consumption using the E-sCAiOVX module is significantly more accurate than assumed VO<sub>2</sub> when compared to TD- or cMRI-derived VO<sub>2</sub> in a pediatric catheterization lab.</p>\",\"PeriodicalId\":19814,\"journal\":{\"name\":\"Pediatric Cardiology\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":1.5000,\"publicationDate\":\"2024-10-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Pediatric Cardiology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s00246-023-03186-x\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2023/5/27 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q3\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Pediatric Cardiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00246-023-03186-x","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2023/5/27 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Measured Oxygen Consumption During Pediatric Cardiac Catheterization is More Accurate than Assumed Oxygen Consumption.
When calculating cardiac index (C.I.) by the Fick method, oxygen consumption (VO2) is often unknown, so assumed values are typically used. This practice introduces a known source of inaccuracy into the calculation. Using a measured VO2 (mVO2) from the CARESCAPE E-sCAiOVX module provides an alternative that may improve accuracy of C.I. calculations. Our aim is to validate this measurement in a general pediatric catheterization population and compare its accuracy with assumed VO2 (aVO2). mVO2 was recorded for all patients undergoing cardiac catheterization with general anesthesia and controlled ventilation during the study period. mVO2 was compared to the reference VO2 (refVO2) determined by the reverse Fick method using cardiac MRI (cMRI) or thermodilution (TD) as a reference standard for measurement of C.I. when available. 193 VO2 measurements were obtained, including 71 with a corresponding cMRI or TD measure of cardiac index for validation. mVO2 demonstrated satisfactory concordance and correlation with the TD- or cMRI-derived refVO2 (ρc = 0.73, r2 = 0.63) with a mean bias of - 3.2% (SD ± 17.3%). Assumed VO2 demonstrated much weaker concordance and correlation with refVO2 (ρc = 0.28, r2 = 0.31) with a mean bias of + 27.5% (SD ± 30.0%). Subgroup analysis of patients < 36 months of age demonstrated that error in mVO2 was not significantly different from that observed in older patients. Many previously reported prediction models for assuming VO2 performed poorly in this younger age range. Measured oxygen consumption using the E-sCAiOVX module is significantly more accurate than assumed VO2 when compared to TD- or cMRI-derived VO2 in a pediatric catheterization lab.
期刊介绍:
The editor of Pediatric Cardiology welcomes original manuscripts concerning all aspects of heart disease in infants, children, and adolescents, including embryology and anatomy, physiology and pharmacology, biochemistry, pathology, genetics, radiology, clinical aspects, investigative cardiology, electrophysiology and echocardiography, and cardiac surgery. Articles which may include original articles, review articles, letters to the editor etc., must be written in English and must be submitted solely to Pediatric Cardiology.