Accuracy of Cardiac Output by Nine Different Pulse Contour Algorithms in Cardiac Surgery Patients: A Comparison with Transpulmonary Thermodilution

作者：Broch Ole; Bein Berthold; Gruenewald Matthias; Masing Sarah; Huenges Katharina; Haneya Assad; Steinfath Markus; Renner Jochen

来源：Biomed Research International, 2016, 2016: 3468015.

DOI：10.1155/2016/3468015

<jats:p><jats:italic>Objective.</jats:italic> Today, there exist several different pulse contour algorithms for calculation of cardiac output (CO). The aim of the present study was to compare the accuracy of nine different pulse contour algorithms with transpulmonary thermodilution before and after cardiopulmonary bypass (CPB).<jats:italic> Methods.</jats:italic> Thirty patients scheduled for elective coronary surgery were studied before and after CPB. A passive leg raising maneuver was also performed. Measurements included CO obtained by transpulmonary thermodilution (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M1"><mml:mi mathvariant="normal">C</mml:mi><mml:msub><mml:mrow><mml:mi mathvariant="normal">O</mml:mi></mml:mrow><mml:mrow><mml:mi mathvariant="normal">T</mml:mi><mml:mi mathvariant="normal">P</mml:mi><mml:mi mathvariant="normal">T</mml:mi><mml:mi mathvariant="normal">D</mml:mi></mml:mrow></mml:msub></mml:math>) and by nine pulse contour algorithms (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M2"><mml:mrow><mml:msub><mml:mrow><mml:mtext>CO</mml:mtext></mml:mrow><mml:mrow><mml:mtext>X</mml:mtext><mml:mn fontstyle="italic">1</mml:mn><mml:mtext>–</mml:mtext><mml:mn fontstyle="italic">9</mml:mn></mml:mrow></mml:msub></mml:mrow></mml:math>). Calibration of pulse contour algorithms was performed by esophageal Doppler ultrasound after induction of anesthesia and 15 min after CPB. Correlations, Bland-Altman analysis, four-quadrant, and polar analysis were also calculated.<jats:italic> Results.</jats:italic> There was only a poor correlation between <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M3"><mml:mtext>C</mml:mtext><mml:msub><mml:mrow><mml:mtext>O</mml:mtext></mml:mrow><mml:mrow><mml:mtext>TPTD</mml:mtext></mml:mrow></mml:msub></mml:math> and <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M4"><mml:mrow><mml:msub><mml:mrow><mml:mtext>CO</mml:mtext></mml:mrow><mml:mrow><mml:mtext>X</mml:mtext><mml:mn fontstyle="italic">1</mml:mn><mml:mtext>–</mml:mtext><mml:mn fontstyle="italic">9</mml:mn></mml:mrow></mml:msub></mml:mrow></mml:math> during passive leg raising and in the period before and after CPB. Percentage error exceeded the required 30% limit. Four-quadrant and polar analysis revealed poor trending ability for most algorithms before and after CPB. The Liljestrand-Zander algorithm revealed the best reliability.<jats:italic> Conclusions.</jats:italic> Estimation of CO by nine different pulse contour algorithms revealed poor accuracy compared with transpulmonary thermodilution. Furthermore, the less-invasive algorithms showed an insufficient capability for trending hemodynamic changes before and after CPB. The Liljestrand-Zander algorithm demonstrated the highest reliability. This trial is registered with <jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="https://clinicaltrials.gov/ct2/show/NCT02438228?term=02438228&amp;rank=1">NCT02438228</jats:ext-link> (ClinicalTrials.gov).</jats:p>

• 出版日期2016