比较两种未经校准的脉搏轮廓心输出量监测仪在非体外循环冠状动脉旁路移植术患者中的准确性，以肺动脉导管热稀释法作为参考。
Comparison of accuracy of two uncalibrated pulse contour cardiac output monitors in off-pump coronary artery bypass surgery patients using pulmonary artery catheter-thermodilution as a reference.
机构信息
Department of Anesthesiology and Perioperative Medicine and Department of Bioengineering, University of Pittsburgh, 408 Benedum Hall, 3700 O'Hara Street, Pittsburgh, PA, 15261, USA.
Retia Medical, Valhalla, NY, USA.
出版信息
BMC Anesthesiol. 2021 Jul 10;21(1):189. doi: 10.1186/s12871-021-01415-5.
BACKGROUND
Cardiac output (CO) is a key measure of adequacy of organ and tissue perfusion, especially in critically ill or complex surgical patients. CO monitoring technology continues to evolve. Recently developed CO monitors rely on unique algorithms based on pulse contour analysis of an arterial blood pressure (ABP) waveform. The objective of this investigation was to compare the accuracy of two monitors using different methods of pulse contour analysis - the Retia Argos device and the Edwards Vigileo-FloTrac device - with pulmonary artery catheter (PAC)-thermodilution as a reference.
METHODS
Fifty-eight patients undergoing off-pump coronary artery bypass surgery formed the study cohort. A total of 572 triplets of CO measurements from each device - Argos, Vigileo-FloTrac (third generation), and thermodilution - were available before and after interventions (e.g., vasopressors, fluids, and inotropes). Bland-Altman analysis accounting for repeated measurements per subject and concordance analysis were applied to assess the accuracy of the CO values and intervention-induced CO changes of each pulse contour device against thermodilution. Cluster bootstrapping was employed to statistically compare the root-mean-squared-errors (RMSE = √(μ + σ), where μ and σ are the Bland-Altman bias and precision errors) and concordance rates of the two devices.
RESULTS
The RMSE (mean (95% confidence intervals)) for CO values was 1.16 (1.00-1.32) L/min for the Argos device and 1.54 (1.33-1.77) L/min for the Vigileo-FloTrac device; the concordance rate for intervention-induced CO changes was 87 (82-92)% for the Argos device and 72 (65-78)% for the Vigileo-FloTrac device; and the RMSE for the CO changes was 17 (15-19)% for the Argos device and 21 (19-23)% for the Vigileo-FloTrac device (p < 0.0167 for all comparisons).
CONCLUSIONS
In comparison with CO measured by the PAC, the Argos device proved to be more accurate than the Vigileo-FloTrac device in CO trending and absolute CO measurement in patients undergoing off-pump coronary artery bypass surgery.
背景
心输出量（CO）是评估器官和组织灌注充足性的关键指标，尤其适用于危重症或复杂手术患者。CO 监测技术不断发展。最近开发的 CO 监测仪基于动脉血压（ABP）波形的脉搏轮廓分析算法，采用独特的算法。本研究的目的是比较两种采用不同脉搏轮廓分析方法的监测仪的准确性- Retia Argos 设备和 Edwards Vigileo-FloTrac 设备-与肺动脉导管（PAC）热稀释法作为参考。
方法
58 例行非体外循环冠状动脉旁路移植术的患者构成研究队列。每个设备（Argos、Vigileo-FloTrac（第三代）和热稀释法）在干预前后（如升压药、液体和正性肌力药）总共可获得 572 组 CO 测量值。应用 Bland-Altman 分析考虑到每个受试者的重复测量和一致性分析，评估每个脉搏轮廓设备的 CO 值和干预引起的 CO 变化的准确性，并与热稀释法进行比较。采用聚类 bootstrap 统计比较两种设备的均方根误差（RMSE=√（μ+σ），其中μ和σ 是 Bland-Altman 偏倚和精度误差）和一致性率。
结果
CO 值的 RMSE（平均值（95%置信区间））为 Argos 设备 1.16（1.00-1.32）L/min，Vigileo-FloTrac 设备 1.54（1.33-1.77）L/min；Argos 设备干预引起的 CO 变化的一致性率为 87（82-92）%，Vigileo-FloTrac 设备为 72（65-78）%；Argos 设备 CO 变化的 RMSE 为 17（15-19）%，Vigileo-FloTrac 设备为 21（19-23）%（所有比较均 p<0.0167）。
结论
与 PAC 测量的 CO 相比，Argos 设备在非体外循环冠状动脉旁路移植术患者的 CO 趋势和绝对 CO 测量方面优于 Vigileo-FloTrac 设备。
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