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
{"title":"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","authors":"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","doi":"10.1016/j.ccrj.2024.04.003","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><p>To evaluate the accuracy of non-calibrated multi-beat analysis continuous cardiac output (CCO<sub>MBA</sub>), against calibrated pulse-contour analysis continuous cardiac output (CCO<sub>PCA</sub>) during a passive leg raise (PLR) and/or a fluid challenge (FC).</p></div><div><h3>Design</h3><p>Observational, single-centre, prospective study.</p></div><div><h3>Setting</h3><p>Tertiary academic medical intensive care unit, Lyon, France.</p></div><div><h3>Participants</h3><p>Adult patients receiving norepinephrine, monitored by CCO<sub>PCA</sub>, and in which a PLR and/or a FC was indicated.</p></div><div><h3>Main outcome measures</h3><p>CCO<sub>MBA</sub> and CCO<sub>PCA</sub> were recorded prior to and during the PLR/FC to evaluate bias and evaluate changes in CCO<sub>MBA</sub> and CCO<sub>PCA</sub> (∆%CCO<sub>MBA</sub> and ∆%CCO<sub>PCA</sub>). Fluid responsiveness was identified by an increase >15% in calibrated cardiac output after FC, to identify the optimal ∆%CCO<sub>MBA</sub> threshold during PLR to predict fluid responsiveness.</p></div><div><h3>Results</h3><p>29 patients (median age 68 [IQR: 57–74]) performed 28 PLR and 16 FC. The bias between methods increased with higher CCO<sub>PCA</sub> values, with a percentage error of 64% (<sub>95%</sub>confidence interval: 52%–77%). ∆%CCO<sub>MBA</sub> adequately tracked changes in ∆%CCO<sub>PCA</sub> with an angular bias of 2 ± 29°. ∆%CCO<sub>MBA</sub> during PLR had an AUROC of 0.92 (<em>P</em> < 0.05), with an optimal threshold >14% to predict fluid responsiveness (sensitivity: 0.99, specificity: 0.87).</p></div><div><h3>Conclusions</h3><p>CCO<sub>MBA</sub> showed a non-constant bias and a percentage error >30% against calibrated CCO<sub>PCA</sub>, but an adequate ability to track changes in CCO<sub>PCA</sub> and to predict fluid responsiveness.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":null,"pages":null},"PeriodicalIF":1.4000,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1441277224000127/pdfft?md5=b5598a5c4abd944b51bf2371a07c3fa7&pid=1-s2.0-S1441277224000127-main.pdf","citationCount":"0","resultStr":"{\"title\":\"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\",\"authors\":\"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\",\"doi\":\"10.1016/j.ccrj.2024.04.003\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objective</h3><p>To evaluate the accuracy of non-calibrated multi-beat analysis continuous cardiac output (CCO<sub>MBA</sub>), against calibrated pulse-contour analysis continuous cardiac output (CCO<sub>PCA</sub>) during a passive leg raise (PLR) and/or a fluid challenge (FC).</p></div><div><h3>Design</h3><p>Observational, single-centre, prospective study.</p></div><div><h3>Setting</h3><p>Tertiary academic medical intensive care unit, Lyon, France.</p></div><div><h3>Participants</h3><p>Adult patients receiving norepinephrine, monitored by CCO<sub>PCA</sub>, and in which a PLR and/or a FC was indicated.</p></div><div><h3>Main outcome measures</h3><p>CCO<sub>MBA</sub> and CCO<sub>PCA</sub> were recorded prior to and during the PLR/FC to evaluate bias and evaluate changes in CCO<sub>MBA</sub> and CCO<sub>PCA</sub> (∆%CCO<sub>MBA</sub> and ∆%CCO<sub>PCA</sub>). Fluid responsiveness was identified by an increase >15% in calibrated cardiac output after FC, to identify the optimal ∆%CCO<sub>MBA</sub> threshold during PLR to predict fluid responsiveness.</p></div><div><h3>Results</h3><p>29 patients (median age 68 [IQR: 57–74]) performed 28 PLR and 16 FC. The bias between methods increased with higher CCO<sub>PCA</sub> values, with a percentage error of 64% (<sub>95%</sub>confidence interval: 52%–77%). ∆%CCO<sub>MBA</sub> adequately tracked changes in ∆%CCO<sub>PCA</sub> with an angular bias of 2 ± 29°. ∆%CCO<sub>MBA</sub> during PLR had an AUROC of 0.92 (<em>P</em> < 0.05), with an optimal threshold >14% to predict fluid responsiveness (sensitivity: 0.99, specificity: 0.87).</p></div><div><h3>Conclusions</h3><p>CCO<sub>MBA</sub> showed a non-constant bias and a percentage error >30% against calibrated CCO<sub>PCA</sub>, but an adequate ability to track changes in CCO<sub>PCA</sub> and to predict fluid responsiveness.</p></div>\",\"PeriodicalId\":49215,\"journal\":{\"name\":\"Critical Care and Resuscitation\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":1.4000,\"publicationDate\":\"2024-06-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.sciencedirect.com/science/article/pii/S1441277224000127/pdfft?md5=b5598a5c4abd944b51bf2371a07c3fa7&pid=1-s2.0-S1441277224000127-main.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Critical Care and Resuscitation\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1441277224000127\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"CRITICAL CARE MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Critical Care and Resuscitation","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1441277224000127","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
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 (CCOMBA), against calibrated pulse-contour analysis continuous cardiac output (CCOPCA) 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 CCOPCA, and in which a PLR and/or a FC was indicated.
Main outcome measures
CCOMBA and CCOPCA were recorded prior to and during the PLR/FC to evaluate bias and evaluate changes in CCOMBA and CCOPCA (∆%CCOMBA and ∆%CCOPCA). Fluid responsiveness was identified by an increase >15% in calibrated cardiac output after FC, to identify the optimal ∆%CCOMBA 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 CCOPCA values, with a percentage error of 64% (95%confidence interval: 52%–77%). ∆%CCOMBA adequately tracked changes in ∆%CCOPCA with an angular bias of 2 ± 29°. ∆%CCOMBA 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
CCOMBA showed a non-constant bias and a percentage error >30% against calibrated CCOPCA, but an adequate ability to track changes in CCOPCA and to predict fluid responsiveness.
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.