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Medición de salida cardíaca por termodilución. Efectos del ciclo respiratorio en su reproducibilidad
JAMA
|April 19, 1985
Resumen
La temporización de las mediciones de salida cardíaca por termodilución durante el ciclo respiratorio mejora la precisión. Las mediciones al final de la exhalación ofrecen una mejor reproducibilidad que la sincronización aleatoria, lo que mejora la utilidad clínica para pacientes en estado crítico.
Área de la Ciencia:
- Medicina de cuidados críticos Medicina de cuidados críticos.
- Fisiología cardiopulmonar Fisiología cardiopulmonar
- Tecnología de Dispositivo Médico Tecnología de Dispositivo Médico
Sus antecedentes:
- La medición del rendimiento cardíaco por termodilución (CO) es vital para el manejo de pacientes en estado crítico.
- Las variaciones significativas y la escasa reproducibilidad en las mediciones de CO en serie limitan la utilidad clínica.
- El momento óptimo de las mediciones de CO dentro del ciclo respiratorio sigue sin estudiarse.
Objetivo del estudio:
- Para investigar el impacto de la sincronización del ciclo respiratorio en la reproducibilidad de la medición de CO por termodilución.
- Para comparar las mediciones de CO tomadas en el pico de inspiración, la exhalación final, y los intervalos aleatorios.
- Proporcionar recomendaciones basadas en la evidencia para optimizar la técnica de medición de CO.
Principales métodos:
- Estudio prospectivo de 32 pacientes (con respiración espontánea y ventilación mecánica).
- Comparación aleatoria de las mediciones de CO de termodilución iniciadas en las fases pico de inspiración, final de exhalación o respiratorias aleatorias.
- Análisis de las desviaciones estándar para evaluar la reproducibilidad de la medición.
Principales resultados:
- Las mediciones de CO iniciadas en el pico de inspiración o exhalación final demostraron desviaciones estándar significativamente más pequeñas en comparación con las inyecciones aleatorias.
- Las mediciones de sincronización a fases respiratorias específicas mejoraron notablemente la reproducibilidad.
- Las inyecciones de tiempo aleatorio llevaron a una mayor variabilidad en las lecturas de CO.
Conclusiones:
- Las mediciones de salida cardíaca de la termodilución deben cronometrarse en relación con el ciclo respiratorio.
- Se recomienda iniciar las mediciones al final de la exhalación para mejorar la reproducibilidad y la utilidad clínica.
- Evite realizar mediciones de CO de termodilución en puntos aleatorios en el ciclo respiratorio.
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