在败血症休克中,心脏输出监测器:它们是否提供重要内容? 一个系统的审查和元分析
Raquel Lamarche-Fontaneto1, Lee Oud2, Kayln D Howell2
1Department of Pulmonary and Critical Care Medicine, Integrated Hospital Care Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA. lamarcr@ccf.org.
Critical care (London, England)
|July 12, 2025
概括
大多数心脏输出 (CO) 监测器在败血性休克患者中与参考方法的一致性较差. 当前的验证方法忽视了关键的实时决策指标,如趋势能力.
科学领域:
- 关键护理医学 关键护理医学
- 生物医学工程 生物医学工程
- 血液动力学监测 监测 血液动力学
背景情况:
- 精确的心脏输出 (CO) 监测对于管理败血症休克至关重要.
- 现有的CO监测设备需要严格评估临床互换性.
研究的目的:
- 系统地评估各种CO监测设备的可互换性与成年ICU患者的感染性休克的参考方法相比.
- 通过使用既定和先进的分析框架来评估协议和趋势能力.
主要方法:
- 在2025年1月之前对前性研究进行系统的文献搜索,比较CO监测器与肺动脉导管 (PAC),跨肺热稀释 (TPTD) 或心声回声仪的研究.
- 包括使用布兰德-阿尔特曼分析,趋势评估 (极/4象限图),精度和时间响应的研究.
- 使用Sidik-Jonkman随机效应模型对偏差,一致限度 (LoA) 和百分比误差 (PE) 的聚合分析.
主要成果:
- 分析了26项研究 (1,323名患者),PAC是最常见的参考方法.
- 聚合分析显示平均偏差为0.15 L min-1 ,LoA为±3.45 L min-1 ,聚合PE为49%,表明整体一致性较差.
- 校准的脉冲轮分析 (PCA) 显示出最佳一致性 (PE 25%),而未校准的PCA,胸部电气生物阻抗和生物反应率显示出不良一致性 (PE ≥52%).
- 在15个数据集中,只有3个数据集达到可接受的趋势一致性值 (≥90%).
结论:
- 大多数CO监测设备在败血症休克患者中与参考标准不充分一致.
- 目前的验证实践主要依赖于布兰德-阿尔特曼分析,未能捕捉出临床实用性的基本性能指标.
- 未来的研究必须优先考虑精度,时间响应和趋势能力,以进行强大的床边设备评估.
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