Transpulmonary thermodilution assessments precise measurements require a precise procedure 英文参考文献.docVIP

Giraud et al. Critical Care 2011,15:195 /content/15/5/195 CO MMENTA RY Transpulmonary thermodilution assessments: precise measurements require a precise procedure Rapha?l Giraud, Nils Siegenthaler and Karim Bendjelid* prospectively investigated in situations characterized by Abstract (1) constant conditions of measurements, (2) the same When incorporating the values of a hemodynamic parameter into the care of patients, the precision of the measurement method should always be considered. A prospective analysis in the previous issue of Critical Care showed that the precision of transpulmonary thermodilution (TPTD) allows for reliable mean values if a standardised procedure is used. The present ?nding has a physiological basis, as TPTD requires a more prolonged transit time, which in turn reduces the e?ects that airway pressure and arrhythmia have on venous return-cardiac output steady states. Moreover, this result suggests that the current accepted threshold value of a 15% increase in cardiac output to identify a positive response to a ?uid challenge could be reduced in the future. Indeed, this value is mainly related to the precision of the pulmonary artery catheter. instrument and operator, and (3) repeated measurements during a short time period. In the present issue of this journal, Monnet and colleagues [1] illustrated the precision of the TPTD tech- nique and the number of cold boluses needed to achieve an acceptable level of precision when measuring CO, GEDV and EVLW in 91 critically ill patients. In this elegant study, the authors performed a series of ? ve successive thermodilution measurements and then ana- lyzed the precision of each sequence to demonstrate that a precision of less than 10% for CO, GEDV and EVLW could be reached with only three cold bolus injections of 15 ml each [1]. In addition, the least signi? cance change (LSC) associated with three boluses was less than 12% for these