Transpulmonary thermodilution using femoral indicator injection a prospective trial in patients with a femoral and a jugular central venous catheter 英文参考文献.docVIP

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Transpulmonary thermodilution using femoral indicator injection a prospective trial in patients with a femoral and a jugular central venous catheter 英文参考文献.doc

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Transpulmonary thermodilution using femoral indicator injection a prospective trial in patients with a femoral and a jugular central venous catheter 英文参考文献

Saugeletal.CriticalCare2010,14:R95 /content/14/3/R95 RESEARCH OpenAccess Transpulmonarythermodilutionusingfemoral indicatorinjection:aprospectivetrialinpatients withafemoralandajugularcentral venouscatheter BerndSaugel1*,AndreasUmgelter1,TiborSchuster2,VeitPhillip1,RolandMSchmid1,WolfgangHuber1 Abstract Introduction:Advancedhemodynamicmonitoringusingtranspulmonarythermodilution(TPTD)isestablishedfor measurementofcardiacindex(CI),globalend-diastolicvolumeindex(GEDVI)andextra-vascularlungwaterindex (EVLWI).TPTDrequiresindicatorinjectionviaacentralvenouscatheter(usuallyplacedviathejugularorsubclavian vein).However,superiorvenacavaaccessisoftennotfeasibleduetotheclinicalsituation.Thisstudyinvestigates theconformityofTPTDusingfemoralaccess. Methods:Thisprospectivestudyinvolvedan18-monthtrialatamedicalintensivecareunitatauniversity hospital.Twenty-fourpatientswithbothasuperiorandaninferiorvenacavacatheteratthesametimewere enrolledinthestudy. Results:TPTD-variableswerecalculatedfromTPTDcurvesafterinjectionoftheindicatorbolusviajugularaccess (TPTDjug)andfemoralaccess(TPTDfem).GEDVIfemandGEDVIjugweresignificantlycorrelated(rm =0.88;P 0.001),butsignificantlydifferent(1,034±275vs.793±180mL/m2;P0.001).Bland-Altmananalysisdemonstrated abiasof+241mL/m2(limitsofagreement:-9and+491mL/m2).GEDVIfem,CIfemandidealbodyweightwere independentlyassociatedwiththebias(GEDVIfem-GEDVIjug).AcorrectionformulaofGEDVIjugafterfemoralTPTD, wascalculated.EVLWIfemandEVLWIjugweresignificantlycorrelated(rm =0.93;P0.001).Bland-Altmananalysis revealedabiasof+0.83mL/kg(limitsofagreement:-2.61and+4.28mL/kg).Furthermore,CIfemandCIjugwere significantlycorrelated(rm =0.95;P0.001).Bland-Altmananalysisdemonstratedabiasof+0.29L/min/m2(limits ofagreement-0.40and+0.97L/min/m2;percentage-error16%). Conclusions:TPTDafterfemoralinjectionofthethermo-bolusprovidesprecisedataonGEDVIwithahigh correlation,butaself-evidentsignificantbiasrelatedtotheaugmentedTPTD-volume.AftercorrectionofGEDVIfem usingacorrection