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Arterielle Pulskonturanalyse zur Messung des Herzindex unter Veränderungen der Vorlast und der aortalen Impedanz

Accuracy of pulse contour cardiac index measurements during changes of preload and aortic impedance

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Zusammenfassung

Hintergrund

Die arterielle Pulskonturanalyse wurde zur Bestimmung des Herzindex (CI) sowohl bei herzchirurgischen als auch bei kritisch kranken Patienten während unterschiedlichen klinischen Bedingungen validiert. Der anhand der Pulskonturanalyse bestimmte Herzindex (CIPC) zeigt eine gute Übereinstimmung mit dem durch arterielle (CITD) oder durch pulmonalarterielle Thermodilution (CIPA) bestimmten Herzindex. Die Genauigkeit der Pulskonturanalyse unter Bedingungen des offenen Thorax mit Veränderungen der Vorlast und der aortalen Impedanz ist jedoch unklar. Daher wurden CIPC, CITD und CIPA in Abhängigkeit dieser Veränderungen durch Sternotomie verglichen.

Methodik

28 Patienten während elektiver koronarer Bypassoperation wurden untersucht. CIPC und CITD, sowie CIPA bei 6 Patienten, wurden vor sowie nach Sternotomie bestimmt, und die relativen Veränderungen ΔCIPC und ΔCITD und ΔCIPA berechnet.

Ergebnisse

Die Sternotomie resultierte bei 25 von 28 Patienten in einem signifikanten Anstieg des CI. Eine Regressionanalyse wurde zwischen CIPC und CITD vor bzw. nach Sternotomie (r2 = 0,87, p<0,0001, r2 = 0,88, p<0,0001) sowie zwischen CIPC und CIPA, vor bzw. nach Sternotomie (r2 = 0,85, p<0,0001, r2 = 0,93, p<0,01) und zwischen ΔCIPC and ΔCITD (r2 = 0,72, p<0,0001) durchgeführt. Eine Bland Altman-Analyse ergab für Bias (m) und Grenzen der Übereinstimmung (2SD) zwischen CIPC und CITD vor und nach Sternotomie sowie zwischen ΔCIPC und ΔCITD: m = –0,03 l/min/m2, 2SD = –0,34 bis 0,28 l/min/m2, m = –0,06 l/min/m2, 2SD = –0,45 bis 0,33 l/min/m2 und m = –0,02 l/min/m2, 2SD = –0,47 bis 0,44T l/min/m2.

Schlussfolgerung

Veränderungen der Vorlast und der aortalen Impedanz während Sternotomie beeinflussen nicht die Genauigkeit der arteriellen Pulskonturanalyse. CIPC, CITD, und CIPA zeigen unter diesen Bedingungen eine gute Übereinstimmung.

Abstract

Background

Cardiac index obtained by arterial pulse contour analysis (CIPC) demonstrated good agreement with arterial or pulmonary arterial thermodilution derived cardiac index (CITD, CIPA) in cardiac surgical or critically ill patients. However as the accuracy of pulse contour analysis during changes of the aortic impedance is unclear, we compared CIPC, CITD and CIPA during changes of preload and the aortic impedance as occurring during sternotomy.

Patients and methods

CIPC und CITD, were compared in 28 patients, (and CIPA in 6 patients) undergoing elective coronary artery bypass grafting, before and after sternotomy. The relative changes ΔCIPC und ΔCIPC were calculated.

Results

Sternotomy resulted in a significant increase in CI in 25 out of 28 patients. Regression analysis was performed between CIPC and CITD before and after sternotomy (r2 = 0.87, p<0.0001, r2 = 0.88, p<0.0001) as well as between CIPC and CIPA, before and after sternotomy (r2 = 0.85, p<0.0001, r2 = 0.93, p<0.01) and between ΔCIPC and ΔCITD (r2 = 0.72, p<0.0001). Bland Altman-Analysis for determining bias (m) and precision (2SD) between CIPC and CITD before and after sternotomy and between ΔCIPC and ΔCITD resulted in m = –0.03 L/min/m2, 2SD = –0.34 to 0.28 L/min/m2, m = –0.06 L/min/m2, 2SD = –0.45 to 0.33 L/min/m2 and m = –0.02 L/min/m2, SD = –0.47 to 0.44 L/min/m2.

Conclusion

Pulse contour analysis derived CIPC accurately reflects thermodilution derived CITD or CIPA during changes of preload and the aortic impedance as occurring during sternotomy.

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Authors and Affiliations

  1. Klinik und Poliklinik für Anästhesiologie, Universitätsklinikum Hamburg-Eppendorf

    T. W. Felbinger, M. S. Goepfert, A. E. Goetz & D. A. Reuter

  2. Klinik für Anästhesiologie, Kliniken Grosshadern-Innenstadt der Universität München

    T. W. Felbinger, M. S. Goepfert, T. Goresch, A. E. Goetz & D. A. Reuter

  3. Klinik und Poliklinik für Anästhesiologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246 , Hamburg

    T. W. Felbinger

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  1. T. W. Felbinger
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  2. M. S. Goepfert
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  3. T. Goresch
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  4. A. E. Goetz
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  5. D. A. Reuter
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Correspondence to T. W. Felbinger.

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Felbinger, T.W., Goepfert, M.S., Goresch, T. et al. Arterielle Pulskonturanalyse zur Messung des Herzindex unter Veränderungen der Vorlast und der aortalen Impedanz. Anaesthesist 54, 755–762 (2005). https://doi.org/10.1007/s00101-005-0847-9

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