tailieunhanh - Báo cáo y học: "Use of minimally invasive hemodynamic monitoring to assess dynamic changes in cardiac output at the bedside"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Use of minimally invasive hemodynamic monitoring to assess dynamic changes in cardiac output at the bedside. | Pinsky Critical Care 2011 15 406 http content 15 2 406 CRITICAL CARE LETTER L_ Use of minimally invasive hemodynamic monitoring to assess dynamic changes in cardiac output at the bedside Michael R Pinsky See related research by Hadian etal. http content 14 6 R212 and related commentary by Critchley http content 15 1 106 I read with dismay the Commentary by Lester Critchley 1 on our recent pulse contour analysis study 2 . We disagree with his statement that based on our data one cannot use arterial pulse contour to assess changes in cardiac output CO . We compared several commercially available arterial pulse contour methods of measuring CO with themselves and pulmonary artery catheter PAC -derived bolus thermodilution COtd and continuous CO CCO modes. We showed that none of these devices trended CO changes well when compared to the others either separately or compared to a pooled CO value of all the devices. Thus clinical trials using CO trending data from one device cannot be extrapolated to similar outcomes using other devices. Dr Critchley concluded that none of the pulse contour devices accurately trend CO changes. If that logic were true then one could also not use PAC CO trending either as it fared worse than the rest when compared to pooled CO values. Lack of proof of CO trending correlation amongst devices does not equate to lack of ability to trend CO by a device. His argument is based on four lines of reasoning that we dispute. First he argued that we pooled PAC COtd and CCO measures. However we also reported separate Bland-Altman analyses for COtd and CCO and the relations were unchanged. Second we then restricted our analysis to low flow states and all devices markedly improved their CO estimates but the concordance remained poor compared to PAC. Furthermore his study 3 as a reference used COtd as cardiac index CItd giving concordance across devices of 90-95 when exclusion criteria of l min m 2 are .