Comparison Between MostCare and Echo-Doppler for Cardiac Output Measurement: an Observational Study
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 发起方
- 入组人数
- 400
- 试验地点
- 14
- 主要终点
- cardiac output
研究概览
简要总结
Recently, an uncalibrated minimally invasive Pulse-code Modulator (PCM) has been developed: the MostCare system. This monitoring system is powered by Pressure Recording Analytical Method (PRAM), which is based on the mathematical analysis of the arterial pressure profile changes. It allows beat-to-beat Stroke Volume (SV) assessment from the pressure signal recorded invasively in radial, brachial, or femoral arteries. The most innovative features of this method are: 1) the lack of a calibration requirement, 2) the analysis of the arterial wave signal is performed at 1000 Hz, 3) a dedicated arterial catheter-transducer is unnecessary. MostCare is powered by PRAM (Pressure Recording Analytical Method) algorithm. The investigators primary end-point was to evaluate the relationship between Cardiac Output (CO) measured by MostCare with CO calculated with Echo-Doppler in Intensive Care Unit (ICU) patients under different clinical conditions. As a secondary end-point the investigators evaluated the relationship between CO measured by MostCare with CO obtained with thermodilution techniques (standard bolus thermodilution or transpulmonary thermodilution, i.e. PiCCO system). This is a prospective multicentre observational study.
详细描述
(*) Study design
A. MostCare system data acquisition Before each CO measurement, the arterial pressure catheter and transducer quality will be assessed as follows: easy aspiration of 5 ml of blood easily re-injected without resistance; visual assessment of the quality of the arterial waveform contour; adequate response to the flush test (square wave). If necessary, the best position for the signal quality will be checked by extending the wrist and manipulating the catheter. For each determination of Echo-Doppler (and ThD-CO when applicable), a corresponding value for MostCare must be obtained by averaging the individual beats over the same time necessary to obtain the Echo-doppler-CO (and ThD-CO when applicable) measurements.
B. Echo-Doppler data acquisition (transoesophageal - TOE - or transthoracic - TTE - echo) Echo-Doppler-CO will be measured using the standard formula CSA x VTI (cross sectional area x velocity time integral x heart rate in ml/min). 2D measurement of the aortic annulus diameter allows calculation of the flow CSA which is then multiplied by the VTI (velocity time integral) of the Pulsed Doppler flow velocity profile across the aortic valve to determine the SV.
Other hemodynamic variables as an ancillary part of the study will compare shortening fraction (SF) or EF fraction from Echocardiography with CCE and dp/dt.
C. Thermodilution data acquisition (ThD-CO) (when applicable) Data coming from ThD pulmonary artery catheter (PAC) or a CVC + femoral artery catheter (transpulmonary thermodilution, PiCCO system) will be collected from the monitor itself or the system for patient monitoring used in the units.
研究设计
- 研究类型
- Observational
- 观察模型
- Cohort
- 时间视角
- Prospective
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Patients equipped with a standard arterial catheter-line (femoral or radial artery) for invasive arterial blood pressure monitoring.
- •Patients requiring an echocardiographic evaluation - Transthoracic Echocardiographic Evaluation (TEE)or Transesophageal Echocardiographic Evaluation (TOE) - as a routine need or in the context of Acute Cardiocirculatory failure with suspected implication of cardiac dysfunction or Acute Respiratory failure and suspicion of cardiac failure.
- •*When a pulmonary artery catheter (PAC, standard bolus thermodilution, ThD) is used or a central venous catheter linked with a femoral artery catheter to measure the transpulmonary thermodilution (PiCCO system: Continuous pulse contour cardiac analysis), the comparison will be done as a secondary end point of the protocol.
- •The point n.3 is optional
排除标准
- •Related to MostCare:
- •pathologies that could affect the quality and reliability of the arterial signal (aortic valve pathologies, aortic aneurysms) and arrhythmias that generate hemodynamic instability (i.e., variations in mean BP measurements > 10%); poor quality of the arterial pressure signal after a standard flush test (i.e., over-damped or under-damped arterial trace).
- •Related to Echo-Doppler: non-feasibility to obtain a fulfilled quality of the images.
- •Patients younger than 18.
结局指标
主要结局
cardiac output
时间窗: comparison of monitoring systems
comparison of cardiac output monitoring systems
次要结局
未报告次要终点
研究者
Sabino Scolletta
MD, Principal Investigator
Azienda Ospedaliera Universitaria Senese