医疗安全

个体化血流动力学管理 -- 将走向何方?

时间:2017-07-13

Personalized hemodynamic management - where is the journey going?

个体化血流动力学管理 -- 将走向何方?

Considerations on the occasion of the recent publication of the clinical validationstudy on CNAP CO.

基于最近出版的关于CNAP CO临床验证研究的思考

(文献原文请见本文结尾 “阅读原文”)

 


 

> Medical community is concerned with essential questions related to hemodynamic (HD) optimization

Hemodynamic (HD) management is an omnipresent issue in the current medical literature. The end-of-the-year-summary of the Journal of Clinical Monitoring and Computing, for example, reflects that cardiovascular and hemodynamic monitoring is alively discussion among the medical experts.[1]

Relevant topics include the validation of new technologies, the impact of hemodynamic monitoring on patient outcome and clinical decision-making, studies on current clinical practice in hemodynamic monitoring, technical aspects and developments in this field, and the use of dynamic cardiac preload parameters in hemodynamic management.[1]

> 医学界关注与血流动力学(HD)优化相关的基本问题

血流动力学(HD)管理是当前医学文献中的热点问题。例如,《Journal of Clinical Monitoring and Computing》杂?#39545;?#24180;终总结时提出:心血管和血流动力学监测是现在医学专家之间的热烈讨论的话题[1]

相关话题的讨论包括对新技术准确性的验证、血流动力学监测对患者结局和临床决策的影响、当前对血流动力学监测的临床实践的研究、该领域的技术及发展以及使用动态?#33041;嗲案?#33655;?#38382;?#36827;行血流动力学管理[1]。 

 

 

> Simple, noninvasive methods are on the rise

Cardiac Output (CO) monitoring is an essential part of hemodynamic optimization.

The awareness of safety, ease-of-use and need for continuous CO management in the course of goal-directed the rapies has grown during the last few years.[1]

> 简单、无创的方法正在逐渐增加

心输出量(CO)监测是血流动力学优化的重要组成部分。

现在CO监测的重点已经开?#21363;?#26377;创方法向微创方法,甚至是完全无创的方法转变。

过去几年来,?#38405;?#26631;导向治疗过程中连续心排量CO管理的安全性、易用性的需求意识逐渐增强[1]

 

 

> Where is the journey going?

A very recent, innovative approach to HD management was presented a few days ago by Drs. Bernd Saugel, Jean-Louis Vincent and Julia Wagner: this concept shows that it might be more effective to optimize cardiovascular dynamics based on the patient’s personal hemodynamic profile rather than on standard value ranges as they do not necessarily represent the optimal individual hemodynamic state.[2]

To be able to implement such innovative the rapies into clinical practice, the challenge is that technologies are required which allow assessing the hemodynamic parameters in EVERY patient. We again face the claim for preferably noninvasive devices with proven clinical accuracy.

> 血流动力学管理将走向何方?

Drs. Bernd Saugel,Jean-Louis Vincent和Julia Wagner几天前提出了一种新型的血流动力学管理方法,此观点提出:根据患者的个体化血流动力学特征而不是标准值范围来优化心血管动力学可能更?#34892;В?#22240;为标准值范围不一定代表个体最佳的血流动力学状态。

为了能够将这些创新的治疗方法应用于临床实践,挑战就在于此技术需要能够评估“每位”患者的血流动力学?#38382;?#25105;们再次面临最佳无创设备的要求:具有临床证明的准确性。

 

 

> The reliable noninvasive solution: CNAP HD

Only recently, noninvasive hemodynamic monitoring with CNAP HD has been clinically validated in a scientific study: “In this prospective clinical method comparison study we evaluated the measurement performance of the volume clamp method-based continuous noninvasive CNCO (by CNAP HD) in comparison with intermittent PAC (Pulmonary Artery Catheter) -CO measurements in patients treated in the ICU after cardiothoracic surgery.”[3]

The study shows promising results with good agreement and excellent trending ability of CNAP CO compared to PAC-CO! [3] Further, signal stability and fast recovery after motion is also reported as a potential “advantage in relation to other technologies for continuous noninvasive CO monitoring.”[3]

> 可靠的无创解决方案:CNAP HD

最近,CNAP HD的无创血流动力学监测已经在一项科学研究中得到了临床验证:“在这项前瞻性临床方法比较研究中,我们评估了病人心胸外科手术治疗后在ICU中将基于体积钳法的连续无创CNCO(CNAP HD)与间断肺动脉导管PAC-CO的测量性能进行比较。”[3]

研究显示,与PAC-CO相比,CNAP CO具有良好的一致性和趋势追踪能力。与此同时,相较于其他连续无创CO监测技术,CNAP CO具?#34892;?#21495;稳定性和运动后快速?#25351;?#31561;潜在优势。”[3]

 

 

> Extending HD monitoring to even more - and finally all patients

The advantages of clinically proven accurate noninvasive methods have already convinced many experts in different settings. “[…] the perioperative setting including intermediate-risk surgery as well as high-dependency unit patients are conceivable applications. In this setting, noninvasive technologies for continuous CO assessment might in the future allow treating more patient groups using perioperative goal-directed hemodynamic the rapy.”[3]

The final goal should be to provide the best (noninvasive) practice and patient treatment in all settings for hemodynamic monitoring and, really in all patients!

> 将血流动力学监测扩展到更多患者,最后是全部的患者

CNAP HD临床验证的准确无创方法的优点已经被在许多不同诊疗环境的专家所接受。“[...]可应用在围术期中度风险手术以及高依赖性病房患者。在这种情况下,连续无创CO技术将来可能治疗更多的使用围手术期目标导向血流动力学治疗的患者群体。”[3]

血流动力学监测的最终目标应该是在所有诊疗环境中为所有患者提供最佳(无创)的血流动力学监测实践和患者治疗!

 


 

References:

[1] Saugel, B., Bendjelid, K., Critchley, L. A., Rex, S., & Scheeren, T. W. L. (2017). Journal of Clinical Monitoring and Computing 2016 end of year summary: cardiovascular and hemodynamic monitoring. Journal of Clinical Monitoring and Computing. doi.org/10.1007/s10877-017-9976-3

[2] Saugel, Bernd; Vincent, Jean-Louis; Wagner, Julia Y. (2017). Personalized hemodynamic management. Current Opinion in Critical Care: Post Author Corrections: May 27, 2017 doi: 10.1097/MCC.0000000000000422

[3] Wagner, J. Y., Körner, A., Schulte-Uentrop, L., Kubik, M., Reichenspurner, H., Kluge, S., Saugel, B. (2017). A comparison of volume clamp method-based continuous noninvasive cardiac output (CNCO) measurement versus intermittent pulmonary artery thermodilution in postoperative cardiothoracic surgery patients. Journalof Clinical Monitoring and Computing, 1–10.doi.org/10.1007/s10877-017-0027-x

 

本文摘自奥地利cnsystems官网http://www.cnsystems.com

 

 

 

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