Ayşegül ÖZGÖK, Süheyla ÜNVER, Dilek KAZANCI, Bahar AYDINLI, Mihrican KOÇ, Huriye KEŞ

Kardiyopulmoner baypas greft cerrahisi yapılan hastalarda termodilüsyon yöntemi ile arteriyel basınç dalga analiz yönteminden elde edilen kardiyak output ölçümlerinin karşılaştırılması

Amaç: Bu çalışmada; koroner arter baypas greft (KABG) cerrahisi boyunca farklı dönemlerde, FloTrac/Vigileo sistemi ve altın standart olan termodilüsyon yönteminden elde ettiğimiz kardiyak debi ölçümleri eşzamanlı olarak kaydedilerek karşılaştırılarak FloTrac/ Vigileo sisteminin doğruluk ve güvenilirlik düzeyi belirlendi. Çalışma planı: Bu çalışmaya etik komisyonu onayı sonrası KABG ameliyatı planlanan, ASA II grubundan 22 hasta dahil edildi. Kardiyopulmoner baypasın farklı zaman dilimlerinde termodilüsyon ve FloTrac/Vigileo sistemi ile ölçülen kardiyak debi, atım hacmi, kalp hızı ve kardiyak indeks değerleri eş zamanlı olarak kaydedildi. Bu dönemler şunlardı: $T_1$: pulmoner artere kateter yerleştirilmesi sonrası yapılan ilk ölçüm, $T_2$: sol internal meme arterinin (sol İMA) çıkarılması aşamasında, $T_3$: kanülasyondan önce, $T_4$: kros klemp açıldıktan hemen sonra, $T_5$: hasta kanı 33 °C’ye ısınırken, $T_6$: hasta kanı 35 °C’ye ısınırken, $T_7$: 36.5 °C’de pompadan çıkmadan önce, $T_8$: pompadan çıktıktan sonra, $T_9$: sternum kapatıldıktan sonra. Tüm veriler SPSS 16.0 versiyon programına aktarıldı ve Bland-Altman analizi ve Pearson korelasyon testi ile değerlendirildi. Bulgular: Kardiyak debi konusunda $T_1$, $T_2$, $T_3$ v e $T_9$ dönemlerinde, kardiyak indeks konusunda ise $T_1$, $T_2$, $T_3$, $T_8$ ve $T_9$ dönemlerinde her iki ölçüm yönteminden elde edilen ortalama değerlerin %95 güven aralığı içinde yer aldığı görüldü. Kardiyak debi ve kardiyak indeks ölçüm sonuçları karşılaştırıldığında da FloTrac/Vigileo ile termodilüsyon yöntemleri bu dönemlerde iyi bir uyum ve pozitif korelasyon sergiledi. Ancak, $T_7$ periyodunda kardiyak indeks konusunda korelasyon tespit edilmedi. Sonuç: Daha komplike durumlar ve inotropik destek alan hastalar için ileri çalışmalara gereksinim olmakla birlikte, kolay kullanım ve daha az invaziv olma avantajı sunan FloTrac/Vigileo sisteminin, kardiyak cerrahi uygulanacak hastalarda ve nonkardiyak cerrahiye hazırlanan kardiyak açıdan risk taşıyan hastalarda kardiyak debinin belirlenmesinde iyi bir seçenek olduğu sonucuna varıldı.

Comparison of cardiac output measurements obtained through thermo dilution method and arterial pressure wave analysis in patients undergoing cardiopulmonary bypass graft surgery

Background: In this study we aimed to determine the accuracy and reliability of the FloTrac/Vigileo system by comparing cardiac output measurements obtained simultaneously from the FloTrac/Vigileo system and the gold standard thermodilution technique at different periods during cardiac arterial bypass graft (CABG) surgery. Methods: After ethics committee approval, 22 patients in the ASA II group who were planned for CABG surgery were included in the study. Cardiac output, stroke volume, heart rate and cardiac index values obtained from the FloTrac/Vigileo system and the thermodilution method were simultaneously recorded during different cardiac bypass periods. These periods were as follows: $T_1$: the first measurement after pulmonary artery catheter insertion; $T_2$: at the time of left internal mammary artery (LIMA) extraction; $T_3$: before cannulation; $T_4$: immediately after releasing the cross-clamp; $T_5$: during warming patient’s blood to 33 °C; $T_6$: during warming patient’s blood to 35 °C; $T_7$: at 36.5 °C before removing the patient from bypass; $T_8$: after the patient was removed from bypass; $T_9$: after the sternum was closed. All data were transferred into SPSS version 16.0 software and evaluated with the Bland-Altman analysis and the Pearson correlation tests. Results: The mean cardiac output values obtained from both measurement techniques at $T_1$, $T_2$, $T_3$ and $T_9$ periods and the mean cardiac index values obtained from both measurement techniques at $T_1$, $T_2$, $T_3$, $T_8$ a nd $T_9$ periods were found to be within the 95% confidence interval. Moreover, when the cardiac output and cardiac index measurement results were compared, the FloTract/Vigileo and thermodilution methods showed a good level of accordance and positive correlation at these periods. But no correlation was found for cardiac index at the $T_7$ period. Conclusion: While there is a need for more studies on more complicated conditions and in patients receiving inotropic support, we concluded that FloTract/Vigileo system, which provides the advantages of ease of use and less invasiveness, is a good choice for determining cardiac output in patients who will have cardiac surgery and in patients with cardiac risk who will have non-cardiac surgery.

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