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Salek N, Jamre M, B. LM, Jalilian AR, Shamsaee M. Feasibility and improvement in production of 191Os/191mIr generator by Tehran Research Reactor (TRR). ANN NUCL ENERGY 2012. [DOI: 10.1016/j.anucene.2011.09.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Monnet X, Anguel N, Jozwiak M, Richard C, Teboul JL. Third-generation FloTrac/Vigileo does not reliably track changes in cardiac output induced by norepinephrine in critically ill patients. Br J Anaesth 2012; 108:615-22. [PMID: 22265900 DOI: 10.1093/bja/aer491] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The ability of the third-generation FloTrac/Vigileo software to track changes in cardiac index (CI) induced by volume expansion and norepinephrine in critically ill patients is unknown. METHODS In subjects with circulatory failure, we administered volume expansion (20 subjects) and increased (20 subjects) or decreased (20 subjects) the dose of norepinephrine. We measured arterial pressure waveform-derived CI provided by the third-generation FloTrac/Vigileo device (CI(pw)) and transpulmonary thermodilution CI (CI(td)) before and after therapeutic interventions. RESULTS Considering the pairs of measurements performed before and after all therapeutic interventions (n=60), a bias between the absolute values of CI(pw) and CI(td) was 0.26 (0.94) litre min(-1) m(-2) and the percentage error was 54%. Changes in CI(pw) tracked changes in CI(td) induced by volume expansion with moderate accuracy [n=20, bias=-0.11 (0.54) litre min(-1) m(-2), r(2)=0.26, P=0.02]. When changes in CI(td) were induced by norepinephrine (n=40), a bias between CI(pw) and CI(td) was 0.01 (0.41) litre min(-1) m(-2) (r(2)=0.11, P=0.04). The concordance rates between changes in CI(pw) and CI(td) induced by volume expansion and norepinephrine were 73% and 60%, respectively. The bias between changes in CI(pw) and CI(td) significantly correlated with changes in total systemic vascular resistance (r(2)=0.41, P<0.0001). CONCLUSIONS The third-generation FloTrac/Vigileo device was moderately reliable for tracking changes in CI induced by volume expansion and poorly reliable for tracking changes in CI induced by norepinephrine.
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Affiliation(s)
- X Monnet
- Hôpitaux universitaires Paris-Sud, Hôpital de Bicêtre, service de réanimation médicale, 78, rue du Général Leclerc, Le Kremlin-Bicêtre F-94270, France.
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Zhang Z, Lu B, Sheng X, Jin N. Accuracy of stroke volume variation in predicting fluid responsiveness: a systematic review and meta-analysis. J Anesth 2011; 25:904-16. [PMID: 21892779 DOI: 10.1007/s00540-011-1217-1] [Citation(s) in RCA: 118] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Accepted: 08/11/2011] [Indexed: 02/07/2023]
Abstract
PURPOSE Stroke volume variation (SVV) appears to be a good predictor of fluid responsiveness in critically ill patients. However, a wide range of its predictive values has been reported in recent years. We therefore undertook a systematic review and meta-analysis of clinical trials that investigated the diagnostic value of SVV in predicting fluid responsiveness. METHODS Clinical investigations were identified from several sources, including MEDLINE, EMBASE, WANFANG, and CENTRAL. Original articles investigating the diagnostic value of SVV in predicting fluid responsiveness were considered to be eligible. Participants included critically ill patients in the intensive care unit (ICU) or operating room (OR) who require hemodynamic monitoring. RESULTS A total of 568 patients from 23 studies were included in our final analysis. Baseline SVV was correlated to fluid responsiveness with a pooled correlation coefficient of 0.718. Across all settings, we found a diagnostic odds ratio of 18.4 for SVV to predict fluid responsiveness at a sensitivity of 0.81 and specificity of 0.80. The SVV was of diagnostic value for fluid responsiveness in OR or ICU patients monitored with the PiCCO or the FloTrac/Vigileo system, and in patients ventilated with tidal volume greater than 8 ml/kg. CONCLUSIONS SVV is of diagnostic value in predicting fluid responsiveness in various settings.
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Affiliation(s)
- Zhongheng Zhang
- Department of Critical Care Medicine, Jinhua Central Hospital, 351# Mingyue Road, Jinhua, 321000, Zhejiang, People's Republic of China.
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Machare-Delgado E, Decaro M, Marik PE. Inferior vena cava variation compared to pulse contour analysis as predictors of fluid responsiveness: a prospective cohort study. J Intensive Care Med 2011; 26:116-24. [PMID: 21595098 DOI: 10.1177/0885066610384192] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Both occult hypoperfusion and volume overload are associated with increased morbidity and mortality in critically ill patients. Accurately predicting fluid responsiveness (FRes) allows for optimization of cardiac performance while avoiding fluid overload and prolonged mechanical ventilation. OBJECTIVE To simultaneously assess the ability to predict FRes using the stroke volume variation (SVV) obtained with the Vigileo/Flotrac monitor and inferior vena cava respiratory variation (ΔIVC) measured by standard echocardiography ([ECHO) during mechanical ventilation. METHODS We included medical intensive care unit (ICU) patients undergoing mechanical ventilation that required vasopressors, had worsening organ function, and that were well adapted to the ventilator. We excluded patients requiring escalating doses of vasopressors, hemodialysis, with ascites and patients with atrial fibrillation or a heart rate >120/min. Stroke volume index (SVI) and SVV were obtained from the Vigileo monitor whereas ΔIVC was obtained with ECHO (M-mode). Doppler ECHO was used to measure SVI and used to determine FRes (defined by SVI increase ≥ 10%). A data set was obtained before and 30 minutes after a 10-minute fluid challenge (FC) with 500 mL of saline. RESULTS In all, 25 patients were prospectively enrolled over an 8-month period. A total of 12 patients had acute respiratory distress syndrome (ARDS), 3 had a cardiac arrest, and 10 had sepsis. The patients' mean age was 61.36 years (±13.7), study enrollment since ICU admission was 3.4 days (±3.39), the Sequential Organ Failure Assessment (SOFA) score was 12.44 (±2.59), and the tidal volume 8.6 mL/kg (±1.68). Of the 25 patients, 8 (32%) were FRes. The correlation coefficient between the baseline ΔIVC and percentage increase in SVI (by ECHO) after an FC was R(2) = .51 with a receiver operating characteristic (ROC) curve of 0.81 while that for the baseline SVV by Vigileo was R(2) = .12 with an ROC curve of 0.57. The mean SVI bias between ECHO and Vigileo was -2 mL/m(2), the precision was -18 to 14 and the mean error was 46%. CONCLUSIONS ECHO assessment of the IVC variation during mechanical ventilation may prove to be a useful technique to predict FRes and guide fluid resuscitation in the ICU. The SVV obtained with the Vigileo monitor failed to predict FRes likely due to lack of calibration and the use of a complex algorithm that may be unreliable in patients with sepsis.
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Affiliation(s)
- Enrique Machare-Delgado
- Division of Pulmonary and Critical Care Medicine, Thomas Jefferson University, Philadelphia, PA, USA
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Kotake Y, Yamada T, Nagata H, Takeda J, Shimizu H. Transient Hemodynamic Change and Accuracy of Arterial Blood Pressure-Based Cardiac Output. Anesth Analg 2011; 113:272-4. [DOI: 10.1213/ane.0b013e31821b44fc] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Teng S, Kaufman J, Pan Z, Czaja A, Shockley H, da Cruz E. Continuous arterial pressure waveform monitoring in pediatric cardiac transplant, cardiomyopathy and pulmonary hypertension patients. Intensive Care Med 2011; 37:1297-301. [PMID: 21626432 DOI: 10.1007/s00134-011-2252-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2010] [Accepted: 04/05/2011] [Indexed: 11/25/2022]
Abstract
PURPOSE A continuous cardiac output monitor based on arterial pressure waveform (FloTrac/Vigileo; Edwards Lifesciences, Irvine, CA) is now approved for use in adults but not in children. This device is minimally invasive, calculates cardiac output continuously and in real time, and is easy to use. Our study sought to validate the FloTrac with the pulmonary artery catheter (PAC) intermittent thermodilution technique in pediatric cardiac patients. METHODS This was a prospective pilot study comparing cardiac output measurements obtained via the FloTrac and arterial pressure waveform analysis with intermittent thermodilution. Subjects carried the diagnosis of pulmonary hypertension or cardiomyopathy, or were in the postoperative course after orthotopic heart transplantation. RESULTS Enrolled in the study were 31 subjects, and 136 data points were obtained. The age range was 8 months to 16 years. The mean body surface area (BSA) was 1.1 m(2). Bland-Altman plots for the mean cardiac outputs of all subjects with a BSA ≥ 1 m(2) showed limits of agreement of -2.7 to 8.0 l/min (± 5.4 l/min). Patients with a BSA ≤ 1 m(2) demonstrated even wider limits of agreement (± 8.5 l/min). The intraclass correlation for the PAC was 0.929 and 0.992 for the FloTrac. CONCLUSION There was poor agreement between the PAC and FloTrac in measuring cardiac output in a population of children with pulmonary hypertension or cardiomyopathy, or after cardiac transplantation. This is in contrast to adult studies published thus far. This suggests that the utility of the FloTrac and measurements obtained from arterial pulse wave analysis in children is uncertain at this time.
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Affiliation(s)
- Sarena Teng
- Division of Critical Care, Department of Pediatrics, The Children's Hospital, Aurora, CO, USA
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Singh S, Taylor MA. Con: the FloTrac device should not be used to follow cardiac output in cardiac surgical patients. J Cardiothorac Vasc Anesth 2011; 24:709-11. [PMID: 20673749 DOI: 10.1053/j.jvca.2010.04.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2010] [Indexed: 11/11/2022]
Affiliation(s)
- Saket Singh
- Department of Anesthesiology, The Western Pennsylvania Hospital, Temple University School of Medicine, Pittsburgh, PA 15224, USA.
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Geerts BF, Aarts LP, Jansen JR. Methods in pharmacology: measurement of cardiac output. Br J Clin Pharmacol 2011; 71:316-30. [PMID: 21284692 DOI: 10.1111/j.1365-2125.2010.03798.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Many methods of cardiac output measurement have been developed, but the number of methods useful for human pharmacological studies is limited. The 'holy grail' for the measurement of cardiac output would be a method that is accurate, precise, operator independent, fast responding, non-invasive, continuous, easy to use, cheap and safe. This method does not exist today. In this review on cardiac output methods used in pharmacology, the Fick principle, indicator dilution techniques, arterial pulse contour analysis, ultrasound and bio-impedance are reviewed.
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Affiliation(s)
- Bart F Geerts
- Departments of Anaesthesiology Intensive Care Medicine, Leiden University Medical Center, Leiden, the Netherlands.
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Jo YY, Song JW, Yoo YC, Park JY, Shim JK, Kwak YL. The uncalibrated pulse contour cardiac output during off-pump coronary bypass surgery: performance in patients with a low cardiac output status and a reduced left ventricular function. Korean J Anesthesiol 2011; 60:237-43. [PMID: 21602972 PMCID: PMC3092957 DOI: 10.4097/kjae.2011.60.4.237] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Revised: 10/08/2010] [Accepted: 10/26/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We compared the continuous cardiac index measured by the FloTrac/Vigileo™ system (FCI) to that measured by a pulmonary artery catheter (CCI) with emphasis on the accuracy of the FCI in patients with a decreased left ventricular ejection fraction (LVEF) and a low cardiac output status during off-pump coronary bypass surgery (OPCAB). We also assessed the influence of several factors affecting the pulse contour, such as the mean arterial pressure (MAP), the systemic vascular resistance index (SVRI) and the use of norepinephrine. METHODS Fifty patients who were undergoing OPCAB (30 patients with a LVEF ≥ 40%, 20 patients with a LVEF < 40%) were enrolled. The FCI and CCI were measured and we performed a Bland-Altman analysis. Subgroup analyses were done according to the LVEF (< 40%), the CCI (≤ 2.4 L/min/m), the MAP (60-80 mmHg), the SVRI (1,600-2,600 dyne/s/cm(5)/m(2)) and the use of norepinephrine. RESULTS The FCI was reliable at all the time points of measurement with an overall bias and limit of agreement of -0.07 and 0.67 L/min/m(2), respectively, resulting in a percentage error of 26.9%. The percentage errors in the patients with a decreased LVEF and in a low cardiac output status were 28.2% and 22.3%, respectively. However, the percentage error in the 91 data pairs outside the normal range of the SVRI was 40.2%. CONCLUSIONS The cardiac output measured by the FloTrac/Vigileo™ system was reliable even in patients with a decreased LVEF and in a low cardiac output status during OPCAB. Acceptable agreement was also noted during the period of heart displacement and grafting of the obtuse marginalis branch.
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Affiliation(s)
- Youn Yi Jo
- Department of Anesthesiology and Pain Medicine, Gachon University of Medicine and Science, Gil Medical Center, Incheon, Korea
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Paarmann H, Groesdonk H, Sedemund-Adib B, Hanke T, Heinze H, Heringlake M, Schön J. Lack of agreement between pulmonary arterial thermodilution cardiac output and the pressure recording analytical method in postoperative cardiac surgery patients ‡. Br J Anaesth 2011; 106:475-81. [DOI: 10.1093/bja/aeq372] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
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Alhashemi JA, Cecconi M, Hofer CK. Cardiac output monitoring: an integrative perspective. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2011; 15:214. [PMID: 21457508 PMCID: PMC3219410 DOI: 10.1186/cc9996] [Citation(s) in RCA: 147] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Jamal A Alhashemi
- Institute of Anesthesiology and Intensive Care Medicine, Triemli City Hospital, Birmensdorfersr 497, 8063 Zurich, Switzerland.
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Hemodynamic Changes During a Combined Psoas Compartment–Sciatic Nerve Block for Elective Orthopedic Surgery. Anesth Analg 2011; 112:719-24. [DOI: 10.1213/ane.0b013e318206bc30] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Vetrugno L, Costa MG, Spagnesi L, Pompei L, Chiarandini P, Gimigliano I, Della Rocca G. Uncalibrated Arterial Pulse Cardiac Output Measurements in Patients With Moderately Abnormal Left Ventricular Function. J Cardiothorac Vasc Anesth 2011; 25:53-8. [DOI: 10.1053/j.jvca.2010.07.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Indexed: 11/11/2022]
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Accuracy of arterial pressure waveform analysis for cardiac output measurement in comparison with thermodilution methods in patients undergoing living donor liver transplantation. J Anesth 2011; 25:178-83. [PMID: 21246221 DOI: 10.1007/s00540-010-1087-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Accepted: 12/15/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE The aim of this study was to assess the accuracy of the first and third versions of arterial pressure waveform cardiac output (APCO(v.1.0) and APCO(v.3.0)) measurements in comparison with thermodilution methods in patients undergoing living donor liver transplantation. METHODS Twenty patients were anesthetized and mechanically ventilated. A radial arterial line was connected to a dedicated transducer for the APCO evaluation (FloTrac™). A pulmonary artery catheter was placed and connected to a computer system (Vigilance™) to measure intermittent thermodilution cardiac output (CO(TD)) and continuous cardiac output (CCO). RESULTS A total of 138 measurements were analyzed. Bland-Altman analysis showed that the mean biases for CO(TD)-APCO(v.3.0), CO(TD)-APCO(v.1.0), and CO(TD)-CCO were 0.89, 1.73, and -0.79 L/min, and the adjusted percentage errors were 37.5, 30.3, and 43%, respectively. While the variance for CO(TD)-APCO(v3.0) was greater, the accuracy (bias) improved by 0.8 L/min as compared with CO(TD)-APCO(v1.0). The difference CO(TD)-APCO(v.3.0) became apparent when systemic vascular resistance was lower than 1000 dyne × s/cm(5), especially below 700 dyne × s/cm(5). CONCLUSION These data suggest that the accuracy of APCO(v.3.0) has improved compared to APCO(v.1.0) due to the updated algorithm, but additional improvements should be evaluated, especially in patients undergoing living donor liver transplantation with low systemic vascular resistance.
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A randomized controlled trial comparing an intraoperative goal-directed strategy with routine clinical practice in patients undergoing peripheral arterial surgery. Eur J Anaesthesiol 2010; 27:788-93. [PMID: 20613538 DOI: 10.1097/eja.0b013e32833cb2dd] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVE We hypothesized that, in vascular surgery patients, the application of a goal-directed strategy based on a pulse contour-derived cardiac index would be associated with a better haemodynamic status than the application of routine perioperative care and that the amount of fluid and/or inotropes required in such a goal-directed therapy depended on the general anaesthetic technique used. METHODS Patients undergoing peripheral arterial bypass grafting were randomly assigned to three groups. In group 1, haemodynamic management was performed according to routine clinical practice. In the two other groups (groups 2 and 3) a goal-directed therapy was applied aiming to maintain the pulse contour-derived cardiac index above 2.5 l m min. Patients in groups 1 and 2 received sevoflurane-based anaesthesia and patients in group 3 propofol-based anaesthesia. Haemodynamic variables, amount of fluid and administration of inotropes were assessed at different time intervals. RESULTS The amount of fluid administered was not significantly different between the groups. Two patients in group 1, 13 patients in group 2 and 12 patients in group 3 were treated with dobutamine (P < 0.001). None of the patients anaesthetized with sevoflurane (groups 1 and 2) experienced postoperative cardiovascular complications, whereas four patients in the total intravenous group (group 3) experienced major postoperative cardiovascular complications (P = 0.005). CONCLUSION In the conditions of the present study, the application of a goal-directed therapy aiming to maintain the cardiac index above 2.5 l min m did not result in a higher tissue oxygen delivery than when applying the standard haemodynamic strategy nor did it depend on the anaesthetic technique used.
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Pugsley J, Lerner AB. Cardiac output monitoring: is there a gold standard and how do the newer technologies compare? Semin Cardiothorac Vasc Anesth 2010; 14:274-82. [PMID: 21059611 DOI: 10.1177/1089253210386386] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
As a principal determinant of oxygen delivery and of blood pressure, cardiac output (CO) represents an important hemodynamic variable. Its accurate measurement, therefore, is important to the clinician caring for critically ill patients in a variety of care environments. Though the first clinical measurement of CO occurred 70 years ago, it was the introduction of the pulmonary artery catheter (PAC) with thermodilution-based determination of CO in the 1970s that set the stage for practical and widespread clinical measurement of CO. Although the usefulness and accuracy of this technique have justified its consideration as a "practical" gold standard in CO measurement, its drawbacks have driven the search for newer, less invasive measurement techniques. The last decade has seen the introduction of several such devices into the clinical arena. This article will serve to give a brief review of the history of CO measurement, to provide a discussion of the measurement of accuracy as it relates to CO measurement, and to discuss some of the newer methods and devices for CO measurement and how they have fared against a "practical" gold standard.
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Affiliation(s)
- Jacob Pugsley
- Beth Israel Deaconess Medical Center, Boston, MA, USA
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Alhashemi JA, Cecconi M, della Rocca G, Cannesson M, Hofer CK. Minimally invasive monitoring of cardiac output in the cardiac surgery intensive care unit. Curr Heart Fail Rep 2010; 7:116-24. [PMID: 20623210 DOI: 10.1007/s11897-010-0019-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Cardiac output monitoring in the cardiac surgery patient is standard practice that is traditionally performed using the pulmonary artery catheter. However, over the past 20 years, the value of pulmonary artery catheters has been challenged, with some authors suggesting that its use might be not only unnecessary but also harmful. New minimally invasive devices that measure cardiac output have become available. In this paper, we review their operative principles, limitations, and utility in an integrated approach that could potentially change patients' outcome. However, it is now clear that it is how the monitor is used (ie, the protocol or therapy associated with its use, or its lack thereof), and not the monitor per se, that should be questioned when a patient's outcome is being evaluated.
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Affiliation(s)
- Jamal A Alhashemi
- Department of Anesthesia and Critical Care, King Abdulaziz University, P.O. Box 31648, Jeddah, 21418, Saudi Arabia
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Yeo LLL, Seow SC, Loh JPY, Phua J. Comparison of Cardiac Output Measurement by Arterial Waveform Analysis and Pulmonary Artery Catheter in Mitral Stenosis. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2010. [DOI: 10.47102/annals-acadmedsg.v39n8p655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Benes J, Chytra I, Altmann P, Hluchy M, Kasal E, Svitak R, Pradl R, Stepan M. Intraoperative fluid optimization using stroke volume variation in high risk surgical patients: results of prospective randomized study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2010; 14:R118. [PMID: 20553586 PMCID: PMC2911766 DOI: 10.1186/cc9070] [Citation(s) in RCA: 300] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2010] [Revised: 05/04/2010] [Accepted: 06/16/2010] [Indexed: 12/16/2022]
Abstract
Introduction Stroke volume variation (SVV) is a good and easily obtainable predictor of fluid responsiveness, which can be used to guide fluid therapy in mechanically ventilated patients. During major abdominal surgery, inappropriate fluid management may result in occult organ hypoperfusion or fluid overload in patients with compromised cardiovascular reserves and thus increase postoperative morbidity. The aim of our study was to evaluate the influence of SVV guided fluid optimization on organ functions and postoperative morbidity in high risk patients undergoing major abdominal surgery. Methods Patients undergoing elective intraabdominal surgery were randomly assigned to a Control group (n = 60) with routine intraoperative care and a Vigileo group (n = 60), where fluid management was guided by SVV (Vigileo/FloTrac system). The aim was to maintain the SVV below 10% using colloid boluses of 3 ml/kg. The laboratory parameters of organ hypoperfusion in perioperative period, the number of infectious and organ complications on day 30 after the operation, and the hospital and ICU length of stay and mortality were evaluated. The local ethics committee approved the study. Results The patients in the Vigileo group received more colloid (1425 ml [1000-1500] vs. 1000 ml [540-1250]; P = 0.0028) intraoperatively and a lower number of hypotensive events were observed (2[1-2] Vigileo vs. 3.5[2-6] in Control; P = 0.0001). Lactate levels at the end of surgery were lower in Vigileo (1.78 ± 0.83 mmol/l vs. 2.25 ± 1.12 mmol/l; P = 0.0252). Fewer Vigileo patients developed complications (18 (30%) vs. 35 (58.3%) patients; P = 0.0033) and the overall number of complications was also reduced (34 vs. 77 complications in Vigileo and Control respectively; P = 0.0066). A difference in hospital length of stay was found only in per protocol analysis of patients receiving optimization (9 [8-12] vs. 10 [8-19] days; P = 0.0421). No difference in mortality (1 (1.7%) vs. 2 (3.3%); P = 1.0) and ICU length of stay (3 [2-5] vs. 3 [0.5-5]; P = 0.789) was found. Conclusions In this study, fluid optimization guided by SVV during major abdominal surgery is associated with better intraoperative hemodynamic stability, decrease in serum lactate at the end of surgery and lower incidence of postoperative organ complications. Trial registration Current Controlled Trials ISRCTN95085011.
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Affiliation(s)
- Jan Benes
- Department of Anesthesiology and Intensive Care, Charles University teaching hospital, alej Svobody 80, Plzen 304 60, Czech Republic.
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Monnet X, Anguel N, Naudin B, Jabot J, Richard C, Teboul JL. Arterial pressure-based cardiac output in septic patients: different accuracy of pulse contour and uncalibrated pressure waveform devices. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2010; 14:R109. [PMID: 20537159 PMCID: PMC2911755 DOI: 10.1186/cc9058] [Citation(s) in RCA: 104] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2009] [Revised: 02/11/2010] [Accepted: 06/10/2010] [Indexed: 12/18/2022]
Abstract
INTRODUCTION We compared the ability of two devices estimating cardiac output from arterial pressure-curve analysis to track the changes in cardiac output measured with transpulmonary thermodilution induced by volume expansion and norepinephrine in sepsis patients. METHODS In 80 patients with septic circulatory failure, we administered volume expansion (40 patients) or introduced/increased norepinephrine (40 patients). We measured the pulse contour-derived cardiac index (CI) provided by the PiCCO device (CIpc), the arterial pressure waveform-derived CI provided by the Vigileo device (CIpw), and the transpulmonary thermodilution CI (CItd) before and after therapeutic interventions. RESULTS The changes in CIpc accurately tracked the changes in CItd induced by volume expansion (bias, -0.20 +/- 0.63 L/min/m2) as well as by norepinephrine (bias, -0.05 +/- 0.74 L/min/m2). The changes in CIpc accurately detected an increase in CItd >or= 15% induced by volume expansion and norepinephrine introduction/increase (area under ROC curves, 0.878 (0.736 to 0.960) and 0.924 (0.795 to 0.983), respectively; P < 0.05 versus 0.500 for both). The changes in CIpw were less reliable for tracking the volume-induced changes in CItd (bias, -0.23 +/- 0.95 L/min/m2) and norepinephrine-induced changes in CItd (bias, -0.01 +/- 1.75 L/min/m2). The changes in CIpw were unable to detect an increase in CItd >or= 15% induced by volume expansion and norepinephrine introduction/increase (area under ROC curves, 0.564 (0.398 to 0.720) and 0.541 (0.377 to 0.700, respectively, both not significantly different from versus 0.500). CONCLUSIONS The CIpc was reliable and accurate for assessing the CI changes induced by volume expansion and norepinephrine. By contrast, the CIpw poorly tracked the trends in CI induced by those therapeutic interventions.
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Affiliation(s)
- Xavier Monnet
- AP-HP, Hôpital de Bicêtre, Service de Réanimation Médicale, 78 Rue du Général Leclerc, Le Kremlin-Bicêtre F-94270, France.
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71
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Kwak HJ, Lee JS, Lee DC, Kim HS, Kim JY. The effect of a sequential compression device on hemodynamics in arthroscopic shoulder surgery using beach-chair position. Arthroscopy 2010; 26:729-33. [PMID: 20511029 DOI: 10.1016/j.arthro.2009.10.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2009] [Revised: 10/01/2009] [Accepted: 10/01/2009] [Indexed: 02/02/2023]
Abstract
PURPOSE This study investigated the effect of intermittent compression by a sequential compression device (SCD) on the incidence of hypotension and other hemodynamic variables in the beach-chair position. METHODS Fifty healthy patients undergoing elective shoulder arthroscopy under general anesthesia were randomly assigned to either the control group (n = 25) or SCD group (n = 25). A standardized protocol for pre-hydration and anesthetic technique was followed. Hemodynamic variables were measured before (pre-induction values) and 5 minutes after the induction of anesthesia in the supine position (baseline values) and 1, 3, and 5 minutes after the patient was raised to a 70 degrees sitting position. The incidence of hypotension was recorded and treated with ephedrine. RESULTS The incidence of hypotension was significantly higher in the control group (16 of 25) than that in the SCD group (7 of 25) (P = .022; odds ratio, 0.219; 95% confidence interval, 0.066 to 0.723). Between the groups, mean arterial pressure, cardiac index, and stroke volume index were significantly higher in the SCD group compared with values in the control group at 1 minute after patients were raised to a 70 degrees sitting position (P = .035, P = .046, and P = .011, respectively). CONCLUSIONS This study showed that the use of an SCD could reduce the incidence of hypotension from 64% to 28% and supports hemodynamic variables such as mean arterial pressure and stroke volume index when patients were changed from the supine to the beach-chair position in those undergoing shoulder arthroscopy. LEVEL OF EVIDENCE Level I, therapeutic randomized controlled trial.
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Affiliation(s)
- Hyun J Kwak
- Department of Anesthesiology and Pain Medicine, Gachon University of Medicine and Science, Gil Medical Center, Incheon, South Korea
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72
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Krejci V, Vannucci A, Abbas A, Chapman W, Kangrga IM. Comparison of calibrated and uncalibrated arterial pressure-based cardiac output monitors during orthotopic liver transplantation. Liver Transpl 2010; 16:773-82. [PMID: 20517912 DOI: 10.1002/lt.22056] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Arterial pressure-based cardiac output monitors (APCOs) are increasingly used as alternatives to thermodilution. Validation of these evolving technologies in high-risk surgery is still ongoing. In liver transplantation, FloTrac-Vigileo (Edwards Lifesciences) has limited correlation with thermodilution, whereas LiDCO Plus (LiDCO Ltd.) has not been tested intraoperatively. Our goal was to directly compare the 2 proprietary APCO algorithms as alternatives to pulmonary artery catheter thermodilution in orthotopic liver transplantation (OLT). The cardiac index (CI) was measured simultaneously in 20 OLT patients at prospectively defined surgical landmarks with the LiDCO Plus monitor (CI(L)) and the FloTrac-Vigileo monitor (CI(V)). LiDCO Plus was calibrated according to the manufacturer's instructions. FloTrac-Vigileo did not require calibration. The reference CI was derived from pulmonary artery catheter intermittent thermodilution (CI(TD)). CI(V)-CI(TD) bias ranged from -1.38 (95% confidence interval = -2.02 to -0.75 L/minute/m(2), P = 0.02) to -2.51 L/minute/m(2) (95% confidence interval = -3.36 to -1.65 L/minute/m(2), P < 0.001), and CI(L)-CI(TD) bias ranged from -0.65 (95% confidence interval = -1.29 to -0.01 L/minute/m(2), P = 0.047) to -1.48 L/minute/m(2) (95% confidence interval = -2.37 to -0.60 L/minute/m(2), P < 0.01). For both APCOs, bias to CI(TD) was correlated with the systemic vascular resistance index, with a stronger dependence for FloTrac-Vigileo. The capability of the APCOs for tracking changes in CI(TD) was assessed with a 4-quadrant plot for directional changes and with receiver operating characteristic curves for specificity and sensitivity. The performance of both APCOs was poor in detecting increases and fair in detecting decreases in CI(TD). In conclusion, the calibrated and uncalibrated APCOs perform differently during OLT. Although the calibrated APCO is less influenced by changes in the systemic vascular resistance, neither device can be used interchangeably with thermodilution to monitor cardiac output during liver transplantation.
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Affiliation(s)
- Vladimir Krejci
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO 63110, USA
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73
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Effects of on-pump and off-pump coronary artery bypass grafting on left ventricular relaxation and compliance: a comprehensive perioperative echocardiography study. Curr Opin Anaesthesiol 2010; 22:71-7. [PMID: 20421229 DOI: 10.1097/aco.0b013e32831f44d0] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
AIMS The short-term effect of coronary artery bypass grafting (CABG) on diastolic function is only moderately investigated. Furthermore, it remains unknown whether avoidance of cardioplegic arrest by an off-pump CABG procedure has advantages over on-pump procedure regarding diastolic relaxation and compliance. We investigated whether components of diastolic function would be improved the day after CABG depending on the type of the surgical procedure. METHODS AND RESULTS Spontaneously breathing on-pump (n = 20) and off-pump CABG (n = 12) patients underwent a comprehensive transthoracic echocardiography examination the day before and the day after elective CABG, including transmitral and pulmonary vein flow parameters, colour M-mode flow propagation velocity (Vp) and tissue Doppler assessment of the average mitral annulus diastolic velocity (Em). Isovolumic relaxation and E-wave deceleration time were corrected for heart rate (IVRTcHR and DTcHR). Left ventricular (LV) relaxation time (τ) and LV operating stiffness (LVOS) were calculated. Overall and independent from operation type and preload, CABG decreased IVRTcHR (107 ± 20 vs. 93 ± 15 ms) (P < 0.01) and τ (54 ± 10 vs. 45 ± 10 ms) (P < 0.01), increased Vp (49 ± 22 vs. 75 ± 37 cm/s) (P < 0.01), and increased Em (6.6 ± 2.0 vs. 7.3 ± 1.3 cm/s, P = 0.06), indicating improved relaxation. LVOS increased (0.13 ± 0.06 vs. 0.22 ± 0.05 mmHg/mL) (P < 0.01), compatible with an impaired compliance. A similar improvement in relaxation and impairment in compliance were observed in both groups. CONCLUSION Myocardial relaxation improved the day after CABG irrespective of the use of cardiopulmonary bypass with cardioplegic arrest. Impairment in compliance could not be prevented by the avoidance of cardioplegia.
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Jeong YB, Kim TH, Roh YJ, Choi IC, Suh JH. Comparison of uncalibrated arterial pressure waveform analysis with continuous thermodilution cardiac output measurements in patients undergoing elective off-pump coronary artery bypass surgery. J Cardiothorac Vasc Anesth 2010; 24:767-71. [PMID: 20399114 DOI: 10.1053/j.jvca.2010.02.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2009] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Monitoring of cardiac output is required during anesthesia for off-pump coronary artery bypass (OPCAB) surgery. Recently, FloTrac, a new device for arterial pressure waveform analysis for cardiac output (APCO) monitoring without external calibration, was developed. The authors have compared APCO with STAT-mode continuous cardiac output (SCCO) in patients undergoing OPCAB surgery. DESIGN A clinical study. SETTING A university hospital (single institution). PARTICIPANTS Thirty consecutive patients undergoing elective OPCAB surgery. INTERVENTIONS Arterial pressure measurement with FloTrac, pulmonary arterial catheter insertion. MEASUREMENTS AND MAIN RESULTS APCO and SCCO measurements were recorded after pulmonary artery catheter insertion (T1), after sternotomy (T2), after heart positioning for left anterior descending artery anastomosis (T3, T4), after heart positioning for obtuse marginal artery anastomosis (T5, T6), after heart positioning for posterior descending artery anastomosis (T7, T8), and after sternal closure (T9). APCO and SCCO were compared using the Bland-Altman method and the percentage error by Critchley's criteria. SCCO and APCO ranged from 2.1 to 6.9 L/min and 1.2 to 7.4 L/min, respectively, and showed low correlation (r = 0.29). The overall bias by the Bland-Altman method between SCCO and APCO was -0.23 L/min, with a precision of -1.4 to 0.9 L/min, and the overall limits of agreement were -2.5 to 2.0 L/min. The overall mean CO was 4.0 ± 0.95 L/min. The overall percentage error between SCCO and APCO measurements was 57%. CONCLUSIONS Uncalibrated APCO values do not agree with thermodilution SCCO and significantly overestimated the SCCO in patients undergoing OPCAB surgery. Further evaluation is required to verify the clinical acceptance of FloTrac APCO in OPCAB surgery.
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Affiliation(s)
- Yong Bo Jeong
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
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75
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Hofer CK, Button D, Weibel L, Genoni M, Zollinger A. Uncalibrated Radial and Femoral Arterial Pressure Waveform Analysis for Continuous Cardiac Output Measurement: An Evaluation in Cardiac Surgery Patients. J Cardiothorac Vasc Anesth 2010; 24:257-64. [DOI: 10.1053/j.jvca.2009.06.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2009] [Indexed: 11/11/2022]
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76
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Schramm S, Albrecht E, Frascarolo P, Chassot PG, Spahn DR. Validity of an Arterial Pressure Waveform Analysis Device: Does the Puncture Site Play a Role in the Agreement With Intermittent Pulmonary Artery Catheter Thermodilution Measurements? J Cardiothorac Vasc Anesth 2010; 24:250-6. [DOI: 10.1053/j.jvca.2009.05.029] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2009] [Indexed: 11/11/2022]
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Hamm JB, Nguyen BV, Kiss G, Wargnier JP, Jauffroy A, Helaine L, Arvieux CC, Gueret G. Assessment of a Cardiac Output Device using Arterial Pulse Waveform Analysis, VigileoTM, in Cardiac Surgery Compared to Pulmonary Arterial Thermodilution. Anaesth Intensive Care 2010; 38:295-301. [DOI: 10.1177/0310057x1003800211] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Many devices are available to assess cardiac output (CO) in critically ill patients and in the operating room. Classical CO monitoring via a pulmonary artery catheter involves continuous cardiac output (CCO) measurement. The second generation of Flotrac/VigileoTM monitors propose an analysis of peripheral arterial pulse waves to calculate CO (APCO) without calibration. The aim of our study was to compare the CO between the Swan Ganz catheter and the VigileoTM. In this observational study, nine patients undergoing coronary artery bypass grafting were prospectively included. APCO, mean (CCO) and instantaneous CO (ICO) were measured. Perioperative and postoperative assessments were performed up to 24 hours post-surgery. Measurements were recorded every minute, resulting in the collection of 6492 data pairs. Comparison of APCO and ICO showed a limited bias of -0.1 l/min but an important percentage error of 48%. Corresponding values were -0.1 l/min and 46% for the APCO versus CCO comparison, and 0 and 17% for ICO versus CCO comparison. Large inter-individual variability does exist. During cardiac surgery and after leaving the operating room, VigileoTM is not clinically equivalent to continuous thermodilution by pulmonary artery catheter. Nevertheless, the connection between CCO and ICO relates the difference between APCO and CCO more to the different algorithms used. Further efforts should be concentrated on assessing the ability of this device to track changes in cardiac output.
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Affiliation(s)
- J.-B. Hamm
- Departments of Anesthesiology and Critical Care Medicine and Cardiac Surgery, University Hospital la Cavale Blanche, Boulevard Tanguy Prigent, Brest, France
- Resident in Anaesthesiology, Departments of Anaesthesiology and Critical Care Medicine
| | - B.-V. Nguyen
- Departments of Anesthesiology and Critical Care Medicine and Cardiac Surgery, University Hospital la Cavale Blanche, Boulevard Tanguy Prigent, Brest, France
- Resident in Anaesthesiology, Departments of Anaesthesiology and Critical Care Medicine
| | - G. Kiss
- Departments of Anesthesiology and Critical Care Medicine and Cardiac Surgery, University Hospital la Cavale Blanche, Boulevard Tanguy Prigent, Brest, France
- Anaesthetist, Departments of Anaesthesiology and Critical Care Medicine
| | - J.-P. Wargnier
- Departments of Anesthesiology and Critical Care Medicine and Cardiac Surgery, University Hospital la Cavale Blanche, Boulevard Tanguy Prigent, Brest, France
- Anaesthetist, Departments of Anaesthesiology and Critical Care Medicine
| | - A. Jauffroy
- Departments of Anesthesiology and Critical Care Medicine and Cardiac Surgery, University Hospital la Cavale Blanche, Boulevard Tanguy Prigent, Brest, France
- Resident in Anaesthesiology, Departments of Anaesthesiology and Critical Care Medicine
| | - L. Helaine
- Departments of Anesthesiology and Critical Care Medicine and Cardiac Surgery, University Hospital la Cavale Blanche, Boulevard Tanguy Prigent, Brest, France
- Anaesthetist, Departments of Anaesthesiology and Critical Care Medicine
| | - C. C. Arvieux
- Departments of Anesthesiology and Critical Care Medicine and Cardiac Surgery, University Hospital la Cavale Blanche, Boulevard Tanguy Prigent, Brest, France
- Professor, Anaesthesiology and Critical Care Medicine Department
| | - G. Gueret
- Departments of Anesthesiology and Critical Care Medicine and Cardiac Surgery, University Hospital la Cavale Blanche, Boulevard Tanguy Prigent, Brest, France
- Consultant, Anaesthesiology and Critical Care Medicine Department
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The FloTrac™ System—Measurement of Stroke Volume and the Assessment of Dynamic Fluid Loading. Int Anesthesiol Clin 2010; 48:45-56. [DOI: 10.1097/aia.0b013e3181b48a1b] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Zimmermann A, Steinwendner J, Hofbauer S, Kirnbauer M, Schneider J, Moser L, Pauser G. The Accuracy of the Vigileo/FloTrac System Has Been Improved—Follow-up After a Software Update: A Blinded Comparative Study of 30 Cardiosurgical Patients. J Cardiothorac Vasc Anesth 2009; 23:929-31. [DOI: 10.1053/j.jvca.2008.12.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2008] [Indexed: 11/11/2022]
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81
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Wittkowski U, Spies C, Sander M, Erb J, Feldheiser A, von Heymann C. [Haemodynamic monitoring in the perioperative phase. Available systems, practical application and clinical data]. Anaesthesist 2009; 58:764-78, 780-6. [PMID: 19669105 DOI: 10.1007/s00101-009-1590-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
A regular hydration status and compensated vascular filling are targets of perioperative fluid and volume management and, in parallel, represent precautions for sufficient stroke volume and cardiac output to maintain tissue oxygenation. The physiological and pathophysiological effects of fluid and volume replacement mainly depend on the pharmacological properties of the solutions used, the magnitude of the applied volume as well as the timing of volume replacement during surgery. In the perioperative setting surgical stress induces physiological and hormonal adaptations of the body, which in conjunction with an increased permeability of the vascular endothelial layer influence fluid and volume management. The target of haemodynamic monitoring in the operation room is to collect data on haemodynamics and global oxygen transport, which enable the anaesthetist to estimate the volume status of the vascular system. Particularly in high risk patients this may improve fluid and volume therapy with respect to maintaining cardiac output. A goal-directed volume management aiming at preventing hypovolaemia may improve the outcome after surgery. The objective of this article is to review the monitoring devices that are currently used to assess haemodynamics and filling status in the perioperative setting. Methods and principles for measuring haemodynamic variables, the measured and calculated parameters as well as clinical benefits and shortcomings of each device are described. Furthermore, the results for monitoring devices from clinical studies of goal-directed fluid and volume therapy which have been published will be discussed.
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Affiliation(s)
- U Wittkowski
- Universitätsklinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Campus Virchow-Klinikum und Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Berlin
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82
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Derichard A, Robin E, Tavernier B, Costecalde M, Fleyfel M, Onimus J, Lebuffe G, Chambon JP, Vallet B. Automated pulse pressure and stroke volume variations from radial artery: evaluation during major abdominal surgery. Br J Anaesth 2009; 103:678-84. [DOI: 10.1093/bja/aep267] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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83
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Assessing fluid responses after coronary surgery: role of mathematical coupling of global end-diastolic volume to cardiac output measured by transpulmonary thermodilution. Eur J Anaesthesiol 2009; 26:954-60. [DOI: 10.1097/eja.0b013e32833098c6] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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84
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de Wilde RBP, Geerts BF, van den Berg PCM, Jansen JRC. A comparison of stroke volume variation measured by the LiDCOplus and FloTrac-Vigileo system. Anaesthesia 2009; 64:1004-9. [PMID: 19686486 DOI: 10.1111/j.1365-2044.2009.06009.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The aim of this study was to compare the accuracy of stroke volume variation (SVV) as measured by the LiDCOplus system (SVVli) and by the FloTrac-Vigileo system (SVVed). We measured SVVli and SVVed in 15 postoperative cardiac surgical patients following five study interventions; a 50% increase in tidal volume, an increase of PEEP by 10 cm H2O, passive leg raising, a head-up tilt procedure and fluid loading. Between each intervention, baseline measurements were performed. 136 data pairs were obtained. SVVli ranged from 1.4% to 26.8% (mean (SD) 8.7 (4.6)%); SVVed from 2.0% to 26.0% (10.2 (4.7)%). The bias was found to be significantly different from zero at 1.5 (2.5)%, p < 0.001, (95% confidence interval 1.1-1.9). The upper and lower limits of agreement were found to be 6.4 and -3.5% respectively. The coefficient of variation for the differences between SVVli and SVVed was 26%. This results in a relative large range for the percentage limits of agreement of 52%. Analysis in repeated measures showed coefficients of variation of 21% for SVVli and 22% for SVVed. The LiDCOplus and FloTrac-Vigileo system are not interchangeable. Furthermore, the determination of SVVli and SVVed are too ambiguous, as can be concluded from the high values of the coefficient of variation for repeated measures. These findings underline Pinsky's warning of caution in the clinical use of SVV by pulse contour techniques.
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Affiliation(s)
- R B P de Wilde
- Department of Intensive Care, Leiden University Medical Centre, Leiden, The Netherlands.
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85
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Lahner D, Kabon B, Marschalek C, Chiari A, Pestel G, Kaider A, Fleischmann E, Hetz H. Evaluation of stroke volume variation obtained by arterial pulse contour analysis to predict fluid responsiveness intraoperatively. Br J Anaesth 2009; 103:346-51. [DOI: 10.1093/bja/aep200] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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86
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de Wilde RBP, Geerts BF, Cui J, van den Berg PCM, Jansen JRC. Performance of three minimally invasive cardiac output monitoring systems. Anaesthesia 2009; 64:762-9. [PMID: 19624632 DOI: 10.1111/j.1365-2044.2009.05934.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We evaluated cardiac output (CO) using three new methods - the auto-calibrated FloTrac-Vigileo (CO(ed)), the non-calibrated Modelflow (CO(mf) ) pulse contour method and the ultra-sound HemoSonic system (CO(hs)) - with thermodilution (CO(td)) as the reference. In 13 postoperative cardiac surgical patients, 104 paired CO values were assessed before, during and after four interventions: (i) an increase of tidal volume by 50%; (ii) a 10 cm H(2)O increase in positive end-expiratory pressure; (iii) passive leg raising and (iv) head up position. With the pooled data the difference (bias (2SD)) between CO(ed) and CO(td), CO(mf) and CO(td) and CO(hs) and CO(td) was 0.33 (0.90), 0.30 (0.69) and -0.41 (1.11) l.min(-1), respectively. Thus, Modelflow had the lowest mean squared error, suggesting that it had the best performance. CO(ed) significantly overestimates changes in cardiac output while CO(mf) and CO(hs) values are not significantly different from those of CO(td). Directional changes in cardiac output by thermodilution were detected with a high score by all three methods.
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Affiliation(s)
- R B P de Wilde
- Department of Intensive Care, Leiden University Medical Center, Leiden, the Netherlands.
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87
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Evaluation of the FloTrac Uncalibrated Continuous Cardiac Output System for Perioperative Hemodynamic Monitoring After Subarachnoid Hemorrhage. J Neurosurg Anesthesiol 2009; 21:218-25. [DOI: 10.1097/ana.0b013e3181a4cd8b] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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88
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Concha MR, Mertz VF, Cortínez LI, González KA, Butte JM. Pulse Contour Analysis and Transesophageal Echocardiography: A Comparison of Measurements of Cardiac Output During Laparoscopic Colon Surgery. Anesth Analg 2009; 109:114-8. [DOI: 10.1213/ane.0b013e3181a491b8] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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89
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Mayer J, Boldt J, Poland R, Peterson A, Manecke GR. RETRACTED: Continuous arterial pressure waveform-based cardiac output using the FloTrac/Vigileo: a review and meta-analysis. J Cardiothorac Vasc Anesth 2009; 23:401-406. [PMID: 19464625 DOI: 10.1053/j.jvca.2009.03.003] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2009] [Indexed: 12/11/2022]
Affiliation(s)
- Jochen Mayer
- Department of Anesthesiology and Intensive Care Medicine, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - Joachim Boldt
- Department of Anesthesiology and Intensive Care Medicine, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - Reagan Poland
- Department of Anesthesiology, University of California San Diego School of Medicine, San Diego, CA
| | - Amanda Peterson
- Department of Anesthesiology, University of California San Diego School of Medicine, San Diego, CA
| | - Gerard R Manecke
- Department of Anesthesiology, University of California San Diego School of Medicine, San Diego, CA.
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90
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Østergaard M, Nielsen J, Nygaard E. Pulse contour cardiac output: an evaluation of the FloTrac method. Eur J Anaesthesiol 2009; 26:484-9. [DOI: 10.1097/eja.0b013e32831f343f] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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91
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Funk DJ, Moretti EW, Gan TJ. Minimally invasive cardiac output monitoring in the perioperative setting. Anesth Analg 2009; 108:887-97. [PMID: 19224798 DOI: 10.1213/ane.0b013e31818ffd99] [Citation(s) in RCA: 160] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
With advancing age and increased co-morbidities in patients, the need for monitoring devices during the perioperative period that allow clinicians to track physiologic variables, such as cardiac output (CO), fluid responsiveness and tissue perfusion, is increasing. Until recently, the only tool available to anesthesiologists to monitor CO was either a pulmonary artery catheter or transesophageal echocardiograph. These devices have their limitations and potential for morbidity. Several new devices (including esophageal Doppler monitors, pulse contour analysis, indicator dilution, thoracic bioimpedance and partial non-rebreathing systems) have recently been marketed which have the ability to monitor CO noninvasively and, in some cases, assess the patient's ability to respond to fluid challenges. In this review, we will describe these new devices including the technology, studies on their efficacy and the limitations of their use.
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Affiliation(s)
- Duane J Funk
- Department of Anesthesiology, Division of Critical Care, Duke University Medical Center, Durham, NC 27710, USA
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92
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Senn A, Button D, Zollinger A, Hofer CK. Assessment of cardiac output changes using a modified FloTrac/Vigileo algorithm in cardiac surgery patients. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2009; 13:R32. [PMID: 19261180 PMCID: PMC2689464 DOI: 10.1186/cc7739] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2008] [Revised: 12/29/2008] [Accepted: 03/04/2009] [Indexed: 11/10/2022]
Abstract
INTRODUCTION The FloTrac/Vigileo (Edwards Lifesciences, Irvine, CA, USA) allows pulse pressure-derived cardiac output measurement without external calibration. Software modifications were performed in order to eliminate initially observed deficits. The aim of this study was to assess changes in cardiac output determined by the FloTrac/Vigileo system (FCO) with an initially released (FCOA) and a modified (FCOB) software version, as well as changes in cardiac output from the PiCCOplus system (PCO; Pulsion Medical Systems, Munich, Germany). Both devices were compared with cardiac output measured by intermittent thermodilution (ICO). METHODS Cardiac output measurements were performed in patients after elective cardiac surgery. Two sets of data (A and B) were obtained using FCOA and FCOB in 50 patients. After calibration of the PiCCOplus system, triplicate FCO and PCO values were recorded and ICO was determined in the supine position and cardiac output changes due to body positioning were recorded 15 minutes later (30 degrees head-up, 30 degrees head-down, supine). Student's t test, analysis of variance and Bland-Altman analysis were calculated. RESULTS Significant changes of FCO, PCO and ICO induced by body positioning were observed in both data sets. For set A, DeltaFCOA was significantly larger than DeltaICO induced by positioning the head down. For set B, there were no significant differences between DeltaFCOB and DeltaICO. For set A, increased limits of agreement were found for FCOA-ICO when compared with PCO-ICO. For set B, mean bias and limits of agreement were comparable for FCOB-ICO and PCO-ICO. CONCLUSIONS The modification of the FloTrac/Vigileo system resulted in an improved performance in order to reliably assess cardiac output and track the related changes in patients after cardiac surgery.
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Affiliation(s)
- Alban Senn
- Institute of Anaesthesiology and Intensive Care Medicine, Triemli City Hospital Zurich, Birmensdorferstrasse 497, 8063 Zurich, Switzerland
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93
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Chatti R, de Rudniki S, Marqué S, Dumenil AS, Descorps-Declère A, Cariou A, Duranteau J, Aout M, Vicaut E, Cholley BP. Comparison of two versions of the Vigileo-FloTrac system (1.03 and 1.07) for stroke volume estimation: a multicentre, blinded comparison with oesophageal Doppler measurements. Br J Anaesth 2009; 102:463-9. [PMID: 19244262 DOI: 10.1093/bja/aep020] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Our aim was to evaluate the validity of stroke volume measurements obtained using the Vigileo-FloTrac system in comparison with those obtained using oesophageal Doppler considered as a reference. METHODS Prospective, multicentre study (four university hospitals), in which investigators were blinded to stroke volume values acquired simultaneously with the other technique. Two different versions of the Vigileo software (1.03 and 1.07) were studied and compared over two consecutive periods of time. Forty critically ill patients (three ICUs) and 20 high-risk surgical patients (one operating theatre) were studied over a 6-month period. RESULTS Two hundred and forty paired stroke volume values obtained using the second version of the Vigileo (1.07) yielded better correlation and agreement (R=0.48, P<0.001; bias=4 ml, limits of agreement: +/- 41 ml) than the 207 paired values obtained using version 1.03 (R=0.12, P=0.1; bias=1 ml, limits of agreement: +/- 75 ml). However, even with the second version, the percentage error in stroke volume measurement was 58%, a value still above the range considered clinically acceptable (30%). CONCLUSIONS The precision of stroke volume estimation using Vigileo-FloTrac has improved with the second version of the software (1.07), but remains insufficient to allow the replacement of the reference technique in the population studied.
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Affiliation(s)
- R Chatti
- Département d'Anesthésie-Réanimation, AP-HP, Hôpital Lariboisière, Paris, France
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94
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Minimally Invasive Cardiac Output Monitoring: Toy Or Tool? Intensive Care Med 2009. [DOI: 10.1007/978-0-387-77383-4_57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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95
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Compton F, Schäfer JH. Noninvasive cardiac output determination: broadening the applicability of hemodynamic monitoring. Semin Cardiothorac Vasc Anesth 2009; 13:44-55. [PMID: 19147529 DOI: 10.1177/1089253208330711] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Although cardiac output (CO) monitoring is usually only used in intensive care units (ICUs) and operating rooms, there is increasing evidence that CO should be determined and optimized as early as possible, even before admission to the ICU, in the care of hemodynamically compromised patients. A variety of different minimally or noninvasive CO determination techniques have been developed, but not all of them are suitable for early hemodynamic monitoring outside the ICU. In this review, the different available methods for CO monitoring are presented and their potential for early hemodynamic assessment is discussed.
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Affiliation(s)
- Friederike Compton
- Department of Nephrology, Campus Benjamin Franklin, Charité University Medicine Berlin, Germany.
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96
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Cecconi M, Rhodes A, Poloniecki J, Della Rocca G, Grounds RM. Bench-to-bedside review: the importance of the precision of the reference technique in method comparison studies--with specific reference to the measurement of cardiac output. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2009; 13:201. [PMID: 19183431 PMCID: PMC2688094 DOI: 10.1186/cc7129] [Citation(s) in RCA: 258] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Bland-Altman analysis is used for assessing agreement between two measurements of the same clinical variable. In the field of cardiac output monitoring, its results, in terms of bias and limits of agreement, are often difficult to interpret, leading clinicians to use a cutoff of 30% in the percentage error in order to decide whether a new technique may be considered a good alternative. This percentage error of ± 30% arises from the assumption that the commonly used reference technique, intermittent thermodilution, has a precision of ± 20% or less. The combination of two precisions of ± 20% equates to a total error of ± 28.3%, which is commonly rounded up to ± 30%. Thus, finding a percentage error of less than ± 30% should equate to the new tested technique having an error similar to the reference, which therefore should be acceptable. In a worked example in this paper, we discuss the limitations of this approach, in particular in regard to the situation in which the reference technique may be either more or less precise than would normally be expected. This can lead to inappropriate conclusions being drawn from data acquired in validation studies of new monitoring technologies. We conclude that it is not acceptable to present comparison studies quoting percentage error as an acceptability criteria without reporting the precision of the reference technique.
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Affiliation(s)
- Maurizio Cecconi
- Department of Anesthesia and Intensive Care, Azienda Ospedaliero Universitaria Udine, Piazzale Santa Maria della Misericordia, Udine, Italy.
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97
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Reply to Letter: Agreed: “PRAM May be Useful to Assess the Cardiovascular Changes in Obese Patients During Laparoscopy”. Obes Surg 2009. [DOI: 10.1007/s11695-008-9743-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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98
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Biancofiore G, Critchley L, Lee A, Bindi L, Bisà M, Esposito M, Meacci L, Mozzo R, DeSimone P, Urbani L, Filipponi F. Evaluation of an uncalibrated arterial pulse contour cardiac output monitoring system in cirrhotic patients undergoing liver surgery. Br J Anaesth 2009; 102:47-54. [DOI: 10.1093/bja/aen343] [Citation(s) in RCA: 130] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Mehta Y, Chand RK, Sawhney R, Bhise M, Singh A, Trehan N. Cardiac output monitoring: comparison of a new arterial pressure waveform analysis to the bolus thermodilution technique in patients undergoing off-pump coronary artery bypass surgery. J Cardiothorac Vasc Anesth 2008; 22:394-9. [PMID: 18503927 DOI: 10.1053/j.jvca.2008.02.015] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2007] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To analyze the clinical agreement between the conventional intermittent bolus thermodilution (TD) technique and a new arterial pressure waveform analysis (APCO) technique (FloTrac; Edward Lifesciences, Irvine, CA) for cardiac output (CO) estimation. DESIGN Prospective observational clinical study. SETTING Cardiac surgery operating room of a tertiary care cardiac center. PARTICIPANTS Twelve patients undergoing elective off-pump coronary artery bypass (OPCAB) surgery. MEASUREMENTS AND MAIN RESULTS CO was determined by 2 different methods: TD and APCO at 8 time points (preinduction, postinduction, poststernotomy, left internal mammary artery to left anterior descending artery anastomosis, left [obtuse marginal/diagonal] anastomosis, right [right coronary/posterior descending coronary artery] anastomosis, postprotamine administration, and poststernal closure) in 12 patients undergoing elective OPCAB surgery. The mean bias and limits of agreement (2 standard deviations) expressed in liters per minute at respective points of measurement were -0.54 +/- 1.12, -0.37 +/- 1.0, -0.42 +/- 1.50, -0.25 +/- 1.18, -0.31 + 1.28, +/-0.41 +/- 1.0, 0.06 +/- 1.50, and 0.09 +/- 1.40. CONCLUSION Good agreement was found between the CO values obtained by the APCO and TD techniques throughout the intraoperative period including the period of coronary artery graft surgery.
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Affiliation(s)
- Yatin Mehta
- Department of Anaesthesiology and Critical Care, Escorts Heart Institute and Research Centre, New Delhi, India.
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Forfori F, Romano SM, Balderi T, Anselmino M, Giunta F. Response to Dr. Bernstein's review: pressure pulse contour-derived stroke volume and cardiac output in the morbidly obese patient. Obes Surg 2008; 19:128-30, author reply 131-3. [PMID: 18946708 DOI: 10.1007/s11695-008-9745-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2008] [Accepted: 10/01/2008] [Indexed: 11/30/2022]
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