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Ronkainen HPO, Ylikauma LA, Pohjola MJ, Ohtonen PP, Erkinaro TM, Vakkala MA, Liisanantti JH, Juvonen TS, Kaakinen TI. Reliability of Bioreactance and Pulse-Power Analysis in Measuring Cardiac Index During Open Abdominal Aortic Surgery. J Cardiothorac Vasc Anesth 2024; 38:1484-1491. [PMID: 38631929 DOI: 10.1053/j.jvca.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/30/2024] [Accepted: 02/05/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVE To investigate the accuracy, precision, and trending ability of noninvasive bioreactance-based Starling SV and the mini invasive pulse-power device LiDCOrapid as compared to thermodilution cardiac output (TDCO) as measured by pulmonary artery catheter when assessing cardiac index (CIx) in the setting of elective open abdominal aortic (AA) surgery. DESIGN A prospective method-comparison study. SETTING Oulu University Hospital, Finland. PARTICIPANTS Forty patients undergoing elective open abdominal aortic surgery. INTERVENTIONS Intraoperative CI measurements were obtained simultaneously with TDCO and the study monitors, resulting in 627 measurement pairs with Starling SV and 497 with LiDCOrapid. MEASUREMENTS AND MAIN RESULTS The Bland-Altman method was used to investigate the agreement among the devices, and four-quadrant plots with error grids were used to assess trending ability. The agreement between TDCO and Starling SV was associated with a bias of 0.18 L/min/m2 (95% confidence interval [CI] = 0.13 to 0.23), wide limits of agreement (LOA = -1.12 to 1.47 L/min/m2), and a percentage error (PE) of 63.7 (95% CI = 52.4-71.0). The agreement between TDCO and LiDCOrapid was associated with a bias of -0.15 L/min/m2 (95% CI = -0.21 to -0.09), wide LOA (-1.56 to 1.37), and a PE of 68.7 (95% CI = 54.9-79.6). The trending ability of neither device was sufficient. CONCLUSION The CI measurements achieved with Starling SV and LiDCOrapid were not interchangeable with TDCO, and the ability to track changes in CI was poor. These results do not support the use of either study device in monitoring CI during open AA surgery.
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Affiliation(s)
- Heikki Pekka Oskari Ronkainen
- Research Group of Surgery, Anesthesiology and Intensive Care Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.
| | - Laura Anneli Ylikauma
- Research Group of Surgery, Anesthesiology and Intensive Care Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Mari Johanna Pohjola
- Research Group of Surgery, Anesthesiology and Intensive Care Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Pasi Petteri Ohtonen
- Research Group of Surgery, Anesthesiology and Intensive Care Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; Division of Operative Care, Oulu University Hospital, Oulu,Finland
| | - Tiina Maria Erkinaro
- Research Group of Surgery, Anesthesiology and Intensive Care Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Merja Annika Vakkala
- Research Group of Surgery, Anesthesiology and Intensive Care Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Janne Henrik Liisanantti
- Research Group of Surgery, Anesthesiology and Intensive Care Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Tatu Sakari Juvonen
- Department of Cardiac Surgery, Heart, and Lung Center, Helsinki University Central Hospital, Helsinki University Hospital, Helsinki, Finland
| | - Timo Ilari Kaakinen
- Research Group of Surgery, Anesthesiology and Intensive Care Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
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Yoshida T, Goto A, Shinoda S, Kotani Y, Mihara T. The epidemiology of postoperative dobutamine and phosphodiesterase inhibitors after adult elective cardiac surgery and its impact on the length of hospital stay: a post hoc analysis from the multicenter retrospective observational study. Heart Vessels 2024; 39:438-445. [PMID: 38197915 DOI: 10.1007/s00380-023-02349-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 12/07/2023] [Indexed: 01/11/2024]
Abstract
The optimal administration of inotrope after cardiac surgery is unknown. This study aimed to investigate the impact of postoperative inotrope on clinical outcomes in adult elective cardiac surgery patients. Data from the Blood Pressure and Relative Optimal Target after Heart Surgery in Epidemiologic Registry study were analyzed, employing propensity score considering the hospital of admission. The primary outcome was the length of hospital stay evaluated using quantile regression. Secondary outcomes were kidney injury progression, renal replacement therapy, atrial fibrillation, mortality, mechanical ventilation duration, and length of intensive care unit (ICU) stay. Among 870 patients from 14 ICUs in Japan, 535 received inotropes within 24 h of ICU admission, with usage rates ranging from 40 to 100% among facilities. After propensity score matching, 218 patients were included in each group. The inotrope group had a significantly longer hospital stay compared to the control group (16 days vs. 14 days; median difference 1.78 [95% confidence interval [CI] 0.31-3.24]; p = 0.018). However, no significant differences were observed in the secondary outcomes, except for mechanical ventilation duration. The results of the sensitivity analysis using a mixed-effects quantile regression analysis considering the hospital of admission for length of hospital stay in the original cohort were consistent with the results of the propensity analyses (median difference in days, 2.35 [95% CI, 0.35-4.36]; p = 0.022). The use of inotropes within 24 h of ICU admission in adult elective cardiac surgery patients was associated with an extended hospitalization period of approximately 2 days, without offering any prognostic benefit. Clinical trial registration: UMIN-CTR, https://www.umin.ac.jp/ctr/index-j.htm , UMIN000037074.
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Affiliation(s)
- Takuo Yoshida
- Department of Health Data Science, Graduate School of Data Science, Yokohama City University, 22-2 Seto, Kanazawa, Yokohama, 236-0027, Japan.
- Intensive Care Unit, Department of Emergency Medicine, The Jikei University School of Medicine, 3-19-18, Nishi-Shinbashi Minato-ku, Tokyo, 105-8471, Japan.
| | - Atsushi Goto
- Department of Health Data Science, Graduate School of Data Science, Yokohama City University, 22-2 Seto, Kanazawa, Yokohama, 236-0027, Japan
| | - Satoru Shinoda
- Department of Biostatistics, School of Medicine, Yokohama City University, Yokohama City, Kanagawa, 236-0004, Japan
| | - Yuki Kotani
- Department of Intensive Care Medicine, Kameda Medical Center, Kamogawa, Japan
- Department of Anesthesia and Intensive Care, Vita-Salute San Raffaele University, Milan, Italy
| | - Takahiro Mihara
- Department of Health Data Science, Graduate School of Data Science, Yokohama City University, 22-2 Seto, Kanazawa, Yokohama, 236-0027, Japan
- Department of Anesthesiology, Yokohama City University School of Medicine, Yokohama, Japan
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3
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Giraud R, Vujovic B, Assouline B, Neto Silva I, Bendjelid K. Do ScvO 2 variations induced by passive leg raising predict fluid responsiveness? A prospective study. Physiol Rep 2021; 9:e15012. [PMID: 34491003 PMCID: PMC8422598 DOI: 10.14814/phy2.15012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/28/2021] [Accepted: 07/30/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The present study investigates whether ScvO2 variations induced by passive leg raising (PLR) are able to predict fluid responsiveness (FR) in mechanically ventilated patients. DESIGN A monocentric prospective clinical study. SETTING An intensive care division in a tertiary hospital. PATIENTS The inclusion criteria were elective postoperative cardiac surgery patients who were over 18 years old, deeply sedated, mechanically ventilated and needed volume expansion (VE). Fluid responders (R) were defined as patients who increased their left ventricular outflow tract velocity time integral (VTI) ≥15% after VE. INTERVENTION In patients included in this study, continuous ScvO2 monitoring (CeVOX device, Pulsion Medical Systems) and VTI (transthoracic echocardiography) were measured simultaneously before and during a PLR test and before and after VE (with 500 ml of saline). MEASUREMENTS AND MAIN RESULTS Thirty-three consecutive patients were included in this study. In 15 patients with a positive PLR test (increase in VTI ≥15%), ScvO2 increased during PLR by 9 ± 4%. In the 18 patients with a negative PLR test, ScvO2 did not significantly change during PLR. VE increased ScvO2 by 9 ± 6% and 2 ± 4% in responders and nonresponders, respectively. If ScvO2 increased by >4% during the PLR test, then a positive VTI response (≥15%) was diagnosed with a sensitivity of 93% (68-99%) and a specificity of 94% (63-99%) (Area under the receiver operating characteristic curve 0.92 ± 0.58, p < 0.05). Moreover, ScvO2 variations were able to distinguish responders to VE from nonresponders to VE with a sensitivity of 87% (68-99%) and a specificity of 89% (63-99%) (Area under the receiver operating characteristic curve 0.89 ± 0.07, p < 0.05). CONCLUSIONS ScvO2 variation induced by PLR is a reliable, minimally invasive parameter for predicting FR at the postoperative cardiac surgery bedside of mechanically ventilated, critically ill patients.
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Affiliation(s)
- Raphaël Giraud
- Intensive Care UnitGeneva University HospitalsGenevaSwitzerland
- Faculty of MedicineUniversity of GenevaGenevaSwitzerland
- Geneva Hemodynamic Research GroupUniversity of GenevaGenevaSwitzerland
| | - Bojana Vujovic
- Intensive Care UnitGeneva University HospitalsGenevaSwitzerland
| | - Benjamin Assouline
- Intensive Care UnitGeneva University HospitalsGenevaSwitzerland
- Faculty of MedicineUniversity of GenevaGenevaSwitzerland
- Geneva Hemodynamic Research GroupUniversity of GenevaGenevaSwitzerland
| | - Ivo Neto Silva
- Intensive Care UnitGeneva University HospitalsGenevaSwitzerland
- Faculty of MedicineUniversity of GenevaGenevaSwitzerland
- Geneva Hemodynamic Research GroupUniversity of GenevaGenevaSwitzerland
| | - Karim Bendjelid
- Intensive Care UnitGeneva University HospitalsGenevaSwitzerland
- Faculty of MedicineUniversity of GenevaGenevaSwitzerland
- Geneva Hemodynamic Research GroupUniversity of GenevaGenevaSwitzerland
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Ylikauma LA, Ohtonen PP, Erkinaro TM, Vakkala MA, Liisanantti JH, Satta JU, Juvonen TS, Kaakinen TI. Bioreactance and fourth-generation pulse contour methods in monitoring cardiac index during off-pump coronary artery bypass surgery. J Clin Monit Comput 2021; 36:879-888. [PMID: 34037919 PMCID: PMC8150147 DOI: 10.1007/s10877-021-00721-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 05/18/2021] [Indexed: 11/30/2022]
Abstract
The pulmonary artery catheter (PAC) is considered the gold standard for cardiac index monitoring. Recently new and less invasive methods to assess cardiac performance have been developed. The aim of our study was to assess the reliability of a non-invasive monitor utilizing bioreactance (Starling SV) and a non-calibrated mini-invasive pulse contour device (FloTrac/EV1000, fourth-generation software) compared to bolus thermodilution technique with PAC (TDCO) during off-pump coronary artery bypass surgery (OPCAB). In this prospective study, 579 simultaneous intra- and postoperative cardiac index measurements obtained with Starling SV, FloTrac/EV1000 and TDCO were compared in 20 patients undergoing OPCAB. The agreement of data was investigated by Bland-Altman plots, while trending ability was assessed by four-quadrant plots with error grids. In comparison with TDCO, Starling SV was associated with a bias of 0.13 L min-1 m-2 (95% confidence interval, 95% CI, 0.07 to 0.18), wide limits of agreement (LOA, - 1.23 to 1.51 L min-1 m-2), a percentage error (PE) of 60.7%, and poor trending ability. In comparison with TDCO, FloTrac was associated with a bias of 0.01 L min-1 m-2 (95% CI - 0.05 to 0.06), wide LOA (- 1.27 to 1.29 L min-1 m-2), a PE of 56.8% and poor trending ability. Both Starling SV and fourth-generation FloTrac showed acceptable mean bias but imprecision due to wide LOA and high PE, and poor trending ability. These findings indicate limited reliability in monitoring cardiac index in patients undergoing OPCAB.
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Affiliation(s)
- Laura Anneli Ylikauma
- Medical Research Center Oulu, Research Group of Surgery, Anesthesiology and Intensive Care Medicine, Oulu University Hospital and University of Oulu, Oulu, Finland.
| | - Pasi Petteri Ohtonen
- Medical Research Center Oulu, Research Group of Surgery, Anesthesiology and Intensive Care Medicine, Oulu University Hospital and University of Oulu, Oulu, Finland.,Division of Operative Care, Oulu University Hospital, Oulu, Finland
| | - Tiina Maria Erkinaro
- Medical Research Center Oulu, Research Group of Surgery, Anesthesiology and Intensive Care Medicine, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Merja Annika Vakkala
- Medical Research Center Oulu, Research Group of Surgery, Anesthesiology and Intensive Care Medicine, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Janne Henrik Liisanantti
- Medical Research Center Oulu, Research Group of Surgery, Anesthesiology and Intensive Care Medicine, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Jari Uolevi Satta
- Medical Research Center Oulu, Research Group of Surgery, Anesthesiology and Intensive Care Medicine, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Tatu Sakari Juvonen
- Medical Research Center Oulu, Research Group of Surgery, Anesthesiology and Intensive Care Medicine, Oulu University Hospital and University of Oulu, Oulu, Finland.,Department of Cardiac Surgery, Heart and Lung Center, Helsinki University Central Hospital, Helsinki University Hospital, Helsinki, Finland
| | - Timo Ilari Kaakinen
- Medical Research Center Oulu, Research Group of Surgery, Anesthesiology and Intensive Care Medicine, Oulu University Hospital and University of Oulu, Oulu, Finland
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5
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Kouz K, Michard F, Bergholz A, Vokuhl C, Briesenick L, Hoppe P, Flick M, Schön G, Saugel B. Agreement between continuous and intermittent pulmonary artery thermodilution for cardiac output measurement in perioperative and intensive care medicine: a systematic review and meta-analysis. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2021; 25:125. [PMID: 33781307 PMCID: PMC8006374 DOI: 10.1186/s13054-021-03523-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 03/01/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Pulmonary artery thermodilution is the clinical reference method for cardiac output monitoring. Because both continuous and intermittent pulmonary artery thermodilution are used in clinical practice it is important to know whether cardiac output measurements by the two methods are clinically interchangeable. METHODS We performed a systematic review and meta-analysis of clinical studies comparing cardiac output measurements assessed using continuous and intermittent pulmonary artery thermodilution in adult surgical and critically ill patients. 54 studies with 1522 patients were included in the analysis. RESULTS The heterogeneity across the studies was high. The overall random effects model-derived pooled estimate of the mean of the differences was 0.08 (95%-confidence interval 0.01 to 0.16) L/min with pooled 95%-limits of agreement of - 1.68 to 1.85 L/min and a pooled percentage error of 29.7 (95%-confidence interval 20.5 to 38.9)%. CONCLUSION The heterogeneity across clinical studies comparing continuous and intermittent pulmonary artery thermodilution in adult surgical and critically ill patients is high. The overall trueness/accuracy of continuous pulmonary artery thermodilution in comparison with intermittent pulmonary artery thermodilution is good (indicated by a pooled mean of the differences < 0.1 L/min). Pooled 95%-limits of agreement of - 1.68 to 1.85 L/min and a pooled percentage error of 29.7% suggest that continuous pulmonary artery thermodilution barely passes interchangeability criteria with intermittent pulmonary artery thermodilution. PROSPERO registration number CRD42020159730.
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Affiliation(s)
- Karim Kouz
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | | | - Alina Bergholz
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Christina Vokuhl
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Luisa Briesenick
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Phillip Hoppe
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Moritz Flick
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Gerhard Schön
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bernd Saugel
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany. .,Outcomes Research Consortium, Cleveland, OH, USA.
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6
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Eisenried A, Klarwein R, Ihmsen H, Wehrfritz A, Tandler R, Heim C, Fechner J. Accuracy and Trending Ability of the Fourth-Generation FloTrac/EV1000 System in Patients With Severe Aortic Valve Stenosis Before and After Surgical Valve Replacement. J Cardiothorac Vasc Anesth 2019; 33:1230-1236. [DOI: 10.1053/j.jvca.2018.09.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Indexed: 11/11/2022]
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7
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Pugin D, Schmitz M, Bendjelid K. Difficult Removal of a Kinked Swan-Ganz Catheter. J Cardiothorac Vasc Anesth 2018; 32:e41-e42. [PMID: 29331551 DOI: 10.1053/j.jvca.2017.07.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Deborah Pugin
- Intensive Care Unit, Geneva University Hospitals, Geneva, Switzerland
| | - Marylin Schmitz
- Intensive Care Unit, Geneva University Hospitals, Geneva, Switzerland
| | - Karim Bendjelid
- Intensive Care Unit, Geneva University Hospitals, Geneva, Switzerland
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8
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Lin SY, Chou AH, Tsai YF, Chang SW, Yang MW, Ting PC, Chen CY. Evaluation of the use of the fourth version FloTrac system in cardiac output measurement before and after cardiopulmonary bypass. J Clin Monit Comput 2017; 32:807-815. [PMID: 29039063 DOI: 10.1007/s10877-017-0071-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 10/06/2017] [Indexed: 12/27/2022]
Abstract
The FloTrac system is a system for cardiac output (CO) measurement that is less invasive than the pulmonary artery catheter (PAC). The purposes of this study were to (1) compare the level of agreement and trending abilities of CO values measured using the fourth version of the FloTrac system (CCO-FloTrac) and PAC-originated continuous thermodilution (CCO-PAC) and (2) analyze the inadequate CO-discriminating ability of the FloTrac system before and after cardiopulmonary bypass (CPB). Fifty patients were included. After exclusion, 32 patients undergoing cardiac surgery with CPB were analyzed. All patients were monitored with a PAC and radial artery catheter connected to the FloTrac system. CO was assessed at 10 timing points during the surgery. In the Bland-Altman analysis, the percentage errors (bias, the limits of agreement) of the CCO-FloTrac were 61.82% (0.16, - 2.15 to 2.47 L min) and 51.80% (0.48, - 1.97 to 2.94 L min) before and after CPB, respectively, compared with CCO-PAC. The concordance rates in the four-quadrant plot were 64.10 and 62.16% and the angular concordance rates (angular mean bias, the radial limits of agreement) in the polar-plot analysis were 30.00% (17.62°, - 70.69° to 105.93°) and 38.63% (- 10.04°, - 96.73° to 76.30°) before and after CPB, respectively. The area under the receiver operating characteristic curve for CCO-FloTrac was 0.56, 0.52, 0.52, and 0.72 for all, ≥ ± 5, ≥ ± 10, and ≥ ± 15% CO changes (ΔCO) of CCO-PAC before CPB, respectively, and 0.59, 0.55, 0.49, and 0.46 for all, ≥ ± 5, ≥ ± 10, and ≥ ± 15% ΔCO of CCO-PAC after CPB, respectively. When CO < 4 L/min was considered inadequate, the Cohen κ coefficient was 0.355 and 0.373 before and after CPB, respectively. The accuracy, trending ability, and inadequate CO-discriminating ability of the fourth version of the FloTrac system in CO monitoring are not statistically acceptable in cardiac surgery.
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Affiliation(s)
- Sheng-Yi Lin
- Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center, No.5, Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan
| | - An-Hsun Chou
- Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center, No.5, Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan
| | - Yung-Fong Tsai
- Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center, No.5, Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan.,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan
| | - Su-Wei Chang
- Clinical Informatics and Medical Statistics Research Center, Chang Gung University College of Medicine, Taoyuan, 333, Taiwan.,Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, 333, Taiwan
| | - Min-Wen Yang
- Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center, No.5, Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan
| | - Pei-Chi Ting
- Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center, No.5, Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan
| | - Chun-Yu Chen
- Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center, No.5, Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan. .,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan.
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9
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Saugel B, Bendjelid K, Critchley LA, Rex S, Scheeren TWL. Journal of Clinical Monitoring and Computing 2016 end of year summary: cardiovascular and hemodynamic monitoring. J Clin Monit Comput 2017; 31:5-17. [PMID: 28064413 DOI: 10.1007/s10877-017-9976-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2016] [Accepted: 01/02/2017] [Indexed: 12/29/2022]
Abstract
The assessment and optimization of cardiovascular and hemodynamic variables is a mainstay of patient management in the care for critically ill patients in the intensive care unit (ICU) or the operating room (OR). It is, therefore, of outstanding importance to meticulously validate technologies for hemodynamic monitoring and to study their applicability in clinical practice and, finally, their impact on treatment decisions and on patient outcome. In this regard, the Journal of Clinical Monitoring and Computing (JCMC) is an ideal platform for publishing research in the field of cardiovascular and hemodynamic monitoring. In this review, we highlight papers published last year in the JCMC in order to summarize and discuss recent developments in this research area.
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Affiliation(s)
- Bernd Saugel
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Karim Bendjelid
- Department of Anesthesiology and Intensive Care, Geneva University Hospitals, Geneva, Switzerland
| | - Lester A Critchley
- Department of Anesthesia and Intensive Care, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Steffen Rex
- Department of Anesthesiology and Department of Cardiovascular Sciences, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Thomas W L Scheeren
- Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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10
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Bendjelid K, Rex S, Scheeren T, Saugel B. Journal of Clinical Monitoring and Computing 2015 end of year summary: cardiovascular and hemodynamic monitoring. J Clin Monit Comput 2016; 30:129-39. [DOI: 10.1007/s10877-016-9838-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 01/27/2016] [Indexed: 11/30/2022]
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11
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Giraud R, Siegenthaler N, Merlani P, Bendjelid K. Reproducibility of transpulmonary thermodilution cardiac output measurements in clinical practice: a systematic review. J Clin Monit Comput 2016; 31:43-51. [PMID: 26753534 DOI: 10.1007/s10877-016-9823-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 01/03/2016] [Indexed: 01/31/2023]
Abstract
Measuring cardiac output (CO) is an integral part of the diagnostic and therapeutic strategy in critically ill patients. During the last decade, the single transpulmonary thermodilution (TPTD) technique was implemented in clinical practice. The purpose of this paper was to systematically review and critically assess the existing data concerning the reproducibility of CO measured using TPTD (COTPTD). A total of 16 studies were identified to potentially be included in our study because these studies had the required information that allowed for calculating the reproducibility of COTPTD measurements. 14 adult studies and 2 pediatric studies were analyzed. In total, 3432 averaged CO values in the adult population and 78 averaged CO values in the pediatric population were analyzed. The overall reproducibility of COTPTD measurements was 6.1 ± 2.0 % in the adult studies and 3.9 ± 2.9 % in the pediatric studies. An average of 3 boluses was necessary for obtaining a mean CO value. Achieving more than 3 boluses did not improve reproducibility; however, achieving less than 3 boluses significantly affects the reproducibility of this technique. The present results emphasize that TPTD is a highly reproducible technique for monitoring CO in critically ill patients, especially in the pediatric population. Our findings suggest that obtaining a mean of 3 measurements for determining CO values is recommended.
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Affiliation(s)
- Raphaël Giraud
- Intensive Care Service, Geneva University Hospitals, 4 Rue Gabrielle Perret-Gentil, 1211, Geneva 14, Switzerland. .,Faculty of Medicine, University of Geneva, Rue Michel-Servet 1, 1206, Geneva, Switzerland. .,Geneva Hemodynamic Research Group, University of Geneva, Rue Michel-Servet 1, 1206, Geneva, Switzerland.
| | - Nils Siegenthaler
- Intensive Care Service, Geneva University Hospitals, 4 Rue Gabrielle Perret-Gentil, 1211, Geneva 14, Switzerland.,Faculty of Medicine, University of Geneva, Rue Michel-Servet 1, 1206, Geneva, Switzerland.,Geneva Hemodynamic Research Group, University of Geneva, Rue Michel-Servet 1, 1206, Geneva, Switzerland
| | - Paolo Merlani
- Intensive Care Service, Geneva University Hospitals, 4 Rue Gabrielle Perret-Gentil, 1211, Geneva 14, Switzerland.,Intensive Care Unit, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, Via Tesserete 46, 6900, Lugano, Switzerland
| | - Karim Bendjelid
- Intensive Care Service, Geneva University Hospitals, 4 Rue Gabrielle Perret-Gentil, 1211, Geneva 14, Switzerland.,Faculty of Medicine, University of Geneva, Rue Michel-Servet 1, 1206, Geneva, Switzerland.,Geneva Hemodynamic Research Group, University of Geneva, Rue Michel-Servet 1, 1206, Geneva, Switzerland
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Accuracy of continuous thermodilution cardiac output monitoring by pulmonary artery catheter during therapeutic hypothermia in post-cardiac arrest patients. Resuscitation 2014; 85:1263-8. [DOI: 10.1016/j.resuscitation.2014.06.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 06/08/2014] [Accepted: 06/22/2014] [Indexed: 11/18/2022]
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Bendjelid K. Hemodynamic monitoring development: helpful technology or expensive luxury? J Clin Monit Comput 2013; 26:337-9. [PMID: 22936361 DOI: 10.1007/s10877-012-9394-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Lavi R, Cheng D. Pro: continuous cardiac output and SvO₂monitoring should be routine during off-pump coronary artery bypass graft surgery. J Cardiothorac Vasc Anesth 2012; 26:1131-5. [PMID: 22633742 DOI: 10.1053/j.jvca.2009.06.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2009] [Indexed: 11/11/2022]
Affiliation(s)
- Ronit Lavi
- Department of Anesthesia and Perioperative Medicine, University of Western Ontario, London, Ontario, Canada
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Giraud R, Siegenthaler N, Morel DR, Bendjelid K. Pre-ejection period to estimate cardiac preload dependency in mechanically ventilated pigs submitted to severe hemorrhagic shock. ACTA ACUST UNITED AC 2012; 71:702-7. [PMID: 21378580 DOI: 10.1097/ta.0b013e3181f96823] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Respiratory change in pre-ejection period (ΔPEP) has been described as a potential parameter for monitoring cardiac preload dependency in critically ill patients. This study was designed to describe the relationship between ΔPEP and pulse pressure variation (PPV) in pigs submitted to severe hemorrhagic shock. METHODS In 17 paralyzed, anesthetized mechanically ventilated pigs, electrocardiography, arterial pressure, and cardiac output derived from pulmonary artery catheter were recorded. Hemorrhagic shock was induced by removal of blood volume followed by restoration. PEP was defined as the time interval between the beginning of the Q wave on the electrocardiogram and the upstroke of the invasive radial arterial pressure curve. RESULTS At baseline, ΔPEP and PPVs were both <12% with PPV significantly correlated with ΔPEP (r = 0.96, p < 0.001). Volume loss induced by hemorrhage significantly increased PPV and ΔPEP values (p < 0.05). During severe hemorrhage, PPV correlated well with ΔPEP (r = 0.88, p < 0.001) with PPV values significantly higher than ΔPEP (p < 0.05). However, the reproducibility of ΔPEP measurements was significantly better than PPV during this step (p < 0.05). Retransfusion significantly decreased PPV and ΔPEP (p < 0.05) with PPV significantly correlated to ΔPEP (r = 0.94, p < 0.001). CONCLUSION Available correlations between PPV and ΔPEP at each time of the study were observed, meaning that ΔPEP is a reliable parameter to estimate and track the changes in cardiac preload dependency. Moreover, during the severe hemorrhagic shock period, ΔPEP measurements were more reproducible than PPV values.
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Affiliation(s)
- Raphael Giraud
- Intensive Care Unit, Geneva University Hospitals, Geneva, Switzerland
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Giraud R, Siegenthaler N, Bendjelid K. Transpulmonary thermodilution assessments: precise measurements require a precise procedure. Crit Care 2011; 15:195. [PMID: 21995848 PMCID: PMC3334767 DOI: 10.1186/cc10459] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
When incorporating the values of a hemodynamic parameter into the care of patients, the precision of the measurement method should always be considered. A prospective analysis in the previous issue of Critical Care showed that the precision of transpulmonary thermodilution (TPTD) allows for reliable mean values if a standardised procedure is used. The present finding has a physiological basis, as TPTD requires a more prolonged transit time, which in turn reduces the effects that airway pressure and arrhythmia have on venous return-cardiac output steady states. Moreover, this result suggests that the current accepted threshold value of a 15% increase in cardiac output to identify a positive response to a fluid challenge could be reduced in the future. Indeed, this value is mainly related to the precision of the pulmonary artery catheter.
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Affiliation(s)
- Raphaël Giraud
- Service of Intensive Care, Geneva University Hospitals, CH-1211 Geneva 14, Switzerland
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Cannesson M, Aboy M, Hofer CK, Rehman M. Pulse pressure variation: where are we today? J Clin Monit Comput 2011; 25:45-56. [PMID: 20390324 DOI: 10.1007/s10877-010-9229-1] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2010] [Accepted: 03/09/2010] [Indexed: 12/19/2022]
Abstract
In the present review we will describe and discuss the physiological and technological background necessary in understanding the dynamic parameters of fluid responsiveness and how they relate to recent softwares and algorithms' applications. We will also discuss the potential clinical applications of these parameters in the management of patients under general anesthesia and mechanical ventilation along with the potential improvements in the computational algorithms.
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Affiliation(s)
- Maxime Cannesson
- Department of Anesthesiology & Perioperative Care, University of California, Irvine, 333 City Boulevard West Side, Orange, CA 92868-3301, USA
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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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Note technique : validation des outils de monitorage du débit cardiaque. MEDECINE INTENSIVE REANIMATION 2011. [DOI: 10.1007/s13546-011-0224-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bendjelid K. Continuous Thermodilution Cardiac Output Monitoring During Therapeutic Hypothermia. Anesth Analg 2011; 112:250-1. [DOI: 10.1213/ane.0b013e3181f33910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Cannesson M. Arterial Pressure Variation and Goal-Directed Fluid Therapy. J Cardiothorac Vasc Anesth 2010; 24:487-97. [DOI: 10.1053/j.jvca.2009.10.008] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2009] [Indexed: 02/01/2023]
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Cannesson M, Desebbe O, Piriou V, Lehot JJ. Monitorage continu et automatisé de la précharge dépendance en anesthésie et en réanimation : intérêts et limites. ACTA ACUST UNITED AC 2010; 29:452-63. [DOI: 10.1016/j.annfar.2010.03.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2009] [Accepted: 03/04/2010] [Indexed: 10/19/2022]
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[Microcirculatory alterations in critically ill patients: pathophysiology, monitoring and treatments]. ACTA ACUST UNITED AC 2010; 29:135-44. [PMID: 20116198 DOI: 10.1016/j.annfar.2009.10.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2008] [Accepted: 10/28/2009] [Indexed: 01/18/2023]
Abstract
Microcirculation represents a complex system devoted to provide optimal tissue substrates and oxygen. Therefore, pathophysiological and technological knowledge developments tailored for capillary circulation analysis should generate major advances for critically ill patients' management. In the future, microcirculatory monitoring in several critical care situations will allow recognition of macro-microcirculatory decoupling, and, hopefully, it will promote the use of treatments aimed at preserving tissue oxygenation and substrate delivery.
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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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Tracking changes in cardiac output: methodological considerations for the validation of monitoring devices. Intensive Care Med 2009; 35:1801-8. [DOI: 10.1007/s00134-009-1570-9] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2009] [Accepted: 06/18/2009] [Indexed: 11/26/2022]
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Simon R, Desebbe O, Hénaine R, Bastien O, Lehot JJ, Cannesson M. Comparaison des valeurs de débit cardiaque obtenues à l’aide d’un nouveau système d’impédancemétrie thoracique avec les données du cathéter artériel pulmonaire en postopératoire de chirurgie cardiaque. ACTA ACUST UNITED AC 2009; 28:537-41. [DOI: 10.1016/j.annfar.2009.04.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2008] [Accepted: 04/21/2009] [Indexed: 10/20/2022]
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Abstract
PURPOSE OF REVIEW Several less invasive cardiac output monitoring techniques are now commercially available and have the potential to replace the pulmonary artery catheter under certain clinical circumstances. The aim of this review is to give a synopsis of the currently available cardiac output measurement methods. This information should help in selecting the appropriate technique in a particular clinical setting. RECENT FINDINGS An overview is given of the currently available techniques for cardiac output monitoring. Recent validation studies demonstrate that pulse wave analysis may be used reliably as an alternative to the pulmonary artery catheter in different clinical settings. The use of transesophageal echocardiography and Doppler measurements is limited due to high operator dependency, the partial carbon dioxide rebreathing technique should be applied in a precisely defined clinical setting to mechanically ventilated patients only, and pulsed dye densitometry as well as the bioimpedance technique are currently primarily applied in an investigational setting. SUMMARY Less invasive cardiac output monitoring techniques may replace the pulmonary artery catheter in different clinical settings considering the specific properties of these techniques. The pulmonary artery catheter, however, may still be recommended for cardiac output measurement in specific clinical situations when monitoring of pulmonary artery pressures is desirable.
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Affiliation(s)
- Christoph K Hofer
- Institute of Anesthesiology and Intensive Care Medicine, Triemli City Hospital, Switzerland.
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Thermodilution and Esophageal Doppler Ultrasound in the Assessment of Blood Flow Changes Induced by Endotoxin and Dobutamine. ACTA ACUST UNITED AC 2008; 65:175-82. [DOI: 10.1097/ta.0b013e31815eb0ff] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Validation and clinical application of a first order step response equation for nitrogen clearance during FRC measurement. J Clin Monit Comput 2007; 22:1-9. [PMID: 18004668 PMCID: PMC2798958 DOI: 10.1007/s10877-007-9101-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2007] [Accepted: 10/15/2007] [Indexed: 11/18/2022]
Abstract
Objective To derive a difference equation based on mass conservation and on alveolar tidal volumes for the calculation of Functional Residual Capacity. Derive an equation for the FRC from the difference equation. Furthermore, to derive and validate a step response equation as a solution of the difference equation within the framework of digital signal processing where the FRC is known a priori. Methods A difference equation for the calculation of Functional Residual Capacity is derived and solved as step response of a first order system. The step response equation calculates endtidal fractions of nitrogen during multiple breath nitrogen clearance. The step response equation contains the eigenvalue defined as the ratio of FRC to the sum of FRC and alveolar tidal ventilation. Agreement of calculated nitrogen fractions with measured fractions is demonstrated with data from a metabolic lung model, measurements from patients in positive pressure ventilation and volunteers breathing spontaneously. Examples of eigenvalue are given and compared between diseased and healthy lungs and between ventilatory settings. Results Comparison of calculated and measured fractions of endtidal nitrogen demonstrates a high degree of agreement in terms of regression and bias and limits of agreement (precision) in Bland & Altman analysis. Examples illustrate the use of the eigenvalue as a possible discriminator between disease states. Conclusion The first order step response equation reliably calculates endtidal fractions of nitrogen during washout based on a Functional Residual Capacity. The eigenvalue may be a clinically valuable index alone or in conjunction with other indices in the analysis of respiratory states and may aid in the setting of the ventilator.
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Cannesson M, Attof Y, Rosamel P, Joseph P, Bastien O, Lehot JJ. Comparison of FloTrac™ cardiac output monitoring system in patients undergoing coronary artery bypass grafting with pulmonary artery cardiac output measurements. Eur J Anaesthesiol 2007; 24:832-9. [PMID: 17666154 DOI: 10.1017/s0265021507001056] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Arterial pulse waveform analysis has been proposed for cardiac output (CO) determination and monitoring without calibration or thermodilution (FloTrac/Vigileo; Edwards Lifesciences, Irvine, CA, USA). The accuracy and clinical applicability of this technology has not been fully evaluated. We designed this prospective study to compare the accuracy of the FloTrac system (CO(FT)) vs. pulmonary artery catheter standard bolus thermodilution (CO(PAC) ) in patients undergoing coronary artery bypass grafting. METHODS We studied 11 patients referred for coronary artery bypass grafting. CO(FT) and CO(PAC) were determined at six time points in the operating room including before and 5 min after volume expansion (500 mL 6% hetastarch). Measurements were performed on arrival in the intensive care unit and every 4 h afterwards. Bland-Altman analysis was used to assess the agreement between CO(FT) and CO(PAC). RESULTS CO(PAC) ranged from 2.0 to 7.6 L min-1 and CO(FT) ranged from 1.9 to 8.2 L min-1. There was a significant relationship between CO(PAC) and CO(FT) (r = 0.662; P < 0.001). Agreement between CO(PAC) and CO(FT) was -0.26 +/- 0.87 L min-1. Volume expansion induced a significant increase in both CO(PAC) and CO(FT) (from 3.4 +/- 0.8 to 4.4 +/- 1.0 L min-1; P < 0.001 and from 3.9 +/- 1.2 to 5.0 +/- 1.1 L min-1; P < 0.001, respectively) and there was a significant relationship between percent change in CO(PAC) and CO(FT) following volume expansion (r = 0.722; P = 0.01). CONCLUSION We found clinically acceptable agreement between CO(FT) and CO(PAC) in this setting. This new device has potential clinical applications.
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Affiliation(s)
- M Cannesson
- Hospives Civils de Lyon, Hôpital Louis Pradel, Department of Anesthesiology, Bron, France.
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Boyle M, Murgo M, Lawrence J, Belessis A, Shehabi Y. Assessment of the accuracy of continuous cardiac output and pulse contour cardiac output in tracking cardiac index changes induced by volume load. Aust Crit Care 2007; 20:106-12. [PMID: 17629491 DOI: 10.1016/j.aucc.2007.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2006] [Revised: 05/22/2007] [Accepted: 05/29/2007] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To assess the ability to track changes in cardiac index (Delta CI) induced by volume loading using continuous pulsed heat thermodilution (CCO), and pulse contour (PCCO) cardiac output (CO) with transpulmonary thermodilution (TD(tp)) CO as reference. DESIGN Prospective observational clinical trial. SETTING Intensive care unit. PATIENTS Twelve ventilated and sedated post-operative cardiac surgery patients. MEASUREMENTS AND RESULTS Each patient had a 7.5F CCO pulmonary artery catheter (Edwards Lifesciences) and a 5F, 20 cm PCCO femoral artery catheter (Pulsion Medical Systems). Forty-five data sets were taken before and after 25 volume loadings of 5 mL/kg of 4% albumin. Volume loading resulted in an increase in CI (2.84 L/(min m(2)) versus 3.12L/(min m(2)), p<.05) although only nine volume loadings changed CI (Delta CI)> or =14%. The change in CI using PCCO (Delta PCCI) was correlated with Delta CI (TD(tp)) (R(2)=.50, p<.0001), whilst Delta CI using CCO (Delta CCI) was not (R(2)=.14). The bias and limits of agreement (LOA) between Delta TD(tp)CI and Delta PCCI was 6.2% (95% CI, +/-5.8%) and 28.4% (95% CI, +/-38.2%) respectively. Delta TD(tp)CI and Delta CCI has a bias of 2.6% (95% CI, +/-8.3%) and LOA of 39.6% (95% CI, +/-63%). Both Delta PCCI and Delta CCI reliably tracked Delta CI> or =14%. CONCLUSION In this small group of patients the continuous cardiac output methods tracked changes in CI, although, in individual cases they did not change in the same direction as the thermodilution method. Critical care nurses need to critically appraise the accuracy and clinical relevance of continuous CO data within the clinical context.
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Affiliation(s)
- Martin Boyle
- Intensive Care Unit, Prince of Wales Hospital, NSW, Australia
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Santamore WP, Gefen N, Avramovich A, Berger P, Kashem A, Barnea O. Right atrial effects on right ventricular ejection fraction derived from thermodilution measurements. J Cardiothorac Vasc Anesth 2007; 21:644-9. [PMID: 17905267 DOI: 10.1053/j.jvca.2007.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2006] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The thermodilution technique provides a convenient means to monitor cardiac output, right ventricular (RV) ejection fraction (EF), and volumes at the bedside. To calculate RVEF from the pulmonary artery temperature curve, the bolus thermodilution technique assumes that right atrial (RA) temperature returns to baseline value within 1 beat following the cold saline injection. The authors hypothesized that this assumption is the reason why the thermodilution technique consistently underestimates RVEF. DESIGN A theoretical analysis and animal study. SETTING Laboratory, university, multi-institutional. PARTICIPANTS Animals. INTERVENTIONS Cold saline injections. MEASUREMENTS AND MAIN RESULTS In 2 porcine experiments, after a rapid injection of cold saline into right atrium, RA temperature took several heartbeats to return to baseline. In a theoretical analysis, if after the cold saline injection RA temperature returned to baseline in 1 beat (RAEF = 1), then thermodilution-derived RVEF(T) = actual RVEF(A). In contrast, if RA temperature took several beats to return to baseline (RAEF = RVEF), then RVEF(T) consistently underestimated RVEF(A). A least square fit of RVEF(A) versus RVEF(T) resulted in RVEF(A) = 1.0 x RVEF(T) + 0.11. Applying this correction (adding 0.11 to RVEF(T)) to the data gave relatively small errors in estimating RVEF over a wide EF range. CONCLUSIONS After injecting cold saline into the right atrium, RA temperature takes several heart beats to return to baseline temperature, leading to underestimating RVEF and overestimating RV volumes. The pulsed thermal energy approach by injecting heat into the RV avoids these problems, but the impact of its small temperature signal on RVEF measurements needs to be determined.
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Affiliation(s)
- William P Santamore
- Department of Physiology, Division of Cardiovascular Research, Temple University, Philadelphia, PA 19140, USA.
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Boyle M, Lawrence J, Belessis A, Murgo M, Shehabi Y. Comparison of dynamic measurements of pulse contour with pulsed heat continuous cardiac output in postoperative cardiac surgical patients. Aust Crit Care 2007; 20:27-32. [PMID: 17424793 DOI: 10.1016/j.aucc.2006.11.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Cardiac output (CO) can be measured using bolus thermodilution via a pulmonary artery catheter (PAC) and as continuous cardiac output (CCO), using pulsed heat thermoditution. Pulse contour cardiac output (PCCO) measures continuous CO by analysis of the arterial waveform after calibration with thermodilution CO. The Pulsion Medical Systems (PiCCO system) achieves this by transpulmonary aortic thermodilution (TDtpa). There is uncertainty regarding the agreement between TDtpa, CCO, and PCCO CO measurements in situations of rapid haemodynamic changes. We studied the agreement of the measures by comparing digital recordings of cardiac index (CI) determined by PCCO and CCO (PCCI and CCI, respectively) made during periods of haemodynamic instability. After ethics committee approval we studied four post-coronary artery bypass graft patients, in the immediate postoperative period. Each patient had a 7.5F CCO catheter (Edwards Lifesciences) and a 5F, 20cm PCCO femoral artery catheter. Digital recordings were obtained for the first 12-18 postoperative hours. Six epochs of instability were identified in the first two to three postoperative hours, and at the commencement of inotropic or vasoactive drugs. Notable features, despite frequent PCCO calibrations, were the marked difference of PCCI compared to CCI. In contradistinction, they tracked very closely during a period of stability. Limitations of both methods were noted. Whilst PCCO responded to rapid change, it developed significant error during haemodynmamic instability and requires frequent recalibration. CCO on the other hand has a considerable time lag in responding to changes in CO. The way a monitor measures CO must be taken into account when using the data in clinical management.
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Affiliation(s)
- Martin Boyle
- Intensive Care, Prince of Wales Hospital, Barker St., Randwick, NSW 2031, Australia.
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