1
|
Husstedt I, Spiesshoefer J, Reinecke H, Giannoni A, Kahles F, Dreher M, Boentert M, Tuleta I. Bioimpedance based determination of cardiac index does not show enough trueness for point of care use in patients with systolic heart failure. J Clin Monit Comput 2023; 37:1229-1237. [PMID: 37074524 DOI: 10.1007/s10877-023-00987-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 02/21/2023] [Indexed: 04/20/2023]
Abstract
Cardiac output (CO) is a key parameter in diagnostics and therapy of heart failure (HF). The thermodilution method (TD) as gold standard for CO determination is an invasive procedure with corresponding risks. As an alternative, thoracic bioimpedance (TBI) has gained popularity for CO estimation as it is non-invasive. However, systolic heart failure (HF) itself might worsen its validity. The present study validated TBI against TD. In patients with and without systolic HF (LVEF ≤ 50% or > 50% and NT-pro-BNP < 125 pg/ml, respectively) right heart catheterization including TD was performed. TBI (Task Force Monitor©, CNSystems, Graz, Austria) was conducted semi-simultaneously. 14 patients with and 17 patients without systolic HF were prospectively enrolled in this study. In all participants, TBI was obtainable. Bland-Altman analysis indicated a mean bias of 0.3 L/min (limits of agreement ± 2.0 L/min, percentage error or PE 43.3%) for CO and a bias of -7.3 ml (limits of agreement ± 34 ml) for cardiac stroke volume (SV). PE was markedly higher in patients with compared to patients without systolic HF (54% vs. 35% for CO). Underlying systolic HF substantially decreases the validity of TBI for estimation of CO and SV. In patients with systolic HF, TBI clearly lacks diagnostic accuracy and cannot be recommended for point-of-care decision making. Depending on the definition of an acceptable PE, TBI may be considered sufficient when systolic HF is absent.Trial registration number: DRKS00018964 (German Clinical Trial Register, retrospectively registered).
Collapse
Affiliation(s)
- Imke Husstedt
- Department of Neurology with Institute for Translational Neurology, University of Muenster, Muenster, Germany.
| | - Jens Spiesshoefer
- Department of Pneumology and Intensive Care Medicine, University Hospital RWTH Aachen, Aachen, Germany
- Institute of Life Sciences, Scuola Superiore Sant´Anna, Pisa, Italy
| | - Holger Reinecke
- Department of Cardiology I, University Hospital Muenster, Muenster, Germany
| | - Alberto Giannoni
- Institute of Life Sciences, Scuola Superiore Sant´Anna, Pisa, Italy
| | - Florian Kahles
- Cardiology and Cardiovascular Medicine Division, University Hospital RWTH Aachen, Aachen, Germany
| | - Michael Dreher
- Department of Pneumology and Intensive Care Medicine, University Hospital RWTH Aachen, Aachen, Germany
| | - Matthias Boentert
- Department of Neurology with Institute for Translational Neurology, University of Muenster, Muenster, Germany
- Department of Medicine, UKM Marienhospital Steinfurt, Steinfurt, Germany
| | - Izabela Tuleta
- Department of Cardiology I, University Hospital Muenster, Muenster, Germany
| |
Collapse
|
2
|
Kamel YA, Elmoniar MM, Fathi YI, Lotfi ME, Alwarraky MS, Yassen KA. Monitoring haemodynamic changes during transjugular portosystemic shunt insertion with electric cardiometry in sedated and spontaneous breathing patients. A diagnostic test accuracy study. J Anaesthesiol Clin Pharmacol 2023; 39:127-133. [PMID: 37250237 PMCID: PMC10220200 DOI: 10.4103/joacp.joacp_198_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 06/04/2021] [Accepted: 06/25/2021] [Indexed: 03/21/2023] Open
Abstract
Background and Aims Transjugular intrahepatic portosystemic shunt (TIPS) allows a high blood volume into systemic circulation abruptly. The primary aim of the study was to investigate the effect of TIPS on systemic, portal hemodynamics, and electric cardiometry (EC) parameters in sedated and spontaneous breathing patients. Secondary aims?? Material and Methods Adult consecutive hepatic patients scheduled for elective TIPS were included. Patients were sedated with bispectral index-guided propofol infusion + fentanyl boluses. EC parameters, i.e., cardiac output (CO) and systemic vascular resistance (SVR) were noted. Noninvasive blood pressure, heart rate, central venous pressure (CVP, cmH2O), and portal venous pressure (PVP, cmH2O) were measured pre- and post-TIPS. Results Thirty-six people were enrolled (n = 25 included) from Aug 2018 to Dec 2019. Data (expressed in median (IQ)) were: age 33 (27-40) years, body mass index 24 (22.0-27) kg/m2, child A 60%, B 36%, and C 4%. Post-TIPS, PVP decreased (from 40 [37-45] to 34 [27-37] mmHg, P < 0.001), whereas CVP increased (from 7 [4-10] to 16 [10.0-19.0] mmHg, P < 0.001). The CO increased (P = 0.03) and SVR reduced (P = 0.012). Conclusion The reduction in PVP following successful TIPS insertion elevated the CVP abruptly. EC was able to monitor an immediate increase in the CO and a reduction in SVR in association with the above PVP and CVP changes. The results of this unique study indicate that EC monitoring is promising; however, further evaluation in a larger population and in correlation with other gold-standard CO monitors is still indicated.
Collapse
Affiliation(s)
- Yasmin A. Kamel
- Department of Anaesthesia, National Liver Institute, Menoufia University, Sheeben Elkom City, Egypt
| | - Mahmoud M. Elmoniar
- Department of Anaesthesia, National Liver Institute, Menoufia University, Sheeben Elkom City, Egypt
| | - Yasser I. Fathi
- Department of Anaesthesia Department, Faculty of Medicine, Menoufia University, Sheeben Elkom City, Egypt
| | - Mamdouh E. Lotfi
- Department of Anaesthesia Department, Faculty of Medicine, Menoufia University, Sheeben Elkom City, Egypt
| | - Mohamed S. Alwarraky
- Department of Radiology, National Liver Institute, Menoufia University, Sheeben Elkom City, Egypt
| | - Khaled A. Yassen
- Department of Anaesthesia, National Liver Institute, Menoufia University, Sheeben Elkom City, Egypt
- Department of Anaesthesia Unit, Surgery Department, College of Medicine, King Faisal University, Al Hasa, Saudi Arabia
| |
Collapse
|
3
|
Martocchia A, Piccoli C, Notarangelo MF, Bentivegna E, Sergi D, Luciani M, Barlattani M, Sesti G, Martelletti P. A bedside ultrasound protocol to the measurement of the systemic vascular resistances: Preliminary results in the patients with sepsis. Clin Hemorheol Microcirc 2023; 83:163-169. [PMID: 36404539 DOI: 10.3233/ch-221613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The use of the ultrasound (US) bedside examination is increasing for the detailed evaluation of the hemodynamic parameters, allowing the physicians to set the appropriate therapeutic strategies with greater precision. OBJECTIVE The aim of this study is to evaluate the hemodynamic parameters (the cardiac output or CO, the central venous pressure or CVP and the systemic vascular resistance or SVR) in the patients with sepsis, by using a bedside US approach. METHODS We consecutively enrolled n.82 patients of S.Andrea Hospital (n.47 with sepsis and n.35 without sepsis), examining the hemodynamic parameters by a bedside US evaluation. RESULTS The incidence of sepsis was more than 50% of cases. The patients with sepsis presented higher comorbidity and polypharmacy (p < 0.01, p < 0.001), with increased creatinine (p < 0.001) and consequent esteemed glomerular filtration rate (p < 0.01), C-reactive protein (p < 0.01), SOFA (Sepsis-related Organ Failure Assessment) score (p < 1.58×10-7) and reduced SVR (p < 0.05). The SOFA score was inversely related to the SVR (p < 0.05). CONCLUSIONS To our best knowledge, this is the first study with a bedside US protocol to measure SVR, beyond the abdominal and cardiac qualitative evaluation.
Collapse
Affiliation(s)
- Antonio Martocchia
- Emergecy Medicine Unit, Sapienza University of Rome, S.Andrea Hospital, Rome, Italy
| | - Cinzia Piccoli
- Emergecy Medicine Unit, Sapienza University of Rome, S.Andrea Hospital, Rome, Italy
| | | | - Enrico Bentivegna
- Emergecy Medicine Unit, Sapienza University of Rome, S.Andrea Hospital, Rome, Italy
| | - Daniela Sergi
- Radiology Unit, Sapienza University of Rome, S.Andrea Hospital, Rome, Italy
| | - Michelangelo Luciani
- Emergecy Medicine Unit, Sapienza University of Rome, S.Andrea Hospital, Rome, Italy
| | - Michela Barlattani
- Internal Medicine Unit, Sapienza University of Rome, S.Andrea Hospital, Rome, Italy
| | - Giorgio Sesti
- Internal Medicine Unit, Sapienza University of Rome, S.Andrea Hospital, Rome, Italy
| | - Paolo Martelletti
- Emergecy Medicine Unit, Sapienza University of Rome, S.Andrea Hospital, Rome, Italy
| |
Collapse
|
4
|
Guha A, Arora D, Mehta Y. Comparative study of cardiac output measurement by regional impedance cardiography and thermodilution method in patients undergoing off pump coronary artery bypass graft surgery. Ann Card Anaesth 2022; 25:335-342. [PMID: 35799563 PMCID: PMC9387605 DOI: 10.4103/aca.aca_44_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background: An ideal CO monitor should be noninvasive, cost effective, reproducible, reliable during various physiological states. Limited literature is available regarding the noninvasive CO monitoring in open chest surgeries. Aim: The aim of this study was to compare the CO measurement by Regional Impedance Cardiography (RIC) and Thermodilution (TD) method in patients undergoing off pump coronary artery bypass graft surgery (OPCAB). Settings and Design: We conducted a prospective observational comparative study of CO measurement by the noninvasive RIC method using the NICaS Hemodynamic Navigator system and the gold standard TD method using pulmonary artery catheter in patients undergoing OPCAB. A total of 150 data pair from the two CO monitoring techniques were taken from 15 patients between 40-70 years at various predefined time intervals of the surgery. Patients and Methods: We have tried to find out the accuracy, precision and cost effectiveness of the newer RIC technique. Mean CO, bias and precision were compared for each pair i.e.TD-CO and RIC-CO as recommended by Bland and Altman. The Sensitivity and specificity of cutoff value to predict change in TD-CO was used to create a Receiver operating characteristic or ROC curve. Results: Mean TD-CO values were around 4.52 ± 1.09 L/min, while mean RIC- CO values were around 4.77± 1.84 L/min. The difference in CO change was found to be statistically not significant (p value 0.667). The bias was small (-0.25). The Bland Altman plot revealed a mean difference of -0.25 litres. The RIC method had a sensitivity of 55.56 % and specificity of 33.33 % in predicting 15% change in CO of TD method and the total diagnostic accuracy was 46.67%. Conclusion: A fair correlation was found between the two techniques. The RIC method may be considered as a promising noninvasive, potentially low cost alternative to the TD technique of hemodynamic measurement.
Collapse
Affiliation(s)
- Amrita Guha
- Department of Cardiac Anaesthesiology, Medanta the Medicity, Gurugram, Haryana, India
| | - Dheeraj Arora
- Department of Cardiac Anaesthesiology, Medanta the Medicity, Gurugram, Haryana, India
| | - Yatin Mehta
- Department of Cardiac Anaesthesiology, Medanta the Medicity, Gurugram, Haryana, India
| |
Collapse
|
5
|
Teixeira-Neto FJ, Valverde A. Clinical Application of the Fluid Challenge Approach in Goal-Directed Fluid Therapy: What Can We Learn From Human Studies? Front Vet Sci 2021; 8:701377. [PMID: 34414228 PMCID: PMC8368984 DOI: 10.3389/fvets.2021.701377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 07/06/2021] [Indexed: 11/13/2022] Open
Abstract
Resuscitative fluid therapy aims to increase stroke volume (SV) and cardiac output (CO) and restore/improve tissue oxygen delivery in patients with circulatory failure. In individualized goal-directed fluid therapy (GDFT), fluids are titrated based on the assessment of responsiveness status (i.e., the ability of an individual to increase SV and CO in response to volume expansion). Fluid administration may increase venous return, SV and CO, but these effects may not be predictable in the clinical setting. The fluid challenge (FC) approach, which consists on the intravenous administration of small aliquots of fluids, over a relatively short period of time, to test if a patient has a preload reserve (i.e., the relative position on the Frank-Starling curve), has been used to guide fluid administration in critically ill humans. In responders to volume expansion (defined as individuals where SV or CO increases ≥10–15% from pre FC values), FC administration is repeated until the individual no longer presents a preload reserve (i.e., until increases in SV or CO are <10–15% from values preceding each FC) or until other signs of shock are resolved (e.g., hypotension). Even with the most recent technological developments, reliable and practical measurement of the response variable (SV or CO changes induced by a FC) has posed a challenge in GDFT. Among the methods used to evaluate fluid responsiveness in the human medical field, measurement of aortic flow velocity time integral by point-of-care echocardiography has been implemented as a surrogate of SV changes induced by a FC and seems a promising non-invasive tool to guide FC administration in animals with signs of circulatory failure. This narrative review discusses the development of GDFT based on the FC approach and the response variables used to assess fluid responsiveness status in humans and animals, aiming to open new perspectives on the application of this concept to the veterinary field.
Collapse
Affiliation(s)
- Francisco José Teixeira-Neto
- Departmento de Cirurgia Veterinária e Reprodução Animal, Faculdade de Medicina Veterinária e Zootecnia, Universidade Estadual Paulista, Botucatu, Brazil
| | - Alexander Valverde
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| |
Collapse
|
6
|
Kobe J, Mishra N, Arya VK, Al-Moustadi W, Nates W, Kumar B. Cardiac output monitoring: Technology and choice. Ann Card Anaesth 2020; 22:6-17. [PMID: 30648673 PMCID: PMC6350438 DOI: 10.4103/aca.aca_41_18] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The accurate quantification of cardiac output (CO) is given vital importance in modern medical practice, especially in high-risk surgical and critically ill patients. CO monitoring together with perioperative protocols to guide intravenous fluid therapy and inotropic support with the aim of improving CO and oxygen delivery has shown to improve perioperative outcomes in high-risk surgical patients. Understanding of the underlying principles of CO measuring devices helps in knowing the limitations of their use and allows more effective and safer utilization. At present, no single CO monitoring device can meet all the clinical requirements considering the limitations of diverse CO monitoring techniques. The evidence for the minimally invasive CO monitoring is conflicting; however, different CO monitoring devices may be used during the clinical course of patients as an integrated approach based on their invasiveness and the need for additional hemodynamic data. These devices add numerical trend information for anesthesiologists and intensivists to use in determining the most appropriate management of their patients and at present, do not completely prohibit but do increasingly limit the use of the pulmonary artery catheter.
Collapse
Affiliation(s)
- Jeff Kobe
- Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Nitasha Mishra
- Department of Anesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Virendra K Arya
- Department of Anesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Waiel Al-Moustadi
- Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Wayne Nates
- Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Bhupesh Kumar
- Department of Anesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
7
|
Pestel G, Fukui K, Higashi M, Schmidtmann I, Werner C. [Meta-analyses on measurement precision of non-invasive hemodynamic monitoring technologies in adults]. Anaesthesist 2019; 67:409-425. [PMID: 29789877 DOI: 10.1007/s00101-018-0452-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
An ideal non-invasive monitoring system should provide accurate and reproducible measurements of clinically relevant variables that enables clinicians to guide therapy accordingly. The monitor should be rapid, easy to use, readily available at the bedside, operator-independent, cost-effective and should have a minimal risk and side effect profile for patients. An example is the introduction of pulse oximetry, which has become established for non-invasive monitoring of oxygenation worldwide. A corresponding non-invasive monitoring of hemodynamics and perfusion could optimize the anesthesiological treatment to the needs in individual cases. In recent years several non-invasive technologies to monitor hemodynamics in the perioperative setting have been introduced: suprasternal Doppler ultrasound, modified windkessel function, pulse wave transit time, radial artery tonometry, thoracic bioimpedance, endotracheal bioimpedance, bioreactance, and partial CO2 rebreathing have been tested for monitoring cardiac output or stroke volume. The photoelectric finger blood volume clamp technique and respiratory variation of the plethysmography curve have been assessed for monitoring fluid responsiveness. In this manuscript meta-analyses of non-invasive monitoring technologies were performed when non-invasive monitoring technology and reference technology were comparable. The primary evaluation criterion for all studies screened was a Bland-Altman analysis. Experimental and pediatric studies were excluded, as were all studies without a non-invasive monitoring technique or studies without evaluation of cardiac output/stroke volume or fluid responsiveness. Most studies found an acceptable bias with wide limits of agreement. Thus, most non-invasive hemodynamic monitoring technologies cannot be considered to be equivalent to the respective reference method. Studies testing the impact of non-invasive hemodynamic monitoring technologies as a trend evaluation on outcome, as well as studies evaluating alternatives to the finger for capturing the raw signals for hemodynamic assessment, and, finally, studies evaluating technologies based on a flow time measurement are current topics of clinical research.
Collapse
Affiliation(s)
- G Pestel
- Klinik für Anästhesiologie, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland.
| | - K Fukui
- Klinik für Anästhesiologie, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - M Higashi
- Klinik für Anästhesiologie, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - I Schmidtmann
- Institut für Medizinische Biometrie, Epidemiologie und Informatik (IMBEI), Universitätsmedizin Mainz, Mainz, Deutschland
| | - C Werner
- Klinik für Anästhesiologie, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| |
Collapse
|
8
|
Saugel B, Cecconi M, Hajjar LA. Noninvasive Cardiac Output Monitoring in Cardiothoracic Surgery Patients: Available Methods and Future Directions. J Cardiothorac Vasc Anesth 2019; 33:1742-1752. [DOI: 10.1053/j.jvca.2018.06.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Indexed: 12/28/2022]
|
9
|
Non-invasive cardiac output measurement with electrical velocimetry in patients undergoing liver transplantation: comparison of an invasive method with pulmonary thermodilution. BMC Anesthesiol 2018; 18:138. [PMID: 30285627 PMCID: PMC6169070 DOI: 10.1186/s12871-018-0600-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 09/20/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The goal of this study was to evaluate the accuracy and interchangeability between continuous cardiac output (CO) measured by electrical velocimetry (COEv) and continuous cardiac output obtained using the pulmonary thermodilution method (COPAC) during living donor liver transplantation (LDLT). METHOD Twenty-three patients were enrolled in this prospective observational study. CO was recorded by both two methods and compared at nine specific time points. The data were analyzed using correlation coefficients, Bland-Altman analysis for the percentage errors, and the concordance rate for trend analysis using a four-quadrant plot. RESULTS In total, 207 paired datasets were recorded during LDLT. CO data were in the range of 2.8-12.7 L/min measured by PAC and 3.4-14.9 L/min derived from the EV machine. The correction coefficient between COPAC and COEv was 0.415 with p < 0.01. The 95% limitation agreement was - 5.9 to 3.4 L/min and the percentage error was 60%. The concordance rate was 56.5%. CONCLUSIONS The Aesculon™ monitor is not yet interchangeable with continuous thermodilution CO monitoring during LDLT. TRIAL REGISTRATION The study was approved by the Institutional Review Board of Chang Gung Medical Foundation in Taiwan (registration number: 201600264B0 ).
Collapse
|
10
|
Altamirano-Diaz L, Welisch E, Dempsey AA, Park TS, Grattan M, Norozi K. Non-invasive measurement of cardiac output in children with repaired coarctation of the aorta using electrical cardiometry compared to transthoracic Doppler echocardiography. Physiol Meas 2018; 39:055003. [PMID: 29695645 DOI: 10.1088/1361-6579/aac02b] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate the equivalence of the ICON® electrical cardiometry (EC) haemodynamic monitor to measure cardiac output (CO) relative to transthoracic Doppler echocardiography (TTE) in paediatric patients with repaired coarctation of the aorta (CoA). APPROACH A group of n = 28 CoA patients and n = 27 matched controls were enrolled. EC and TTE were performed synchronously on each participant and CO measurements compared using linear regression and Bland-Altman analysis. The CoA group was further subdivided into two groups, with n = 10 and without n = 18 increased left ventricular outflow tract velocity (iLVOTv) for comparison. MAIN RESULTS CO measurements from EC and TTE in controls showed a strong correlation (R = 0.80, p < 0.001) and an acceptable percentage error (PE) of 28.1%. However, combining CoA and control groups revealed a moderate correlation (R = 0.57, p < 0.001) and a poor PE (44.2%). We suspected that the CO in a subset of CoA participants with iLVOTv was overestimated by TTE. Excluding the iLVOTv CoA participants improved the correlation (R = 0.77, p < 0.001) and resulted in an acceptable PE of 31.2%. SIGNIFICANCE CO measurements in paediatric CoA patients in the absence of iLVOTv are clinically equivalent between EC and TTE. The presence of iLVOTv may impact the accuracy of CO measurement by TTE, but not EC.
Collapse
Affiliation(s)
- Luis Altamirano-Diaz
- Department of Paediatrics, Western University, London, Ontario, Canada. Children's Health Research Institute, London, Ontario, Canada. Paediatric Cardiopulmonary Research Laboratory, London Health Sciences Centre, London, Ontario, Canada
| | | | | | | | | | | |
Collapse
|
11
|
Teefy P, Bagur R, Phillips C, Karimi-Shahri K, Teefy J, Sule R, Dempsey AA, Norozi K. Impact of Obesity on Noninvasive Cardiac Hemodynamic Measurement by Electrical Cardiometry in Adults With Aortic Stenosis. J Cardiothorac Vasc Anesth 2018; 32:2505-2511. [PMID: 29903682 DOI: 10.1053/j.jvca.2018.04.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVES There are substantial potential benefits to noninvasive cardiac monitoring methods, such as electrical cardiometry (EC), over more invasive methods, including significantly reduced risk of complications, lower up-front and operational costs, ease of use, and continuous monitoring. To take advantage of these technologies, clinical equivalence to currently established methods must be determined. The authors sought to determine if the noninvasive measurement of cardiac index (CI) by EC was clinically equivalent to thermodilution (TD) in adult patients with aortic stenosis (AS). DESIGN This is a cross-sectional study comparing measurement devices in a single patient group. SETTING Single-center, university teaching hospital. PARTICIPANTS The study included 52 adult patients with aortic stenosis undergoing right heart catheterization. INTERVENTIONS Cardiac output (CO) was measured concurrently using EC with an ICON device and TD in 52 participants with AS. CI values were to determine the accuracy and precision of EC in reference to TD. Percentage error (PE) was used to assess their clinical equivalence. The participants were divided further into groups (normal and overweight/obese) based on body mass index and the analysis was repeated. MEASUREMENTS AND MAIN RESULTS CO measurement made by EC in adult patients with obesity or overweight was reduced significantly relative to TD. This was not observed in normal-weight adult AS patients. EC provided clinically equivalent measurements to TD for measuring CI in normal-weight adult AS patients (PE = 25.0%), but not for those adult AS patients with overweight or obesity (PE = 42.3%). CONCLUSION Overall, the ICON device produced lower CO and index measurements relative to TD in adult patients with AS. Overweight and obesity also significantly affected the relative precision and accuracy of the ICON electrical cardiometric device to measure CI in these patients.
Collapse
Affiliation(s)
- Patrick Teefy
- Department of Paediatrics, Division of Paediatric Cardiology, Western University, London, Canada
| | - Rodrigo Bagur
- Department of Paediatrics, Division of Paediatric Cardiology, Western University, London, Canada
| | - Chantal Phillips
- Department of Paediatrics, Division of Paediatric Cardiology, Western University, London, Canada
| | - Kourosh Karimi-Shahri
- Department of Paediatrics, Division of Paediatric Cardiology, Western University, London, Canada
| | - John Teefy
- Department of Paediatrics, Division of Paediatric Cardiology, Western University, London, Canada
| | - Raksha Sule
- Department of Paediatrics, Division of Paediatric Cardiology, Western University, London, Canada
| | - Adam A Dempsey
- Department of Paediatrics, Division of Paediatric Cardiology, Western University, London, Canada; Children's Health Research Institute, London, Canada; Paediatric Cardiopulmonary Research Laboratory, London Health Sciences Centre, London, Canada
| | - Kambiz Norozi
- Department of Paediatrics, Division of Paediatric Cardiology, Western University, London, Canada; Children's Health Research Institute, London, Canada; Paediatric Cardiopulmonary Research Laboratory, London Health Sciences Centre, London, Canada; Department of Paediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany; Department of Paediatric Cardiology and Intensive Care Medicine, University of Goettingen, Goettingen, Germany.
| |
Collapse
|
12
|
KROHOVA J, CZIPPELOVA B, TURIANIKOVA Z, LAZAROVA Z, TONHAJZEROVA I, JAVORKA M. Preejection Period as a Sympathetic Activity Index: a Role of Confounding Factors. Physiol Res 2017; 66:S265-S275. [DOI: 10.33549/physiolres.933682] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
In previous studies, one of the systolic time intervals – preejection period (PEP) – was used as an index of sympathetic activity reflecting the cardiac contractility. However, PEP could be also influenced by several other cardiovascular variables including preload, afterload and diastolic blood pressure (DBP). The aim of this study was to assess the behavior of the PEP together with other potentially confounding cardiovascular system characteristics in healthy humans during mental and orthostatic stress (head-up tilt test – HUT). Forty-nine healthy volunteers (28 females, 21 males, mean age 18.6 years (SD=1.8 years)) participated in the study. We recorded finger arterial blood pressure by volume-clamp method (Finometer Pro, FMS, Netherlands), PEP, thoracic fluid content (TFC) – a measure of preload, and cardiac output (CO) by impedance cardiography (CardioScreen® 2000, Medis, Germany). Systemic vascular resistance (SVR) – a measure of afterload – was calculated as a ratio of mean arterial pressure and CO. We observed that during HUT, an expected decrease in TFC was accompanied by an increase of PEP, an increase of SVR and no significant change in DBP. During mental stress, we observed a decrease of PEP and an increase of TFC, SVR and DBP. Correlating a change in assessed measures (delta values) between mental stress and previous supine rest, we found that ΔPEP correlated negatively with ΔCO and positively with ΔSVR. In orthostasis, no significant correlation between ΔPEP and ΔDBP, ΔTFC, ΔCO, ΔMBP or ΔSVR was found. We conclude that despite an expected increase of sympathetic activity during both challenges, PEP behaved differently indicating an effect of other confounding factors. To interpret PEP values properly, we recommend simultaneously to measure other variables influencing this cardiovascular measure.
Collapse
Affiliation(s)
- J. KROHOVA
- Department of Physiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
| | | | | | | | | | | |
Collapse
|
13
|
Cibis T, McEwan A, Sieber A, Eskofier B, Lippmann J, Friedl K, Bennett M. Diving Into Research of Biomedical Engineering in Scuba Diving. IEEE Rev Biomed Eng 2017; 10:323-333. [PMID: 28600260 DOI: 10.1109/rbme.2017.2713300] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The physiologic response of the human body to different environments is a complex phenomenon to ensure survival. Immersion and compressed gas diving, together, trigger a set of responses. Monitoring those responses in real time may increase our understanding of them and help us to develop safety procedures and equipment. This review outlines diving physiology and diseases and identifies physiological parameters worthy of monitoring. Subsequently, we have investigated technological approaches matched to those in order to evaluated their capability for underwater application. We focused on wearable biomedical monitoring technologies, or those which could be transformed to wearables. We have also reviewed current safety devices, including dive computers and their underlying decompression models and algorithms. The review outlines the necessity for biomedical monitoring in scuba diving and should encourage research and development of new methods to increase diving safety.
Collapse
|
14
|
|
15
|
Alvarez Escudero J, Calvo Vecino JM, Veiras S, García R, González A. Clinical Practice Guideline (CPG). Recommendations on strategy for reducing risk of heart failure patients requiring noncardiac surgery: reducing risk of heart failure patients in noncardiac surgery. ACTA ACUST UNITED AC 2015; 62:359-419. [PMID: 26164471 DOI: 10.1016/j.redar.2015.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 05/04/2015] [Indexed: 12/29/2022]
Affiliation(s)
- J Alvarez Escudero
- Professor and Head of the Department of Anesthesiology, University Hospital, Santiago de Compostela, La Coruña, Spain
| | - J M Calvo Vecino
- Professor and Head of the Department of Anesthesiology, University Hospital, Santiago de Compostela, La Coruña, Spain; Associated Professor and Head of the Department of Anesthesiology, Infanta Leonor University Hospital, Complutense University of Madrid, Madrid, Spain.
| | - S Veiras
- Department of Anesthesiology, University Hospital, Santiago de Compostela, La Coruña, Spain
| | - R García
- Department of Anesthesiology, Puerta del Mar University Hospital. Cadiz, Spain
| | - A González
- Department of Anesthesiology, Puerta de Hierro University Hospital. Madrid, Spain
| | | |
Collapse
|
16
|
Vincent JL, Pelosi P, Pearse R, Payen D, Perel A, Hoeft A, Romagnoli S, Ranieri VM, Ichai C, Forget P, Della Rocca G, Rhodes A. Perioperative cardiovascular monitoring of high-risk patients: a consensus of 12. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2015; 19:224. [PMID: 25953531 PMCID: PMC4424585 DOI: 10.1186/s13054-015-0932-7] [Citation(s) in RCA: 130] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
A significant number of surgical patients are at risk of intra- or post-operative complications or both, which are associated with increased lengths of stay, costs, and mortality. Reducing these risks is important for the individual patient but also for health-care planners and managers. Insufficient tissue perfusion and cellular oxygenation due to hypovolemia, heart dysfunction or both is one of the leading causes of perioperative complications. Adequate perioperative management guided by effective and timely hemodynamic monitoring can help reduce the risk of complications and thus potentially improve outcomes. In this review, we describe the various available hemodynamic monitoring systems and how they can best be used to guide cardiovascular and fluid management in the perioperative period in high-risk surgical patients.
Collapse
Affiliation(s)
- Jean-Louis Vincent
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, 808 route de Lennik, 1070, Brussels, Belgium.
| | - Paolo Pelosi
- AOU IRCCS San Martino-IST, Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Largo Rosanna Benzi 8, 16132, Genoa, Italy.
| | - Rupert Pearse
- Adult Critical Care Unit, Royal London Hospital, Whitechapel Road, London, E1 1BB, UK.
| | - Didier Payen
- Department of Anesthesiology and Critical Care, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris 7 Denis Diderot, 75475, Paris, Cedex 10, France.
| | - Azriel Perel
- Department of Anesthesiology and Intensive Care, Sheba Medical Center, Tel Aviv University, Tel Aviv, 52621, Israel.
| | - Andreas Hoeft
- Department of Anesthesiology and Intensive Care Medicine, University of Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany.
| | - Stefano Romagnoli
- Department of Human Health Sciences, Section of Anesthesiology and Intensive Care, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Largo Giovanni Alessandro Brambilla 3, 50139, Florence, Italy.
| | - V Marco Ranieri
- Department of Anesthesia and Intensive Care Medicine, University of Turin, S.Giovanni Battista Molinette Hospital, 10126, Turin, Italy.
| | - Carole Ichai
- Medico-Surgical Intensive Care Unit, Saint-Roch University Hospital, University of Nice, 5 Rue Pierre Dévoluy, 06006, Nice, France.
| | - Patrice Forget
- Service d'Anesthésiologie, Cliniques Universitaires Saint-Luc, Institute of Neuroscience (IoNS), Université catholique de Louvain, Avenue Hippocrate 10, 1200, Brussels, Belgium.
| | - Giorgio Della Rocca
- Department of Anesthesia and Intensive Care Medicine, University Hospital, Medical School, University of Udine, P. le S. Maria della Misericordia 15, 33100, Udine, Italy.
| | - Andrew Rhodes
- Department of Intensive Care Medicine, St George's Healthcare NHS Trust, Blackshaw Road, London, SW17 0QT, UK.
| |
Collapse
|
17
|
Saugel B, Cecconi M, Wagner J, Reuter D. Noninvasive continuous cardiac output monitoring in perioperative and intensive care medicine. Br J Anaesth 2015; 114:562-75. [DOI: 10.1093/bja/aeu447] [Citation(s) in RCA: 208] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
|
18
|
Blohm ME, Obrecht D, Hartwich J, Mueller GC, Kersten JF, Weil J, Singer D. Impedance cardiography (electrical velocimetry) and transthoracic echocardiography for non-invasive cardiac output monitoring in pediatric intensive care patients: a prospective single-center observational study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2014; 18:603. [PMID: 25407329 PMCID: PMC4261789 DOI: 10.1186/s13054-014-0603-0] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Accepted: 10/20/2014] [Indexed: 11/23/2022]
Abstract
Introduction Electrical velocimetry (EV) is a type of impedance cardiography, and is a non-invasive and continuously applicable method of cardiac output monitoring. Transthoracic echocardiography (TTE) is non-invasive but discontinuous. Methods We compared EV with TTE in pediatric intensive care patients in a prospective single-center observational study. Simultaneous, coupled, left ventricular stroke volume measurements were performed by EV using an Aesculon® monitor and TTE (either via trans-aortic valve flow velocity time integral [EVVTI], or via M-mode [EVMM]). H0: bias was less than 10% and the mean percentage error (MPE) was less than 30% in Bland–Altman analysis between EV and TTE. If appropriate, data were logarithmically transformed prior to Bland–Altman analysis. Results A total of 72 patients (age: 2 days to 17 years; weight: 0.8 to 86 kg) were analyzed. Patients were divided into subgroups: organ transplantation (OTX, n =28), sepsis or organ failure (SEPSIS, n =16), neurological patients (NEURO, n =9), and preterm infants (PREM, n =26); Bias/MPE for EVVTI was 7.81%/26.16%. In the EVVTI subgroup analysis for OTX, NEURO, and SEPSIS, bias and MPE were within the limits of H0, whereas the PREM subgroup had a bias/MPE of 39.00%/46.27%. Bias/MPE for EVMM was 8.07%/37.26% where the OTX and NEURO subgroups were within the range of H0, but the PREM and SEPSIS subgroups were outside the range. Mechanical ventilation, non-invasive continuous positive airway pressure ventilation, body weight, and secondary abdominal closure were factors that significantly affected comparison of the methods. Conclusions This study shows that EV is comparable with aortic flow-based TTE for pediatric patients.
Collapse
Affiliation(s)
- Martin Ernst Blohm
- Department of Pediatrics, Division of Neonatology and Pediatric Intensive Care, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg, 20246, Germany.
| | - Denise Obrecht
- Department of Pediatrics, Division of Neonatology and Pediatric Intensive Care, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg, 20246, Germany.
| | - Jana Hartwich
- Department of Pediatrics, Division of Neonatology and Pediatric Intensive Care, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg, 20246, Germany. .,Current address: Department of Neurology, Elbe Kliniken Stade, Bremervörder Str. 111, Stade, 21682, Germany.
| | - Goetz Christoph Mueller
- Department of Pediatric Cardiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg, 20246, Germany.
| | - Jan Felix Kersten
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg, 20246, Germany.
| | - Jochen Weil
- Department of Pediatric Cardiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg, 20246, Germany.
| | - Dominique Singer
- Department of Pediatrics, Division of Neonatology and Pediatric Intensive Care, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg, 20246, Germany.
| |
Collapse
|
19
|
Malik V, Subramanian A, Chauhan S, Hote M. Correlation of Electric Cardiometry and Continuous Thermodilution Cardiac Output Monitoring Systems. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/wjcs.2014.47016] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
20
|
Busse L, Davison DL, Junker C, Chawla LS. Hemodynamic monitoring in the critical care environment. Adv Chronic Kidney Dis 2013; 20:21-9. [PMID: 23265593 DOI: 10.1053/j.ackd.2012.10.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Revised: 10/18/2012] [Accepted: 10/19/2012] [Indexed: 12/24/2022]
Abstract
Hemodynamic monitoring is essential to the care of the critically ill patient. In the hemodynamically unstable patient where volume status is not only difficult to determine, but excess fluid administration can lead to adverse consequences, utilizing markers that guide resuscitation can greatly affect outcomes. Several markers and devices have been developed to aid the clinician in assessing volume status with the ultimate goal of optimizing tissue oxygenation and organ perfusion. Early static measures of volume status, including pulmonary artery occlusion pressure and central venous pressure, have largely been replaced by newer dynamic measures that rely on real-time measurements of physiological parameters to calculate volume responsiveness. Technological advances have lead to the creation of invasive and noninvasive devices that guide the physician through the resuscitative process. In this manuscript, we review the physiologic rationale behind hemodynamic monitoring, define the markers of volume status and volume responsiveness, and explore the various devices and technologies available for the bedside clinician.
Collapse
|
21
|
Abstract
PURPOSE OF REVIEW A number of less-invasive haemodynamic monitoring devices have been introduced in recent years, largely replacing the pulmonary artery catheter (PAC) as a standard monitoring tool. Apart from tracking cardiac output (CO), these monitors provide additional haemodynamic parameters. The aim of this article is to review the most widely used less-invasive monitoring modalities, their technical characteristics and limitations regarding their clinical performance. RECENT FINDINGS The utilization of CO monitoring in the perioperative setting has been shown to be associated with improved outcomes if integrated into a haemodynamic optimization strategy. These findings provide the basis of recent recommendations for perioperative monitoring. SUMMARY An array of monitoring modalities have been introduced that can reliably track CO in the perioperative setting and make the PAC dispensable in most clinical situations. In order to be used safely and efficiently, knowledge regarding the inherent monitoring techniques and their limitations, their clinical validity and the utility of the parameters provided is crucial.
Collapse
|
22
|
Marik PE. Noninvasive cardiac output monitors: a state-of the-art review. J Cardiothorac Vasc Anesth 2012; 27:121-34. [PMID: 22609340 DOI: 10.1053/j.jvca.2012.03.022] [Citation(s) in RCA: 200] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Indexed: 12/26/2022]
Affiliation(s)
- Paul E Marik
- Division of Pulmonary and Critical Care Medicine, Eastern Virginia Medical School, Norfolk, VA 23507, USA.
| |
Collapse
|
23
|
Pérez Vela J, Martín Benítez J, Carrasco González M, De la Cal López M, Hinojosa Pérez R, Sagredo Meneses V, del Nogal Saez F. Guías de práctica clínica para el manejo del síndrome de bajo gasto cardíaco en el postoperatorio de cirugía cardíaca. Med Intensiva 2012; 36:e1-44. [DOI: 10.1016/j.medin.2012.02.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Accepted: 01/07/2012] [Indexed: 01/04/2023]
|
24
|
Porhomayon J, Zadeii G, Congello S, Nader ND. Applications of minimally invasive cardiac output monitors. Int J Emerg Med 2012; 5:18. [PMID: 22531454 PMCID: PMC3353182 DOI: 10.1186/1865-1380-5-18] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2010] [Accepted: 04/24/2012] [Indexed: 11/10/2022] Open
Abstract
Because of the increasing age of the population, critical care and emergency medicine physicians have seen an increased number of critically ill patients over the last decade. Moreover, the trend of hospital closures in the United States t imposes a burden of increased efficiency. Hence, the identification of devices that facilitate accurate but rapid assessments of hemodynamic parameters without the added burden of invasiveness becomes tantamount. The purpose of this review is to understand the applications and limitations of these new technologies.
Collapse
Affiliation(s)
- Jahan Porhomayon
- VA Western New York Healthcare System, Division of Critical Care and Pain Medicine, Department of Anesthesiology, State University of New York at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY, USA.
| | | | | | | |
Collapse
|
25
|
Monitoring the patient at risk of hemodynamic instability in remote locations. Int Anesthesiol Clin 2012; 50:141-72. [PMID: 22481561 DOI: 10.1097/aia.0b013e318250ebb1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
|
26
|
Porhomayon J, El-Solh A, Papadakos P, Nader ND. Cardiac output monitoring devices: an analytic review. Intern Emerg Med 2012; 7:163-71. [PMID: 22147648 DOI: 10.1007/s11739-011-0738-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2010] [Accepted: 11/22/2011] [Indexed: 10/14/2022]
Abstract
To evaluate cardiac output (CO), both invasive and semi-invasive monitors are used in critical care medicine. The pulmonary artery catheter is an invasive tool to assess CO with the major criticism that the level of its invasiveness is not supported by an improvement in patients' outcomes. The interest in a lesser invasive techniques is high. Therefore, alternative techniques have been developed recently, and are used frequently in critical care medicine. Cardiac output can be monitored continuously by different devices that analyze the stroke volume and CO. The purpose of this review is to understand these new technologies and their applications and limitations.
Collapse
MESH Headings
- Cardiac Catheterization/instrumentation
- Cardiac Catheterization/methods
- Cardiac Output/physiology
- Cardiology/instrumentation
- Cardiology/methods
- Critical Care/methods
- Echocardiography, Doppler/instrumentation
- Echocardiography, Doppler/methods
- Echocardiography, Transesophageal/instrumentation
- Echocardiography, Transesophageal/methods
- Electric Impedance
- Equipment Design
- Equipment Safety
- Extracorporeal Membrane Oxygenation/instrumentation
- Extracorporeal Membrane Oxygenation/methods
- Female
- Hemodynamics/physiology
- Humans
- Lithium
- Male
- Monitoring, Physiologic/instrumentation
- Monitoring, Physiologic/methods
- Sensitivity and Specificity
- Ultrasonography, Doppler, Pulsed/instrumentation
- Ultrasonography, Doppler, Pulsed/methods
- Ultrasonography, Interventional/instrumentation
- Ultrasonography, Interventional/methods
Collapse
Affiliation(s)
- Jahan Porhomayon
- Department of Anesthesiology, VA Western New York Healthcare System, State University of New York at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY 14215, USA.
| | | | | | | |
Collapse
|
27
|
Yamada T, Tsutsui M, Sugo Y, Sato T, Akazawa T, Sato N, Yamashita K, Ishihara H, Takeda J. Multicenter study verifying a method of noninvasive continuous cardiac output measurement using pulse wave transit time: a comparison with intermittent bolus thermodilution cardiac output. Anesth Analg 2012; 115:82-7. [PMID: 22467885 DOI: 10.1213/ane.0b013e31824e2b6c] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Many technologies have been developed for minimally invasive monitoring of cardiac output. Estimated continuous cardiac output (esCCO) measurement using pulse wave transit time is one noninvasive method. Because it does not require any additional sensors other than those for conducting 3 basic forms of monitoring (electrocardiogram, pulse oximeter wave, and noninvasive (or invasive) arterial blood pressure measurement), esCCO measurement is potentially useful in routine clinical circulatory monitoring for any patient including low-risk patients. We evaluated the efficacy of noninvasive esCCO using pulse wave transit time in this multicenter study. METHODS We compared esCCO and intermittent bolus thermodilution cardiac output (TDCO) in 213 patients, 139 intensive care units (ICUs), and 74 operating rooms (ORs), at 7 participating institutions. We performed electrocardiogram, pulse oximetry, TDCO, and arterial blood pressure measurements in patients in ICUs and ORs; a single calibration was performed to measure esCCO continuously. TDCO measurement was performed once daily for ICU patients and every hour for OR patients, and just before the removal of the pulmonary arterial catheter from patients in both the ICU and OR. We evaluated esCCO against TDCO with correlation analysis and Bland and Altman analysis and also assessed the change of bias over time. Furthermore, we inspected the impact of change in systemic vascular resistance (SVR) on change in bias because abnormal SVR was assumed to be a factor contributing to the change of the bias. RESULTS From among 588 esCCO and TDCO datasets (excluding calibration points), 587 datasets were analyzed for 213 patients. The analysis results show a correlation coefficient of 0.79 (P < 0.0001, 95% confidence limits of 0.756-0.819), a bias (mean difference between esCCO and TDCO) of 0.13 L/min (95% confidence interval of bias 0.04-0.22 L/min), and a precision (1 SD) of 1.15 L/min (95% prediction interval was -2.13 to 2.39 L/min). There were no significant differences among 3 defined time intervals over 48 hours after calibration (repeated-measures analysis of variance P = 0.781) in the ICU. The influence of SVR on esCCO analysis showed a correlation coefficient between SVR and an error of 0.37 (P < 0.0001, 95% confidence interval 0.298-0.438). CONCLUSION The efficacy of noninvasive esCCO technology was compared with TDCO in 213 cases. Five hundred eighty-seven datasets comparing esCCO and TDCO showed close correlation and small bias and precision, which were comparable to current arterial waveform analysis technologies.
Collapse
Affiliation(s)
- Takashige Yamada
- Department of Anesthesiology, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Bernstein DP, Henry IC, Banet MJ, Dittrich T. Stroke volume obtained by electrical interrogation of the brachial artery: transbrachial electrical bioimpedance velocimetry. Physiol Meas 2012; 33:629-49. [DOI: 10.1088/0967-3334/33/4/629] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
29
|
Cardiac output assessed by invasive and minimally invasive techniques. Anesthesiol Res Pract 2011; 2011:475151. [PMID: 21776254 PMCID: PMC3137960 DOI: 10.1155/2011/475151] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Accepted: 03/22/2011] [Indexed: 12/11/2022] Open
Abstract
Cardiac output (CO) measurement has long been considered essential to the assessment and guidance of therapeutic decisions in critically ill patients and for patients undergoing certain high-risk surgeries. Despite controversies, complications and inherent errors in measurement, pulmonary artery catheter (PAC) continuous and intermittent bolus techniques of CO measurement continue to be the gold standard. Newer techniques provide less invasive alternatives; however, currently available monitors are unable to provide central circulation pressures or true mixed venous saturations. Esophageal Doppler and pulse contour monitors can predict fluid responsiveness and have been shown to decrease postoperative morbidity. Many minimally invasive techniques continue to suffer from decreased accuracy and reliability under periods of hemodynamic instability, and so few have reached the level of interchangeability with the PAC.
Collapse
|
30
|
Digby GC, Driver HS, Fitzpatrick M, Ropchan G, Parker CM. Use of Bioimpedance to Assess Changes in Hemodynamics During Acute Administration of CPAP. Cardiol Res 2011; 2:51-57. [PMID: 28348662 PMCID: PMC5358188 DOI: 10.4021/cr18w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2011] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Attempts to investigate the mechanisms by which continuous positive airway pressure (CPAP) therapy improves heart function in patients with obstructive sleep apnea (OSA) have been limited by the lack of non-invasive methods to assess cardiac performance. We used transthoracic electrical bioimpedance (TEB) to assess acute hemodynamic changes including heart rate (HR), stroke volume (SV), cardiac output (CO) and cardiac index (CI) during PAP titration in (1) post-operative cardiac surgery patients, (2) patients with severe OSA, and (3) normal healthy volunteers. METHODS Post-operative cardiac surgery patients were studied via TEB and pulmonary artery catheter (PAC) during acute titration of positive end-expiratory pressure (PEEP) while mechanically ventilated. Patients with severe OSA were studied non-invasively by TEB during acute CPAP titration in supine stage 2 sleep, and normal subjects while awake and recumbent. RESULTS In post-operative cardiac surgery patients (n = 3), increasing PEEP to 18 cmH2O significantly reduced SV and CI relative to baseline. There was no difference between TEB and PAC in terms of ability to assess variations in hemodynamic parameters. In patients with severe OSA (n = 3), CPAP titration to optimal pressure to alleviate obstructive apneas reduced HR, SV, CO and CI significantly compared to without CPAP. In three healthy subjects, maximal tolerated CPAP reduced SV and CO significantly compared to baseline. CONCLUSIONS Acute administration of CPAP causes a decrease in CO and CI, apparently a consequence of a reduction in SV. TEB appears to be an accurate and reproducible non-invasive method of detecting changes in hemodynamics.
Collapse
Affiliation(s)
| | - Helen S. Driver
- Department of Medicine, Queen’s University, Kingston, Ontario, Canada
- Sleep Disorders Laboratory, Kingston General Hospital, Kingston, Ontario, Canada
| | - Michael Fitzpatrick
- Department of Medicine, Queen’s University, Kingston, Ontario, Canada
- Sleep Disorders Laboratory, Kingston General Hospital, Kingston, Ontario, Canada
| | - Glorianne Ropchan
- Department of Surgery, Queen’s University, Kingston, Ontario, Canada
| | - Christopher M. Parker
- Department of Medicine, Queen’s University, Kingston, Ontario, Canada
- Department of Physiology, Queen’s University, Kingston, Ontario, Canada
| |
Collapse
|
31
|
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.
| | | | | |
Collapse
|
32
|
Critchley LA, Lee A, Ho AMH. A Critical Review of the Ability of Continuous Cardiac Output Monitors to Measure Trends in Cardiac Output. Anesth Analg 2010; 111:1180-92. [DOI: 10.1213/ane.0b013e3181f08a5b] [Citation(s) in RCA: 380] [Impact Index Per Article: 27.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
|
33
|
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.
Collapse
Affiliation(s)
- Jamal A Alhashemi
- Department of Anesthesia and Critical Care, King Abdulaziz University, P.O. Box 31648, Jeddah, 21418, Saudi Arabia
| | | | | | | | | |
Collapse
|
34
|
Kolb J, Kitzler TM, Tauber T, Morris N, Skrabal F, Kotanko P. Proto-dialytic cardiac function relates to intra-dialytic morbid events. Nephrol Dial Transplant 2010; 26:1645-51. [DOI: 10.1093/ndt/gfq599] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
|
35
|
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.
Collapse
|
36
|
Transthoracic electrical bioimpedence cardiac output: comparison with multigated equillibrium radionuclide cardiography. J Clin Monit Comput 2010; 24:155-9. [PMID: 20229061 DOI: 10.1007/s10877-010-9225-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2009] [Accepted: 02/17/2010] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Thoracic electrical bioimpedance (TEB) for measuring cardiac output (CO) is being explored increasingly as an alternative to pulmonary artery catheter. The major advantage of this technology is that it is non-invasive and easy to perform. Several studies have compared it to thermodilution cardiac output using PA catheter, with variable correlation. Multigated radionuclide equilibrium cardiography (RNEC) method of cardiac output measurement is known to be reliable. OBJECTIVE To compare cardiac output measured by thoracic electrical bioimpdenace with that measured by multigated radionuclide equilibrium cardiography. PATIENTS AND METHODS CO studies were performed sequentially at a single sitting by TEB and RNEC methods among patients with cardiac symptoms referred for radionuclide study as part of their evaluation. TEB CO was measured by placing two pairs of electrodes on either side of neck and two other pairs on either side of the lower chest. Stroke volume was estimated from the sequential changes in transthoracic electrical bioimpedance induced by rhythmic aortic blood flow, using Kubicek equation. RNEC-CO was measured by intravenous injection of radio-active Technitium-tagged RBCs followed by ECG gated blood pool imaging over the chest (MUGA study). Bland-Altman analysis was used to compare the measurements. RESULTS A total of 32 subjects with proven or suspected ischemic heart disease, but without overt cardiac failure, edema or arrhythmias were studied (M:F::26:6; mean age: 48 +/- 12 years). The mean TEB-CO was 3.54 +/- 1.052 l/min and mean RNEC-CO was 3.907 +/- 0.952 l/min. Correlation coefficient (r) for these measurements was 0.67 (p < 0.01), with bias: -0.421 l/min; precision: 1.557 l/min; and percentage error of measurement: 42.35%. CONCLUSIONS This study observed a moderate correlation between TEB and RNEC methods of CO measurement. Further studies are indicated to explore the relative utility of TEB in comparison with RNEC as well as other methods of CO measurement before considering its use in patients with ischemic heart disease.
Collapse
|
37
|
Hemodynamic changes after administration of mannitol measured by a noninvasive cardiac output monitor. J Neurosurg Anesthesiol 2009; 21:248-52. [PMID: 19543004 DOI: 10.1097/ana.0b013e3181a6aebf] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Mannitol is the most commonly used hyperosmotic agent in neurosurgery. Being an agent that increases intravascular volume by withdrawing water from the brain, it may cause significant changes in stroke volume (SV), cardiac output (CO), systemic vascular resistance and blood pressure. In this study, we monitored the hemodynamic changes in response to a single dose of mannitol by using a noninvasive CO monitor based on the thoracic electrical bioimpedance technique, in patients undergoing craniotomy. Eleven adult patients undergoing elective craniotomy received mannitol 1.0 g/kg 15 minutes before dural opening. The following hemodynamic variables were recorded: heart rate, systolic blood pressure, diastolic blood pressure, SV, CO, and cardiac index. The measurements were made before the administration of mannitol, at 1, 2, 5, 10, 15, 20, 25, 30, 35, 40, and 45 minutes after the termination of the mannitol infusion. Urine output was measured at 10, 20, 30, 40, 50, 60, 90, and 120 minutes after termination of the mannitol infusion. Heart rate values from 25 to 45 minutes were significantly lower compared with the premannitol values (P<0.05). All the postmannitol systolic blood pressure values were significantly lower than the premannitol value (P<0.05). SV increased significantly for 15 minutes after administration of mannitol (P<0.05). SV at 45 minutes was significantly lower than that from 1 to 30 minutes (P<0.05). Cardiac index also showed a similar change with a significant increase at 1 to 10 minutes and a decrease at 40 to 45 minutes compared with 1 to 15 minutes.The rate of urine secretion was higher during the first 10 minutes (40+/-15 mL/kg/ h) than during the rest of the study period. The overall fluid balance at the end of 120 minutes was -370+/-987 mL. In this study using noninvasive measurement of CO by thoracic bioimpedance plethysmography during craniotomy, a single bolus dose of mannitol 1.0 g/kg caused a significant but short duration changes in the hemodynamic variables. The changes in SV, and CO, lasted for only 15 minutes after the infusion.
Collapse
|
38
|
Ali Z, Umamaheswara Rao GS, Jaganath A. Haemodynamic changes during craniotomy monitored by a bioimpedance plethysmographic noninvasive cardiac output monitor. J Clin Monit Comput 2009; 23:157-61. [PMID: 19205908 DOI: 10.1007/s10877-009-9166-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2008] [Accepted: 01/22/2009] [Indexed: 01/28/2023]
Abstract
BACKGROUND Profound cardiovascular changes may occur at various stages during a craniotomy. These changes require a detailed haemodynamic analysis including cardiac output. In the present study, we used a monitor based on electrical bioimpedance method for noninvasive cardiac output measurement. METHODS In 17 ASA I and II patients undergoing elective craniotomies for supratentorial tumours, the following haemodynamic parameters were measured noninvasively: heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), stroke volume (SV), cardiac output (CO) and systemic vascular resistance (SVR). Haemodynamic changes in response to the following events were studied: (a) induction of anaesthesia with thiopentone, (b) 15 min of air-O(2)-isoflurane anaesthesia, (c) infiltration of the scalp with lidocaine adrenaline mixture, and (d) change of inspired gas mixture to N(2)O-O(2)-isoflurane. RESULTS HR increased (P < 0.001) and SV decreased (P < 0.001) while CO remained unchanged, one min after administration of thiopentone. After 15 min of isoflurane anaesthesia, HR increased (P < 0.001) and, SBP (P = 0.02), DBP (P = 0.002) and SV (P = 0.003) decreased significantly without change in CO. Three minutes after infiltration of the scalp with lidocaine-adrenaline mixture, there was an increase in SBP (P = 0.001), DBP (P = 0.007), SV (P = 0.007) and CO (P = 0.001) and a decrease in SVR (P < 0.001). Addition of nitrous oxide (60%) to the inspired gas mixture decreased SBP (P = 0.003) and DBP (P = 0.001) with a trend for decrease in CO (P < 0.1). The changes recorded in the present study conform to those that have been documented earlier by using invasive monitoring. CONCLUSION Bioimpedance plethysmography is a useful noninvasive technique for monitoring and detailed analysis of the rapidly changing systemic haemodynamics during a craniotomy. The device could be useful for investigating important haemodynamic changes in specific neurosurgical settings.
Collapse
Affiliation(s)
- Zulfiqar Ali
- Department of Neuroanaesthesia, All India Institute of Medical Sciences, New Delhi, India
| | | | | |
Collapse
|
39
|
Sathyaprabha TN, Pradhan C, Rashmi G, Thennarasu K, Raju TR. Noninvasive cardiac output measurement by transthoracic electrical bioimpedence: influence of age and gender. J Clin Monit Comput 2008; 22:401-8. [PMID: 19005768 DOI: 10.1007/s10877-008-9148-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2008] [Accepted: 10/18/2008] [Indexed: 11/26/2022]
Abstract
BACKGROUND Thoracic electrical bioimpedance (TEB) as a method of measuring cardiac output (CO) is being explored increasingly over the last two decades, as a non-invasive alternative to the pulmonary artery catheter. The objective of this study was to establish normative data for measurement of CO by TEB and define the effect of age and gender on CO. METHOD Stroke volume (SV) of 397 normal individuals (203 men, 194 women) in the age range of 10-77 years was determined using Kubisek and Bernstein formulae by TEB method. Derived cardiac parameters including CO, cardiac index (CI), systemic vascular resistance and resistance index were calculated and analyzed. RESULTS We found significant difference in CO among age groups and between gender. CO between Kubicek formula and Bernstein formula correlated well, but their means differed significantly. Cardiac indices peak in the third and seventh decade and were comparable between genders. CONCLUSION A comprehensive data set of normalized values expressed as 95% confidence interval and mean +/- SD in different age groups and different gender was possible for cardiac parameters using TEB.
Collapse
|