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Souza RSE, Melo WBD, Freire CMV, Vilas Boas WW. Comparative study between suprasternal and apical windows: a user-friendly cardiac output measurement for the anesthesiologist. Braz J Anesthesiol 2021:S0104-0014(21)00264-5. [PMID: 34246688 PMCID: PMC10362443 DOI: 10.1016/j.bjane.2021.02.063] [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: 05/11/2020] [Revised: 02/18/2021] [Accepted: 02/27/2021] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION Transthoracic echocardiography is a safe and readily available tool for noninvasive monitoring of Cardiac Output (CO). The use of the suprasternal window situated at the sternal notch can be an alternative approach for estimating blood flow. The present study aimed to compare two methods of CO calculation. We compared the descending aorta Velocity-Time Integral (VTI) measurement from the suprasternal window view with the standard technique to determine CO that uses VTI measurements from the LVOT (Left Ventricular Outflow Tract) view. We also aimed to find out whether after basic training a non-echocardiographer operator can obtain reproducible measurements of VTI using this approach. METHODS In the first part of the study, 26 patients without known cardiovascular diseases were evaluated and VTI data were acquired from the suprasternal window by a non-echocardiographer and an echocardiographer. Next, 17 patients were evaluated by an echocardiographer only and VTI and CO measurements were obtained from suprasternal and apical windows. Data were analyzed using the Bland and Altman method (BA), correlation and regression. RESULTS We found a strong correlation between measurements obtained by a non-expert and an expert echocardiographer and detected that an inexperienced trainee can acquire VTI measurements from the suprasternal window view. Regarding agreement between CO measurements, data obtained showed a positive correlation and the Bland and Altman analysis presented a total variation of 38.9%. CONCLUSION Regarding accuracy, it is likely that TTE (Transthoracic Echocardiogram) measurements of CO from the suprasternal window view are comparable to other minimally invasive techniques currently available. Due to its user-friendliness and low cost, it can be a convenient technique for obtaining perioperative hemodynamic measurements, even by inexperienced operators.
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Affiliation(s)
- Rafaela Souto E Souza
- Hospital das Clínicas da Universidade Federal de Minas Gerais (HC/UFMG), Belo Horizonte, MG, Brazil.
| | - Wendhell Barros de Melo
- Hospital das Clínicas da Universidade Federal de Minas Gerais (HC/UFMG), Belo Horizonte, MG, Brazil
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Abstract
During surgery, one of the primary functions of the anesthesiologist is to monitor the patient and ensure safe and effective conduct of anesthesia to provide the optimum operating conditions. Standard guidelines for perioperative monitoring have been firmly established by the American Society of Anesthesiologists. However, in recent years, new advances in technology has led to the development of many new monitoring modalities, especially involving the neurologic and cardiovascular systems. This article presents a targeted review to discuss the functions and limitations of these new monitors and how they are applied in the modern operating room setting.
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Affiliation(s)
- Yi Deng
- Department of Anesthesiology and Critical Care Medicine, Baylor College of Medicine, 1 Baylor Plaza, MSC 120, Houston, TX 77030, USA.
| | - Jovany Cruz Navarro
- Department of Anesthesiology, Baylor College of Medicine, 1 Baylor Plaza, MSC 120, Houston, TX 77030, USA; Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Sandeep Markan
- Department of Anesthesiology and Critical Care Medicine, Baylor College of Medicine, 1 Baylor Plaza, MSC 120, Houston, TX 77030, USA
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Latham HE, Bengtson CD, Satterwhite L, Stites M, Subramaniam DP, Chen GJ, Simpson SQ. Stroke volume guided resuscitation in severe sepsis and septic shock improves outcomes. J Crit Care 2017; 42:42-46. [PMID: 28672146 DOI: 10.1016/j.jcrc.2017.06.028] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 06/26/2017] [Accepted: 06/27/2017] [Indexed: 12/20/2022]
Abstract
To determine whether stroke volume (SV) guided fluid resuscitation in patients with severe sepsis and septic shock alters Intensive Care Unit (ICU) fluid balance and secondary outcomes, this retrospective cohort study evaluated consecutive patients admitted to an ICU with the primary diagnosis of severe sepsis or septic shock. Cohorts were based on fluid resuscitation guided by changes in SV or by usual care (UC). The SV group comprised 100 patients, with 91 patients in the UC group. Net fluid balance for the ICU stay was lower in the SV group (1.77L) than in the UC group (5.36L) (p=0.022). ICU length of stay was 2.89days shorter (p=0.03) and duration of vasopressors was 32.8h less (p=0.001) in the SV group. SV group required less mechanical ventilation (RR, 0.51; p=0.0001). The SV group was less likely to require acute hemodialysis (6.25%) compared with the UC group (19.5%) (RR, 0.32; p=0.01). In multivariable analysis, SV was an independent predictor of lower fluid balance, LOS, time on vasopressors, and not needing mechanical ventilation. This study demonstrated that SV guided fluid resuscitation in patients with severe sepsis and septic shock was associated with reduced fluid balance and improved secondary outcomes.
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Affiliation(s)
- Heath E Latham
- Division of Pulmonary and Critical Care Medicine, The University of Kansas Medical Center, 3901 Rainbow Blvd, MS 3007, Kansas City, KS 66160, United States.
| | - Charles D Bengtson
- Division of Pulmonary and Critical Care Medicine, The University of Kansas Medical Center, 3901 Rainbow Blvd, MS 3007, Kansas City, KS 66160, United States.
| | - Lewis Satterwhite
- Division of Pulmonary and Critical Care Medicine, The University of Kansas Medical Center, 3901 Rainbow Blvd, MS 3007, Kansas City, KS 66160, United States.
| | - Mindy Stites
- Department of Nursing, The University of Kansas Medical Center, 3901 Rainbow Blvd, MS 2018, Kansas City, KS 66160, United States.
| | - Dipti P Subramaniam
- Department of Internal Medicine, Division of Health Services Research, The University of Kansas Medical Center, 3901 Rainbow Blvd, MS 1037, Kansas City, KS 66160, United States.
| | - G John Chen
- Department of Internal Medicine, Division of Health Services Research, The University of Kansas Medical Center, 3901 Rainbow Blvd, MS 1037, Kansas City, KS 66160, United States.
| | - Steven Q Simpson
- Division of Pulmonary and Critical Care Medicine, The University of Kansas Medical Center, 3901 Rainbow Blvd, MS 3007, Kansas City, KS 66160, United States.
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A comparison of volume clamp method-based continuous noninvasive cardiac output (CNCO) measurement versus intermittent pulmonary artery thermodilution in postoperative cardiothoracic surgery patients. J Clin Monit Comput 2017; 32:235-244. [DOI: 10.1007/s10877-017-0027-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 05/06/2017] [Indexed: 10/19/2022]
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Kamoi S, Pretty C, Balmer J, Davidson S, Pironet A, Desaive T, Shaw GM, Chase JG. Improved pressure contour analysis for estimating cardiac stroke volume using pulse wave velocity measurement. Biomed Eng Online 2017; 16:51. [PMID: 28438216 PMCID: PMC5404318 DOI: 10.1186/s12938-017-0341-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 04/19/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Pressure contour analysis is commonly used to estimate cardiac performance for patients suffering from cardiovascular dysfunction in the intensive care unit. However, the existing techniques for continuous estimation of stroke volume (SV) from pressure measurement can be unreliable during hemodynamic instability, which is inevitable for patients requiring significant treatment. For this reason, pressure contour methods must be improved to capture changes in vascular properties and thus provide accurate conversion from pressure to flow. METHODS This paper presents a novel pressure contour method utilizing pulse wave velocity (PWV) measurement to capture vascular properties. A three-element Windkessel model combined with the reservoir-wave concept are used to decompose the pressure contour into components related to storage and flow. The model parameters are identified beat-to-beat from the water-hammer equation using measured PWV, wave component of the pressure, and an estimate of subject-specific aortic dimension. SV is then calculated by converting pressure to flow using identified model parameters. The accuracy of this novel method is investigated using data from porcine experiments (N = 4 Pietrain pigs, 20-24.5 kg), where hemodynamic properties were significantly altered using dobutamine, fluid administration, and mechanical ventilation. In the experiment, left ventricular volume was measured using admittance catheter, and aortic pressure waveforms were measured at two locations, the aortic arch and abdominal aorta. RESULTS Bland-Altman analysis comparing gold-standard SV measured by the admittance catheter and estimated SV from the novel method showed average limits of agreement of ±26% across significant hemodynamic alterations. This result shows the method is capable of estimating clinically acceptable absolute SV values according to Critchely and Critchely. CONCLUSION The novel pressure contour method presented can accurately estimate and track SV even when hemodynamic properties are significantly altered. Integrating PWV measurements into pressure contour analysis improves identification of beat-to-beat changes in Windkessel model parameters, and thus, provides accurate estimate of blood flow from measured pressure contour. The method has great potential for overcoming weaknesses associated with current pressure contour methods for estimating SV.
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Affiliation(s)
- Shun Kamoi
- Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand
| | - Christopher Pretty
- Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand
| | - Joel Balmer
- Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand
| | - Shaun Davidson
- Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand
| | - Antoine Pironet
- GIGA Cardiovascular Science, University of Liege, Liege, Belgium
| | - Thomas Desaive
- GIGA Cardiovascular Science, University of Liege, Liege, Belgium
| | - Geoffrey M. Shaw
- Intensive Care Unit, Christchurch Hospital, Christchurch, New Zealand
| | - J. Geoffrey Chase
- Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand
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Power P, Bone A, Simpson N, Yap CH, Gower S, Bailey M. Comparison of pulmonary artery catheter, echocardiography, and arterial waveform analysis monitoring in predicting the hemodynamic state during and after cardiac surgery. Int J Crit Illn Inj Sci 2017; 7:156-162. [PMID: 28971029 PMCID: PMC5613407 DOI: 10.4103/2229-5151.214411] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Objective: The aim of this trial was to determine whether Flotrac Vigileo™ (FV™) provides a reliable representation of the hemodynamic state of a cardiac surgical patient population when compared to pulmonary artery catheter (PAC) and echocardiography in the peril-operative period. Design: This was a prospective observational trial comparing perioperative hemodynamic states using transesophageal echocardiography (TEE), transthoracic echocardiography (TTE), FV™ and PAC during and post cardiothoracic surgery. Setting: Tertiary regional hospital Intensive Care Unit (ICU). Participants: 50 consecutive adult cardiothoracic patients with written consent provided. Intervention: Comparison of the perioperative hemodynamic states using echocardiography, FV™ and PAC was performed. Evaluation of the hemodynamic state (HDS) was performed using TEE, TTE, PAC and FV™ during and after cardiac surgery. Data were compared between the three hemodynamic assessment modalities. Main Outcome Measure: Predicted hemodynamic state. Results: FV™ and PAC were shown to correlate poorly with TEE/TTE assessment of the hemodynamic state. Both PAC and FV™ showed significant discordance with echocardiographic assessment of the hemodynamic state. Conclusions: In this trial, FV™ and PAC were shown to agree poorly with TTE/TEE assessment of the HDS in an adult cardiothoracic population. Agreement between the FV™ and PAC was also poor. Caution is recommended in interpreting isolated hemodynamic monitoring data. All hemodynamic monitoring devices have inherent sources of error. Caution is advised in interpreting any single device or measurement as a gold standard. We suggest that hemodynamic measuring devices such as FV™/PAC may act as triggers for a global hemodynamic assessment including consideration of TTE/TEE.
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Affiliation(s)
- Paul Power
- Intensive Care Unit, University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia
| | - Allison Bone
- Intensive Care Unit, University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia
| | - Nicholas Simpson
- Intensive Care Unit, University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia.,Deakin University School of Medicine, Barwon Health, Geelong, Victoria, Australia
| | - Cheng-Hon Yap
- Department of Cardiothoracic Surgery, University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Simon Gower
- Department of Anaesthesia, University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia
| | - Michael Bailey
- Department of Epidemiology and Preventive Medicine, Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
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Marshall K, Thomovsky E, Johnson P, Brooks A. A Review of Available Techniques for Cardiac Output Monitoring. Top Companion Anim Med 2016; 31:100-108. [DOI: 10.1053/j.tcam.2016.08.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Accepted: 08/04/2016] [Indexed: 12/25/2022]
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Li X, He H, Sun B. Veno-venous extracorporeal membrane oxygenation support during lung volume reduction surgery for a severe respiratory failure patient with emphysema. J Thorac Dis 2016; 8:E240-3. [PMID: 27076979 DOI: 10.21037/jtd.2016.02.22] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The use of extracorporeal membrane oxygenation (ECMO) in adults has increased in popularity and importance for the support of patients with cardiac or pulmonary failure, but rarely been described as a means of support during anaesthesia and surgery. We report the case of a patient who required lung volume reduction because of emphysema where veno-venous ECMO was required both during surgery and for the first four days postoperatively. We describe the anaesthetic management of this patient who had severe respiratory failure, review other alternatives and discuss why ECMO was particularly suited to this case.
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Affiliation(s)
- Xuyan Li
- Beijing Institute of Respiratory Medicine, Department of Respiratory and Critical Care Medicine, Beijing ChaoYang Hospital, Capital Medical University, Beijing 100020, China
| | - Hangyong He
- Beijing Institute of Respiratory Medicine, Department of Respiratory and Critical Care Medicine, Beijing ChaoYang Hospital, Capital Medical University, Beijing 100020, China
| | - Bing Sun
- Beijing Institute of Respiratory Medicine, Department of Respiratory and Critical Care Medicine, Beijing ChaoYang Hospital, Capital Medical University, Beijing 100020, China
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Minimally invasive or noninvasive cardiac output measurement: an update. J Anesth 2016; 30:461-80. [DOI: 10.1007/s00540-016-2154-9] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 02/17/2016] [Indexed: 12/15/2022]
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Yamazoe M, Mizuno A, Nishi Y, Niwa K. Arterial-pressure-based cardiac output analysis reveals the usefulness of pericardiocentesis. J Cardiothorac Vasc Anesth 2015; 29:e26-8. [PMID: 25661640 DOI: 10.1053/j.jvca.2014.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Masahiro Yamazoe
- Division of Cardiology, St. Luke's International Hospital, Tokyo, Japan
| | - Atsushi Mizuno
- Division of Cardiology, St. Luke's International Hospital, Tokyo, Japan
| | - Yutaro Nishi
- Division of Cardiology, St. Luke's International Hospital, Tokyo, Japan
| | - Koichiro Niwa
- Division of Cardiology, St. Luke's International Hospital, Tokyo, Japan
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Morgaz J, Granados MDM, Muñoz-Rascón P, Dominguez JM, Fernández-Sarmiento JA, Gómez-Villamandos RJ, Navarrete R. Comparison of thermodilution, lithium dilution, and pulse contour analysis for the measurement of cardiac output in 3 different hemodynamic states in dogs. J Vet Emerg Crit Care (San Antonio) 2014; 24:562-70. [PMID: 25142925 DOI: 10.1111/vec.12219] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 07/14/2014] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To (1) evaluate lithium dilution (LiDCO) and transpulmonary thermodilution (PiCCOTD ) in relation to traditional thermodilution (PAC-TD) for determining cardiac output (CO) in 3 different hemodynamic states in dogs and to (2) compare the continuous CO values obtained using power analysis (PulseCO) with continuous PiCCO (PiCCOc). DESIGN Prospective randomized study. SETTING University research laboratory. ANIMALS Fourteen healthy Beagles. INTERVENTIONS CO was measured using PAC-TD, LiDCO, and PiCCOTD in 3 different hemodynamic states induced in random order and defined on the basis of the mean arterial pressure (MAP). Normodynamic state was defined as the baseline MAP and 1 MAC sevoflurane. The hypodynamic state was induced with a deep level of sevoflurane anesthesia. The hyperdynamic state was induced with noradrenaline. After these measurements were obtained in each hemodynamic state, CO was monitored continuously for 30 min using PulseCO and PiCCOc. Agreement was assessed using Bland-Altman analysis and intraclass correlation coefficients, and a trend score was determined for the continuous CO measurements. MEASUREMENTS AND MAIN RESULTS There was good agreement among the 3 modalities of CO measurement in each hemodynamic state. The mean CIPAC-TD /CIPICCOTD bias was -0.04 ± 1.19 L/min/m(2) (limits of agreement, -2.37/1.93 L/min/m(2) ), and the mean CIPAC-TD /CILiDCO bias was -0.11 ± 1.55 L/min/m(2) (limits of agreement, -3.04/2.93 L/min/m(2) ). The mean CIPulseCO -CIPiCCOc bias was -0.04 ± 1.91 L/min/m(2) (limits of agreement, -1.95/1.87 L/min/m(2) ), which suggested good agreement. The CIPulseCO -CIPiCCOc trend score, calculated from 252 paired comparisons, was 93.3% positive after zone exclusion (∆CI < 15%). CONCLUSIONS Both LiDCO and PiCCOTD agreed well with PAC-TD for the measurement of CO under different hemodynamic conditions. Moreover, PiCCOc appears to be an accurate method for monitoring continuous CO in dogs as its performance for measurement was similar to that of PulseCO.
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Affiliation(s)
- Juan Morgaz
- Department of Animal Medicine and Surgery, University of Córdoba, Córdoba, Spain
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Pienn M, Kovacs G, Tscherner M, Johnson TR, Kullnig P, Stollberger R, Olschewski A, Olschewski H, Bálint Z. Determination of cardiac output with dynamic contrast-enhanced computed tomography. Int J Cardiovasc Imaging 2013; 29:1871-8. [PMID: 23974909 DOI: 10.1007/s10554-013-0279-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Accepted: 08/17/2013] [Indexed: 10/26/2022]
Abstract
Cardiac output (CO) is an important diagnostic and prognostic factor in the haemodynamic evaluation of patients. The gold standard for CO measurement, thermodilution, requires an invasive right-heart catheterisation (RHC). In this pilot study we aimed to determine the accuracy of non-invasive CO determination from dynamic contrast-enhanced computed tomography (CT) compared to thermodilution. Patients who underwent diagnostic or follow-up RHC due to suspected or known pulmonary vascular disease at our department and required a thoracic CT between June 2011 and August 2012 were included. CO was determined from CT attenuation-time curves in the pulmonary artery and the ascending aorta using a dynamic contrast-enhanced CT sequence. CO determined in N = 18 patients by dynamic CT in the pulmonary artery was in very good agreement with thermodilution data (r = 0.84). Bland-Altman analysis showed a systematic overestimation of 0.7 ± 0.6 l/min compared to thermodilution. Data from the ascending aorta also showed a good correlation, but with a larger scattering of the values. The average effective dose for the dynamic investigation was 1.2 ± 0.7 mSv. CO determined with dynamic contrast-enhanced CT in the main pulmonary artery reliably predicts the values obtained by thermodilution during RHC. This non-invasive technique might provide an alternative for repeated invasive right-heart catheter investigations in the follow-up of pulmonary arterial hypertension patients.
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Affiliation(s)
- Michael Pienn
- Ludwig Boltzmann Institute for Lung Vascular Research, Stiftingtalstrasse 24, 8010, Graz, Austria
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