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Abstract
PURPOSE OF REVIEW The purpose of this article is to review various contemporary cardiac output (CO) measurement technologies available and their utility in critically ill patients. RECENT FINDINGS CO measurement devices can be invasive, minimally invasive, or noninvasive depending upon their method of CO measurement. All devices have pros and cons, with pulmonary artery catheter (PAC) being the gold standard. The invasive techniques are more accurate; however, their invasiveness can cause more complications. The noninvasive devices predict CO via mathematical modeling with several assumptions and are thus prone to errors in clinical situations. Recently, PAC has made a comeback into clinical practice especially in cardiac intensive care units (ICUs). Critical care echocardiography (CCE) is an upcoming tool that not only provides CO but also helps in differential diagnosis. Lack of proper training and nonavailability of equipment are the main hindrances to the wide adoption of CCE. SUMMARY PAC thermodilution for CO measurement is still gold standard and most suitable in patients with cardiac pathology and with experienced user. CCE offers an alternative to thermodilution and is suitable for all ICUs; however, structural training is required.
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Affiliation(s)
- Virendra K Arya
- Department of Anesthesiology, Perioperative and Pain Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
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Continuous Estimation of Cardiac Output in Critical Care: A Noninvasive Method Based on Pulse Wave Transit Time Compared with Transpulmonary Thermodilution. Crit Care Res Pract 2020; 2020:8956372. [PMID: 32765907 PMCID: PMC7387954 DOI: 10.1155/2020/8956372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 06/02/2020] [Indexed: 12/15/2022] Open
Abstract
Purpose Estimation of cardiac output (CO) and evaluation of change in CO as a result of therapeutic interventions are essential in critical care medicine. Whether noninvasive tools estimating CO, such as continuous cardiac output (esCCOTM) methods, are sufficiently accurate and precise to guide therapy needs further evaluation. We compared esCCOTM with an established method, namely, transpulmonary thermodilution (TPTD). Patients and Methods. In a single center mixed ICU, esCCOTM was compared with the TPTD method in 38 patients. The primary endpoint was accuracy and precision. The cardiac output was assessed by two investigators at baseline and after eight hours. Results In 38 critically ill patients, the two methods correlated significantly (r = 0.742). The Bland–Altman analysis showed a bias of 1.6 l/min with limits of agreement of −1.76 l/min and +4.98 l/min. The percentage error for COesCCO was 47%. The correlation of trends in cardiac output after eight hours was significant (r = 0.442), with a concordance of 74%. The performance of COesCCO could not be linked to the patient's condition. Conclusion The accuracy and precision of the esCCOTM method were not clinically acceptable for our critical patients. EsCCOTM also failed to reliably detect changes in cardiac output.
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Abstract
PURPOSE OF REVIEW Bedside cardiac output (CO) measurement is an important part of routine hemodynamic monitoring in the differential diagnosis of circulatory shock and fluid management. Different choices of CO measurement devices are available. The purpose of this review is to review the importance of CO [or stroke volume (SV)] measurement and to discuss the various methods (devices) used in determination of CO. RECENT FINDINGS CO measurement devices can be classified into two types: those use simple physical principles with minimal assumptions, and those predicting CO via mathematical modelling with a number of assumptions. Both have pros and cons, with the former being more accurate but with limited continuous monitoring capability whereas the latter less accurate but usually equipped with continuous monitoring functionality. With frequent updates in mathematical models, research data constantly become outdated in this area. Recent data suggest devices based on mathematical modelling have limited accuracies and poor precisions. SUMMARY Measurement of CO or SV is important in critically ill patients. Most devices have accuracy and reliability issues. The choice of device should depend on the purpose of measurement. For diagnostic purposes, devices based on simple physical principles, especially thermodilution and transthoracic echocardiography are more reliable due to accuracy.
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Schneck E, Drubel P, Schürg R, Markmann M, Kohl T, Henrich M, Sander M, Koch C. Evaluation of pulse wave transit time analysis for non-invasive cardiac output quantification in pregnant patients. Sci Rep 2020; 10:1857. [PMID: 32024981 PMCID: PMC7002624 DOI: 10.1038/s41598-020-58910-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 01/22/2020] [Indexed: 01/09/2023] Open
Abstract
Pregnant patients undergoing minimally-invasive foetoscopic surgery for foetal spina bifida have a need to be subjected to advanced haemodynamic monitoring. This observational study compares cardiac output as measured by transpulmonary thermodilution monitoring with the results of non-invasive estimated continuous cardiac output monitoring. Transpulmonary thermodilution-based pulse contour analysis was performed for usual anaesthetic care, while non-invasive estimated continuous cardiac output monitoring data were additionally recorded. Thirty-five patients were enrolled, resulting in 199 measurement time points. Cardiac output measurements of the non-invasive estimated continuous cardiac output monitoring showed a weak correlation with the corresponding thermodilution measurements (correlation coefficient: 0.44, R2: 0.19; non-invasive estimated continuous cardiac output: 7.4 [6.2-8.1]; thermodilution cardiac output: 8.9 [7.8-9.8]; p ≤ 0.001), while cardiac index experienced no such correlation. Furthermore, neither stroke volume nor stroke volume index correlated with the corresponding thermodilution-based data. Even though non-invasive estimated continuous cardiac output monitoring consistently underestimated the corresponding thermodilution parameters, no trend analysis was achievable. Summarizing, we cannot suggest the use of non-invasive estimated continuous cardiac output monitoring as an alternative to transpulmonary thermodilution for cardiac output monitoring in pregnant patients undergoing minimally-invasive foetoscopic surgery for spina bifida.
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Affiliation(s)
- Emmanuel Schneck
- Justus Liebig University of Giessen, Department of Anesthesiology, Operative Intensive Care Medicine and Pain Therapy, Rudolf-Buchheim-Strasse 7, 35392, Giessen, Germany.
| | - Pascal Drubel
- Justus Liebig University of Giessen, Department of Anesthesiology, Operative Intensive Care Medicine and Pain Therapy, Rudolf-Buchheim-Strasse 7, 35392, Giessen, Germany
| | - Rainer Schürg
- Justus Liebig University of Giessen, Department of Anesthesiology, Operative Intensive Care Medicine and Pain Therapy, Rudolf-Buchheim-Strasse 7, 35392, Giessen, Germany
| | - Melanie Markmann
- Justus Liebig University of Giessen, Department of Anesthesiology, Operative Intensive Care Medicine and Pain Therapy, Rudolf-Buchheim-Strasse 7, 35392, Giessen, Germany
| | - Thomas Kohl
- German Center for Fetal Surgery & Minimally Invasive Therapy (DZFT), University Hospital of Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Michael Henrich
- Department of Anesthesiology and Intensive Care Medicine, St. Vincentius Clinics, Suedendstrasse 32, 76137, Karlsruhe, Germany
| | - Michael Sander
- Justus Liebig University of Giessen, Department of Anesthesiology, Operative Intensive Care Medicine and Pain Therapy, Rudolf-Buchheim-Strasse 7, 35392, Giessen, Germany
| | - Christian Koch
- Justus Liebig University of Giessen, Department of Anesthesiology, Operative Intensive Care Medicine and Pain Therapy, Rudolf-Buchheim-Strasse 7, 35392, Giessen, Germany
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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.
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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
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Best practice & research clinical anaesthesiology: Advances in haemodynamic monitoring for the perioperative patient: Perioperative cardiac output monitoring. Best Pract Res Clin Anaesthesiol 2019; 33:139-153. [PMID: 31582094 DOI: 10.1016/j.bpa.2019.05.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 05/01/2019] [Accepted: 05/16/2019] [Indexed: 12/15/2022]
Abstract
Less invasive or even completely non-invasive haemodynamic monitoring technologies have evolved during the last decades. Even established, invasive devices such as the pulmonary artery catheter and transpulmonary thermodilution have still an evidence-based place in the perioperative setting, albeit only in special patient populations. Accumulating evidence suggests to use continuous haemodynamic monitoring, especially flow-based variables such as stroke volume or cardiac output to prevent occult hypoperfusion and, consequently, decrease morbidity and mortality perioperatively. However, there is still a substantial gap between evidence provided by randomised trials and the implementation of haemodynamic monitoring in daily clinical routine. Given the fact that perioperative morbidity and mortality are higher than anticipated and anaesthesiologists are in charge to deal with this problem, the recent advances in minimally invasive and non-invasive monitoring technologies may facilitate more widespread use in the operating theatre, as in addition to costs, the degree of invasiveness of any monitoring tool determines the frequency of its application, at least perioperatively. This review covers the currently available invasive, non-invasive and minimally invasive techniques and devices and addresses their indications and limitations.
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Cardiac output and stroke volume variation measured by the pulse wave transit time method: a comparison with an arterial pressure-based cardiac output system. J Clin Monit Comput 2018; 33:385-392. [PMID: 29948667 DOI: 10.1007/s10877-018-0171-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 06/13/2018] [Indexed: 01/08/2023]
Abstract
Hemodynamic monitoring is mandatory for perioperative management of cardiac surgery. Recently, the estimated continuous cardiac output (esCCO) system, which can monitor cardiac output (CO) non-invasively based on pulse wave transit time, has been developed. Patients who underwent cardiovascular surgeries with hemodynamics monitoring using arterial pressure-based CO (APCO) were eligible for this study. Hemodynamic monitoring using esCCO and APCO was initiated immediately after intensive care unit admission. CO values measured using esCCO and APCO were collected every 6 h, and stroke volume variation (SVV) data were obtained every hour while patients were mechanically ventilated. Correlation and Bland-Altman analyses were used to compare APCO and esCCO. Welch's analysis of variance, and four-quadrant plot and polar plot analyses were performed to evaluate the effect of time course, and the trending ability. A p-value < 0.05 was considered statistically significant. Twenty-one patients were included in this study, and 143 and 146 datasets for CO and SVV measurement were analyzed. Regarding CO, the correlation analysis showed that APCO and esCCO were significantly correlated (r = 0.62), and the bias ± precision and percentage error were 0.14 ± 1.94 (L/min) and 69%, respectively. The correlation coefficient, bias ± precision, and percentage error for SVV evaluation were 0.4, - 3.79 ± 5.08, and 99%, respectively. The time course had no effects on the biases between CO and SVV. Concordance rates were 80.3 and 75.7% respectively. While CO measurement with esCCO can be a reliable monitor after cardiovascular surgeries, SVV measurement with esCCO may require further improvement.
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Minimally invasive cardiac output technologies in the ICU: putting it all together. Curr Opin Crit Care 2018; 23:302-309. [PMID: 28538248 DOI: 10.1097/mcc.0000000000000417] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE OF REVIEW Haemodynamic monitoring is a cornerstone in the diagnosis and evaluation of treatment in critically ill patients in circulatory distress. The interest in using minimally invasive cardiac output monitors is growing. The purpose of this review is to discuss the currently available devices to provide an overview of their validation studies in order to answer the question whether these devices are ready for implementation in clinical practice. RECENT FINDINGS Current evidence shows that minimally invasive cardiac output monitoring devices are not yet interchangeable with (trans)pulmonary thermodilution in measuring cardiac output. However, validation studies are generally single centre, are based on small sample sizes in heterogeneous groups, and differ in the statistical methods used. SUMMARY Minimally and noninvasive monitoring devices may not be sufficiently accurate to replace (trans)pulmonary thermodilution in estimating cardiac output. The current paradigm shift to explore trending ability rather than investigating agreement of absolute values alone is to be applauded. Future research should focus on the effectiveness of these devices in the context of (functional) haemodynamic monitoring before adoption into clinical practice can be recommended.
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Magliocca A, Rezoagli E, Anderson TA, Burns SM, Ichinose F, Chitilian HV. Cardiac Output Measurements Based on the Pulse Wave Transit Time and Thoracic Impedance Exhibit Limited Agreement With Thermodilution Method During Orthotopic Liver Transplantation. Anesth Analg 2018; 126:85-92. [PMID: 28598912 DOI: 10.1213/ane.0000000000002171] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Orthotopic liver transplantation (OLT) is characterized by significant intraoperative hemodynamic variability. Accurate and real-time cardiac output (CO) monitoring aids clinical decision making during OLT. The purpose of this study is to compare accuracy, precision, and trending ability of CO estimation obtained noninvasively using pulse wave transit time (estimated continuous cardiac output [esCCO; Nihon Kohden, Tokyo, Japan]) or thoracic bioimpedance (ICON; Osypka Medical GmbH, Berlin, Germany) to thermodilution cardiac output (TDCO) measured with a pulmonary artery catheter. METHODS Nineteen patients undergoing OLT were enrolled. CO measurements were collected with esCCO, ICON, and thermodilution at 5 time points: (T1) pulmonary artery catheter insertion; (T2) surgical incision; (T3) portal reperfusion; (T4) hepatic arterial reperfusion; and (T5) abdominal closure. The results were analyzed with Bland-Altman plot, percentage error (the percentage of the difference between the CO estimated with the noninvasive monitoring device and CO measured with the thermodilution technique), 4-quadrant plot with concordance rate (the percentage of the total number of points in the I and III quadrant of the 4-quadrant plot), and concordance correlation coefficient (a measure of how well the pairs of observations deviate from the 45-degree line of perfect agreement). RESULTS Although TDCO increased at T3-T5, both esCCO and ICON failed to track the changes of CO with sufficient accuracy and precision. The mean bias of esCCO and ICON compared to TDCO were -2.0 L/min (SD, ±2.7 L/min) and -3.3 L/min (SD, ±2.8 L/min), respectively. The percentage error was 69% for esCCO and 77% for ICON. The concordance correlation coefficient was 0.653 (95% confidence interval [CI], 0.283-0.853) for esCCO and 0.310 (95% CI, -0.167 to 0.669) for ICON. Nonetheless, esCCO and ICON exhibited reasonable trending ability of TDCO (concordance rate: 95% [95% CI, 88-100] and 100% [95% CI, 93-100]), respectively. The mean bias was correlated with systemic vascular resistance (SVR) and arterial elastance (Ea) for esCCO (SVR, r = 0.610, 95% CI, 0.216-0.833, P < .0001; Ea, r = 0.692, 95% CI, 0.347-0.872; P < .0001) and ICON (SVR, r = 0.573, 95% CI, 0.161-0.815, P < .0001; Ea, r = 0.612, 95% CI, 0.219-0.834, P < .0001). CONCLUSIONS The noninvasive CO estimation with esCCO and ICON exhibited limited accuracy and precision, despite with reasonable trending ability, when compared to TDCO, during OLT. The inaccuracy of esCCO and ICON is especially large when SVR and Ea were decreased during the neohepatic phase. Further refinement of the technology is desirable before noninvasive techniques can replace TDCO during OLT.
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Affiliation(s)
- Aurora Magliocca
- From the Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.,Department of Health Science, School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Emanuele Rezoagli
- From the Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.,Department of Health Science, School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Thomas Anthony Anderson
- From the Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Sara Maria Burns
- From the Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Fumito Ichinose
- From the Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Hovig Vatche Chitilian
- From the Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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Perioperative Cardiac Output Monitoring Utilizing Non-pulse Contour Methods. CURRENT ANESTHESIOLOGY REPORTS 2017. [DOI: 10.1007/s40140-017-0240-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Nguyen LS, Squara P. Non-Invasive Monitoring of Cardiac Output in Critical Care Medicine. Front Med (Lausanne) 2017; 4:200. [PMID: 29230392 PMCID: PMC5715400 DOI: 10.3389/fmed.2017.00200] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 11/02/2017] [Indexed: 12/21/2022] Open
Abstract
Critically ill patients require close hemodynamic monitoring to titrate treatment on a regular basis. It allows administering fluid with parsimony and adjusting inotropes and vasoactive drugs when necessary. Although invasive monitoring is considered as the reference method, non-invasive monitoring presents the obvious advantage of being associated with fewer complications, at the expanse of accuracy, precision, and step-response change. A great many methods and devices are now used over the world, and this article focuses on several of them, providing with a brief review of related underlying physical principles and validation articles analysis. Reviewed methods include electrical bioimpedance and bioreactance, respiratory-derived cardiac output (CO) monitoring technique, pulse wave transit time, ultrasound CO monitoring, multimodal algorithmic estimation, and inductance thoracocardiography. Quality criteria with which devices were reviewed included: accuracy (closeness of agreement between a measurement value and a true value of the measured), precision (closeness of agreement between replicate measurements on the same or similar objects under specified conditions), and step response change (delay between physiological change and its indication). Our conclusion is that the offer of non-invasive monitoring has improved in the past few years, even though further developments are needed to provide clinicians with sufficiently accurate devices for routine use, as alternative to invasive monitoring devices.
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Affiliation(s)
- Lee S Nguyen
- Critical Care Medicine Department, CMC Ambroise Paré, Neuilly-sur-Seine, France
| | - Pierre Squara
- Critical Care Medicine Department, CMC Ambroise Paré, Neuilly-sur-Seine, France
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Laher AE, Watermeyer MJ, Buchanan SK, Dippenaar N, Simo NCT, Motara F, Moolla M. A review of hemodynamic monitoring techniques, methods and devices for the emergency physician. Am J Emerg Med 2017; 35:1335-1347. [PMID: 28366285 DOI: 10.1016/j.ajem.2017.03.036] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 03/15/2017] [Accepted: 03/16/2017] [Indexed: 02/07/2023] Open
Abstract
The emergency department (ED) is frequently the doorway to the intensive care unit (ICU) for a significant number of critically ill patients presenting to the hospital. Hemodynamic monitoring (HDM) which is a key component in the effective management of the critically ill patient presenting to the ED, is primarily concerned with assessing the performance of the cardiovascular system and determining the correct therapeutic intervention to optimise end-organ oxygen delivery. The spectrum of hemodynamic monitoring ranges from simple clinical assessment and routine bedside monitoring to point of care ultrasonography and various invasive monitoring devices. The clinician must be aware of the range of available techniques, methods, interventions and technological advances as well as possess a sound approach to basic hemodynamic monitoring prior to selecting the optimal modality. This article comprises an in depth discussion of an approach to hemodynamic monitoring techniques and principles as well as methods of predicting fluid responsiveness as it applies to the ED clinician. We review the role, applicability and validity of various methods and techniques that include; clinical assessment, passive leg raising, blood pressure, finger based monitoring devices, the mini-fluid challenge, the end-expiratory occlusion test, central venous pressure monitoring, the pulmonary artery catheter, ultrasonography, bioreactance and other modern invasive hemodynamic monitoring devices.
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Affiliation(s)
- Abdullah E Laher
- Department of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, South Africa; Department of Critical Care, Faculty of Health Sciences, University of the Witwatersrand, South Africa.
| | - Matthew J Watermeyer
- Department of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Sean K Buchanan
- Department of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Nicole Dippenaar
- Department of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | | | - Feroza Motara
- Department of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Muhammed Moolla
- Department of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, South Africa; Department of Critical Care, Faculty of Health Sciences, University of the Witwatersrand, South Africa
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Obata Y, Mizogami M, Nyhan D, Berkowitz DE, Steppan J, Barodka V. Pilot Study: Estimation of Stroke Volume and Cardiac Output from Pulse Wave Velocity. PLoS One 2017; 12:e0169853. [PMID: 28060961 PMCID: PMC5218503 DOI: 10.1371/journal.pone.0169853] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 12/22/2016] [Indexed: 02/01/2023] Open
Abstract
Background Transesophageal echocardiography (TEE) is increasingly replacing thermodilution pulmonary artery catheters to assess hemodynamics in patients at high risk for cardiovascular morbidity. However, one of the drawbacks of TEE compared to pulmonary artery catheters is the inability to measure real time stroke volume (SV) and cardiac output (CO) continuously. The aim of the present proof of concept study was to validate a novel method of SV estimation, based on pulse wave velocity (PWV) in patients undergoing cardiac surgery. Methods This is a retrospective observational study. We measured pulse transit time by superimposing the radial arterial waveform onto the continuous wave Doppler waveform of the left ventricular outflow tract, and calculated SV (SVPWV) using the transformed Bramwell-Hill equation. The SV measured by TEE (SVTEE) was used as a reference. Results A total of 190 paired SV were measured from 28 patients. A strong correlation was observed between SVPWV and SVTEE with the coefficient of determination (R2) of 0.71. A mean difference between the two (bias) was 3.70 ml with the limits of agreement ranging from -20.33 to 27.73 ml and a percentage error of 27.4% based on a Bland-Altman analysis. The concordance rate of two methods was 85.0% based on a four-quadrant plot. The angular concordance rate was 85.9% with radial limits of agreement (the radial sector that contained 95% of the data points) of ± 41.5 degrees based on a polar plot. Conclusions PWV based SV estimation yields reasonable agreement with SV measured by TEE. Further studies are required to assess its utility in different clinical situations.
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Affiliation(s)
- Yurie Obata
- Division of Cardiac Anesthesia, Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Maki Mizogami
- Department of Anesthesiology and Reanimatology, University of Fukui, Fukui, Japan
| | - Daniel Nyhan
- Division of Cardiac Anesthesia, Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Dan E. Berkowitz
- Division of Cardiac Anesthesia, Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Jochen Steppan
- Division of Cardiac Anesthesia, Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Viachaslau Barodka
- Division of Cardiac Anesthesia, Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
- * E-mail:
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Sabate A, Koo M. Intravenous fluids: Concepts and rationality of use. Cir Esp 2016; 94:369-71. [PMID: 27324832 DOI: 10.1016/j.ciresp.2016.04.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 04/26/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Antoni Sabate
- Servicio de Anestesiología y Reanimación, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España; Universidad de Barcelona Health Campus, L'Hospitalet de Llobregat, Barcelona, España.
| | - Maylin Koo
- Servicio de Anestesiología y Reanimación, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España; Universidad de Barcelona Health Campus, L'Hospitalet de Llobregat, Barcelona, España
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Teboul JL, Saugel B, Cecconi M, De Backer D, Hofer CK, Monnet X, Perel A, Pinsky MR, Reuter DA, Rhodes A, Squara P, Vincent JL, Scheeren TW. Less invasive hemodynamic monitoring in critically ill patients. Intensive Care Med 2016; 42:1350-9. [DOI: 10.1007/s00134-016-4375-7] [Citation(s) in RCA: 187] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 04/28/2016] [Indexed: 11/28/2022]
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16
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Smetkin AA, Hussain A, Fot EV, Zakharov VI, Izotova NN, Yudina AS, Dityateva ZA, Gromova YV, Kuzkov VV, Bjertnæs LJ, Kirov MY. Estimated continuous cardiac output based on pulse wave transit time in off-pump coronary artery bypass grafting: a comparison with transpulmonary thermodilution. J Clin Monit Comput 2016; 31:361-370. [PMID: 26951494 DOI: 10.1007/s10877-016-9853-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 02/28/2016] [Indexed: 11/30/2022]
Abstract
To evaluate the accuracy of estimated continuous cardiac output (esCCO) based on pulse wave transit time in comparison with cardiac output (CO) assessed by transpulmonary thermodilution (TPTD) in off-pump coronary artery bypass grafting (OPCAB). We calibrated the esCCO system with non-invasive (Part 1) and invasive (Part 2) blood pressure and compared with TPTD measurements. We performed parallel measurements of CO with both techniques and assessed the accuracy and precision of individual CO values and agreement of trends of changes perioperatively (Part 1) and postoperatively (Part 2). A Bland-Altman analysis revealed a bias between non-invasive esCCO and TPTD of 0.9 L/min and limits of agreement of ±2.8 L/min. Intraoperative bias was 1.2 L/min with limits of agreement of ±2.9 L/min and percentage error (PE) of 64 %. Postoperatively, bias was 0.4 L/min, limits of agreement of ±2.3 L/min and PE of 41 %. A Bland-Altman analysis of invasive esCCO and TPTD after OPCAB found bias of 0.3 L/min with limits of agreement of ±2.1 L/min and PE of 40 %. A 4-quadrant plot analysis of non-invasive esCCO versus TPTD revealed overall, intraoperative and postoperative concordance rate of 76, 65, and 89 %, respectively. The analysis of trending ability of invasive esCCO after OPCAB revealed concordance rate of 73 %. During OPCAB, esCCO demonstrated poor accuracy, precision and trending ability compared to TPTD. Postoperatively, non-invasive esCCO showed better agreement with TPTD. However, invasive calibration of esCCO did not improve the accuracy and precision and the trending ability of method.
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Affiliation(s)
- Alexey A Smetkin
- Department of Anesthesiology and Intensive Care Medicine, Northern State Medical University, Troitsky Av. 51, Arkhangelsk, Russian Federation, 163000. .,Department of Anesthesiology and Intensive Care Medicine, City Hospital #1 of Arkhangelsk, Suvorova Str. 1, Arkhangelsk, Russian Federation, 163000. .,Department of Clinical Medicine (Anesthesiology), Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway.
| | - Ayyaz Hussain
- Department of Anesthesiology and Intensive Care Medicine, Northern State Medical University, Troitsky Av. 51, Arkhangelsk, Russian Federation, 163000
| | - Evgenia V Fot
- Department of Anesthesiology and Intensive Care Medicine, Northern State Medical University, Troitsky Av. 51, Arkhangelsk, Russian Federation, 163000.,Department of Anesthesiology and Intensive Care Medicine, City Hospital #1 of Arkhangelsk, Suvorova Str. 1, Arkhangelsk, Russian Federation, 163000
| | - Viktor I Zakharov
- Department of Anesthesiology and Intensive Care Medicine, Northern State Medical University, Troitsky Av. 51, Arkhangelsk, Russian Federation, 163000
| | - Natalia N Izotova
- Department of Anesthesiology and Intensive Care Medicine, Northern State Medical University, Troitsky Av. 51, Arkhangelsk, Russian Federation, 163000
| | - Angelika S Yudina
- Department of Anesthesiology and Intensive Care Medicine, Northern State Medical University, Troitsky Av. 51, Arkhangelsk, Russian Federation, 163000
| | - Zinaida A Dityateva
- Department of Anesthesiology and Intensive Care Medicine, Northern State Medical University, Troitsky Av. 51, Arkhangelsk, Russian Federation, 163000
| | - Yanina V Gromova
- Department of Anesthesiology and Intensive Care Medicine, Northern State Medical University, Troitsky Av. 51, Arkhangelsk, Russian Federation, 163000
| | - Vsevolod V Kuzkov
- Department of Anesthesiology and Intensive Care Medicine, Northern State Medical University, Troitsky Av. 51, Arkhangelsk, Russian Federation, 163000.,Department of Anesthesiology and Intensive Care Medicine, City Hospital #1 of Arkhangelsk, Suvorova Str. 1, Arkhangelsk, Russian Federation, 163000
| | - Lars J Bjertnæs
- Department of Clinical Medicine (Anesthesiology), Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
| | - Mikhail Y Kirov
- Department of Anesthesiology and Intensive Care Medicine, Northern State Medical University, Troitsky Av. 51, Arkhangelsk, Russian Federation, 163000.,Department of Anesthesiology and Intensive Care Medicine, City Hospital #1 of Arkhangelsk, Suvorova Str. 1, Arkhangelsk, Russian Federation, 163000.,Department of Clinical Medicine (Anesthesiology), Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
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Le Manach Y, Collins GS. Disagreement between cardiac output measurement devices: which device is the gold standard? Br J Anaesth 2015; 116:451-3. [PMID: 26515806 DOI: 10.1093/bja/aev356] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Y Le Manach
- Departments of Anesthesia & Clinical Epidemiology and Biostatistics, Michael DeGroote School of Medicine, Faculty of Health Sciences, McMaster University and the Perioperative Research Group, Population Health Research Institute, Hamilton, Canada
| | - G S Collins
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Windmill Road, Oxford, UK
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