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Maraey A, Chacko P, Moukarbel GV. Thoracic impedance monitoring in heart failure: from theory to practice. Expert Rev Med Devices 2024:1-4. [PMID: 38655906 DOI: 10.1080/17434440.2024.2347412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 04/22/2024] [Indexed: 04/26/2024]
Affiliation(s)
- Ahmed Maraey
- Division of Cardiovascular Medicine, University of Toledo Medical Center, Toledo, OH, USA
| | - Paul Chacko
- Division of Cardiovascular Medicine, University of Toledo Medical Center, Toledo, OH, USA
| | - George V Moukarbel
- Division of Cardiovascular Medicine, University of Toledo Medical Center, Toledo, OH, USA
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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).
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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
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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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Yolcu S, Kaya A. Use of Tissue Oxygen Saturation Levels as a Vital Sign in the ED Triage. JOURNAL OF CLINICAL AND EXPERIMENTAL INVESTIGATIONS 2019. [DOI: 10.5799/jcei/5832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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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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Accuracy, Precision, and Trending Ability of Electrical Cardiometry Cardiac Index versus Continuous Pulmonary Artery Thermodilution Method: A Prospective, Observational Study. BIOMED RESEARCH INTERNATIONAL 2017; 2017:2635151. [PMID: 29130036 PMCID: PMC5654291 DOI: 10.1155/2017/2635151] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 07/21/2017] [Accepted: 08/20/2017] [Indexed: 11/17/2022]
Abstract
Introduction Evaluation of accuracy, precision, and trending ability of cardiac index (CI) measurements using the Aesculon™ bioimpedance electrical cardiometry (Aesc) compared to the continuous pulmonary artery thermodilution catheter (PAC) technique before, during, and after cardiac surgery. Methods A prospective observational study with fifty patients with ASA 3-4. At six time points (T), measurements of CI simultaneously by continuous cardiac output pulmonary thermodilution and thoracic bioimpedance and standard hemodynamics were performed. Analysis was performed using Bland-Altman, four-quadrant plot, and polar plot methodology. Results CI obtained with pulmonary artery thermodilution and thoracic bioimpedance ranged from 1.00 to 6.75 L min−1 and 0.93 to 7.25 L min−1, respectively. Bland-Altman analysis showed a bias between CIBIO and CIPAC of 0.52 liters min−1 m−2, with LOA of [−2.2; 1.1] liters min−1 m−2. Percentage error between the two techniques was above 30% at every time point. Polar plot methodology and 4-quadrant analysis showed poor trending ability. Skin incision had no effect on the results. Conclusion CI obtained by continuous PAC and CI obtained by Aesculon bioimpedance are not interchangeable in cardiac surgical patients. No effects of skin incision were found. International clinical trial registration number is ISRCTN26732484.
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Yolcu S, Erdur B. Use of tissue oxygenation (StO2) monitor in the ED. Am J Emerg Med 2014; 32:938-40. [DOI: 10.1016/j.ajem.2014.04.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 04/14/2014] [Accepted: 04/17/2014] [Indexed: 11/28/2022] Open
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Chamos C, Vele L, Hamilton M, Cecconi M. Less invasive methods of advanced hemodynamic monitoring: principles, devices, and their role in the perioperative hemodynamic optimization. Perioper Med (Lond) 2013; 2:19. [PMID: 24472443 PMCID: PMC3964331 DOI: 10.1186/2047-0525-2-19] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 08/30/2013] [Indexed: 01/20/2023] Open
Abstract
The monitoring of the cardiac output (CO) and other hemodynamic parameters, traditionally performed with the thermodilution method via a pulmonary artery catheter (PAC), is now increasingly done with the aid of less invasive and much easier to use devices. When used within the context of a hemodynamic optimization protocol, they can positively influence the outcome in both surgical and non-surgical patient populations. While these monitoring tools have simplified the hemodynamic calculations, they are subject to limitations and can lead to erroneous results if not used properly. In this article we will review the commercially available minimally invasive CO monitoring devices, explore their technical characteristics and describe the limitations that should be taken into consideration when clinical decisions are made.
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Affiliation(s)
- Christos Chamos
- Senior clinical fellow in cardiac anaesthesia, St George's Healthcare NHS Trust, London, UK.
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Wang JJ, Hu WC, Kao T, Liu CP, Lin SK. Development of forearm impedance plethysmography for the minimally invasive monitoring of cardiac pumping function. ACTA ACUST UNITED AC 2011. [DOI: 10.4236/jbise.2011.42018] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Afterload Assessment With or Without Central Venous Pressure: A Preliminary Clinical Comparison. ACTA ACUST UNITED AC 2010; 10:246-52. [DOI: 10.1007/s10558-010-9113-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Carrillo López A, Sala MF, Salgado AR. El papel del catéter de Swan-Ganz en la actualidad. Med Intensiva 2010; 34:203-14. [DOI: 10.1016/j.medin.2009.05.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2009] [Revised: 05/21/2009] [Accepted: 05/26/2009] [Indexed: 02/02/2023]
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Brissaud O, Guichoux J, Villega F, Orliaguet G. [What non invasive haemodynamic assessment in paediatric intensive care unit in 2009?]. ACTA ACUST UNITED AC 2010; 29:233-41. [PMID: 20116968 DOI: 10.1016/j.annfar.2009.12.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2009] [Accepted: 12/15/2009] [Indexed: 10/19/2022]
Abstract
The haemodynamic assessment of the patients is a daily activity in paediatric intensive care unit. It completes and is guided by the clinical examination. The will to develop the least invasive possible coverage of the patients is a constant concern. The haemodynamic monitoring, all the more if it is invasive, ceaselessly has to put in balance the profit and the risk of beginning this technique at a fragile patient. In the last three decades, numerous non-invasive haemodynamic tools were developed. The ideal one must be reliable, reproducible, with a time of fast, easily useful answer, with a total harmlessness, cheap and allowing a monitoring continues. Among all the existing tools (oesophageal Doppler ultrasound method, transthoracic echocardiography, NICO, thoracic impedancemetry, plethysmography, sublingual capnography), no one allies all these qualities. We can consider that the transthoracic echocardiography gets closer to most of these objectives. We shall blame it for its cost and for the fact that it is an intermittent monitoring but both in the diagnosis and in the survey, it has no equal among the non-invasive tools of haemodynamic assessment from part the quality and the quantity of the obtained information. The learning of the basic functions (contractility evaluation, cardiac output, cardiac and the vascular filling) useful for the start of a treatment is relatively well-to-do. We shall miss the absence of training in this tool in France in its paediatric and neonatal specificity within the university or interuniversity framework.
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Affiliation(s)
- O Brissaud
- Unité de réanimation pédiatrique et néonatale, hôpital des enfants, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France.
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Comparison of electrical velocimetry and transthoracic thermodilution technique for cardiac output assessment in critically ill patients. Eur J Anaesthesiol 2009; 26:1067-71. [DOI: 10.1097/eja.0b013e32832bfd94] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Funk DJ, Moretti EW, Gan TJ. Minimally invasive cardiac output monitoring in the perioperative setting. Anesth Analg 2009; 108:887-97. [PMID: 19224798 DOI: 10.1213/ane.0b013e31818ffd99] [Citation(s) in RCA: 160] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
With advancing age and increased co-morbidities in patients, the need for monitoring devices during the perioperative period that allow clinicians to track physiologic variables, such as cardiac output (CO), fluid responsiveness and tissue perfusion, is increasing. Until recently, the only tool available to anesthesiologists to monitor CO was either a pulmonary artery catheter or transesophageal echocardiograph. These devices have their limitations and potential for morbidity. Several new devices (including esophageal Doppler monitors, pulse contour analysis, indicator dilution, thoracic bioimpedance and partial non-rebreathing systems) have recently been marketed which have the ability to monitor CO noninvasively and, in some cases, assess the patient's ability to respond to fluid challenges. In this review, we will describe these new devices including the technology, studies on their efficacy and the limitations of their use.
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Affiliation(s)
- Duane J Funk
- Department of Anesthesiology, Division of Critical Care, Duke University Medical Center, Durham, NC 27710, USA
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Tang WHW, Tong W. Measuring impedance in congestive heart failure: current options and clinical applications. Am Heart J 2009; 157:402-11. [PMID: 19249408 PMCID: PMC3058607 DOI: 10.1016/j.ahj.2008.10.016] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2008] [Accepted: 10/07/2008] [Indexed: 02/07/2023]
Abstract
Measurement of impedance is becoming increasingly available in the clinical setting as a tool for assessing hemodynamics and volume status in patients with heart failure. The 2 major categories of impedance assessment are the band electrode method and the implanted device lead method. The exact sources of the impedance signal are complex and can be influenced by physiologic effects such as blood volume, fluid, and positioning. This article provides a critical review of our current understanding and promises of impedance measurements, the techniques that have evolved, as well as the evidence and limitations regarding their clinical applications in the setting of heart failure management.
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Affiliation(s)
- W H Wilson Tang
- Heart and Vascular Institute, Cleveland Clinic, OH 44195, USA.
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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.
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Schubert S, Schmitz T, Weiss M, Nagdyman N, Huebler M, Alexi-Meskishvili V, Berger F, Stiller B. Continuous, non-invasive techniques to determine cardiac output in children after cardiac surgery: evaluation of transesophageal Doppler and electric velocimetry. J Clin Monit Comput 2008; 22:299-307. [PMID: 18665449 DOI: 10.1007/s10877-008-9133-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2008] [Accepted: 07/08/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Continuous and non-invasive measurement of cardiac output (CO) may contribute helpful information to the care and treatment of the critically ill pediatric patient. Different methods are available but their clinical verification is still a major problem. AIM Comparison of reliability and safety of two continuous non-invasive methods with transthoracic echocardiography (TTE) for CO measurement: electric velocimetry technique (EV, Aesculon) and transesophageal Doppler (TED, CardioQP). METHODS/MATERIAL: In 26 infants and children who had undergone corrective cardiac surgery at a median age of 3.5 (1-17) years CO and stroke volume (SV) were obtained by EV, TED and TTE. Each patient had five measurements on the first day after surgery, during mechanical ventilation and sedation. RESULTS Values for CO and SV from TED and EV correlated well with those of TTE (r = 0.85 and r = 0.88), but mean values were significantly lower than the values of TTE for TED (P = 0.02) and EV (P = 0.001). According to Bland-Altman analysis, bias was 0.36 l/min with a precision of 1.67 l/min for TED vs. TTE and 0.87 l/min (bias) with a precision of 3.26 l/min for EV vs. TTE. No severe adverse events were observed and the handling of both systems was easy in the sedated child. CONCLUSIONS In pediatric patients non-invasive measurement of CO and SV with TED and EV is useful for continuous monitoring after heart surgery. Both new methods seem to underestimate cardiac output in terms of absolute values. However, TED shows tolerable bias and precision and may be helpful for continuous CO monitoring in a deeply sedated and ventilated pediatric patient, e.g. in the operating room or intensive care unit.
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Affiliation(s)
- Stephan Schubert
- Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
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Abstract
PURPOSE OF REVIEW Several less invasive cardiac output monitoring techniques are now commercially available and have the potential to replace the pulmonary artery catheter under certain clinical circumstances. The aim of this review is to give a synopsis of the currently available cardiac output measurement methods. This information should help in selecting the appropriate technique in a particular clinical setting. RECENT FINDINGS An overview is given of the currently available techniques for cardiac output monitoring. Recent validation studies demonstrate that pulse wave analysis may be used reliably as an alternative to the pulmonary artery catheter in different clinical settings. The use of transesophageal echocardiography and Doppler measurements is limited due to high operator dependency, the partial carbon dioxide rebreathing technique should be applied in a precisely defined clinical setting to mechanically ventilated patients only, and pulsed dye densitometry as well as the bioimpedance technique are currently primarily applied in an investigational setting. SUMMARY Less invasive cardiac output monitoring techniques may replace the pulmonary artery catheter in different clinical settings considering the specific properties of these techniques. The pulmonary artery catheter, however, may still be recommended for cardiac output measurement in specific clinical situations when monitoring of pulmonary artery pressures is desirable.
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Affiliation(s)
- Christoph K Hofer
- Institute of Anesthesiology and Intensive Care Medicine, Triemli City Hospital, Switzerland.
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Baker AB, McLeod CN, Roxburgh AJ, Bannister P. Descending Aortic Flow Contribution to Intrathoracic Impedance—Development and Preliminary Testing of a Dual Impedance Model. J Clin Monit Comput 2008; 22:11-22. [DOI: 10.1007/s10877-007-9102-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2007] [Accepted: 10/22/2007] [Indexed: 11/27/2022]
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Hofer CK, Zollinger A. Less Invasive Cardiac Output Monitoring: Characteristics and Limitations. Intensive Care Med 2007. [DOI: 10.1007/0-387-35096-9_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Wang JJ, Wang PW, Liu CP, Lin SK, Hu WC, Kao T. Evaluation of changes in cardiac output from the electrical impedance waveform in the forearm. Physiol Meas 2007; 28:989-99. [PMID: 17827648 DOI: 10.1088/0967-3334/28/9/002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We tested the validity of regional impedance cardiography (RIC) for measuring changes in both cardiac output and stroke volume by comparing the values with a 2D ultrasound technique in response to the breath-hold manipulation. Among 13 subjects, changes in the maximum amplitude of the regional impedance waveform from the forearm conformed to those in stroke volume (r = 0.86, p < 0.001) and cardiac output (r = 0.76, p < 0.003) measured with the ultrasound technique in baseline and immediately after a 30 s breath-hold maneuver. We also found that the per cent change in cardiac output (r = 0.73, p < 0.005) and the per cent change in stroke volume (r = 0.84, p < 0.0003) by the echocardiography were both positively correlated with the per cent change in the peak impedance amplitude. In addition, both the change and the per cent change in the mean area under the impedance curve were consistent with those in the stroke volume, respectively. Accordingly, the regional electrical impedance waveform from lower limbs may be helpful in providing a non-invasive and continuous assessment of left ventricular output, especially during cardiac procedures.
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Affiliation(s)
- Jia-Jung Wang
- Department of Biomedical Engineering, I-Shou University, Taiwan, Republic of China.
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Hewitt NA, Braaf SC. The clinical application of pulse contour cardiac output and intrathoracic volume measurements in critically ill patients. Aust Crit Care 2006; 19:86-94. [PMID: 16933635 DOI: 10.1016/s1036-7314(06)80003-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Cardiac output (CO) determination by pulmonary artery (PA) catheter has increasingly been criticised within the literature due to its invasive nature and poor correlation between the pressure measurements and intravascular volume status in mechanically ventilated patients. Consequently, alternative less invasive technologies to PA catheterisation are emerging within intensive care. One such novel technology are pulse contour CO (PCCO) systems. They establish comprehensive and continuous haemodynamic monitoring utilising a central venous catheter (CVC) and an arterial line. Furthermore, a key feature of this technology is its ability to produce intrathoracic volume measurements which may provide a better estimation of cardiac preload as well as indicate the presence and severity of pulmonary oedema. This article aims to discuss the theoretical basis and clinical application of PCCO systems, how PCCO systems differ from PA catheters and how the intrathoracic volume measurements are derived. Understanding these advanced concepts will ensure that clinicians are able to employ this innovative monitoring technology more effectively.
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Abstract
OBJECTIVES To examine the published evidence regarding the use of transthoracic electric bioimpedance (TEB) for the non-invasive monitoring of cardiac output in the ED. METHOD Databases of the medical literature, relevant textbooks and the Internet were searched for articles regarding TEB. Criteria for inclusion were drawn up prior to examination of the articles and included adherence to guidelines for comparing methods of clinical measurement. RESULTS Results are discussed under the following headings: technological capability, diagnostic accuracy, limitations, range of possible uses, therapeutic impact, impact on health care providers, patient outcome and future directions. CONCLUSION TEB is a technique for the non-invasive monitoring of cardiac output whose ease of use, continuous data acquisition and versatility suggest it may have a role to play in the care of patients in our EDs.
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Affiliation(s)
- Ogilvie Thom
- Department of Epidemiology and Preventive Medicine, Monash University, Box Hill Hospital, Victoria, Australia.
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Gunn SR, Fink MP, Wallace B. Equipment review: the success of early goal-directed therapy for septic shock prompts evaluation of current approaches for monitoring the adequacy of resuscitation. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2005; 9:349-59. [PMID: 16137384 PMCID: PMC1269450 DOI: 10.1186/cc3725] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
A recent trial utilizing central venous oxygen saturation (SCVO2) as a resuscitation marker in patients with sepsis has resulted in its inclusion in the Surviving Sepsis Campaign guidelines. We review the evidence behind SCVO2 and its relationship to previous trials of goal-directed therapy. We compare SCVO2 to other tools for assessing the adequacy of resuscitation including physical examination, biochemical markers, pulmonary artery catheterization, esophageal Doppler, pulse contour analysis, echocardiography, pulse pressure variation, and tissue capnometry. It is unlikely that any single technology can improve outcome if isolated from an organized pattern of early recognition, algorithmic resuscitation, and frequent reassessment. This article includes a response to the journal's Health Technology Assessment questionnaire by the manufacturer of the SCVO2 catheter.
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Affiliation(s)
- Scott R Gunn
- Departments of Critical Care Medicine and Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Mitchell P Fink
- Departments of Critical Care Medicine and Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Engoren M, Barbee D. Comparison of Cardiac Output Determined by Bioimpedance, Thermodilution, and the Fick Method. Am J Crit Care 2005. [DOI: 10.4037/ajcc2005.14.1.40] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
• Background Cardiac output can be determined by using a variety of methods.• Objectives To determine the precision and bias between 3 methods for determining cardiac output: bioimpedance, thermodilution, and the Fick method.• Methods Cardiac output was determined by using bioimpedance via neck and thorax patches and thermodilution via pulmonary artery catheter in 46 patients in the intensive care unit. A subset of 15 patients also had cardiac output determined by using the Fick method.• Results Mean (SD) cardiac output in all patients was 6.3 (2.2) L/min by thermodilution and 5.6 (2.0) L/min by bioimpedance. In the 15 patients in whom all 3 methods were used, mean cardiac output was 6.0 (1.7) L/min by thermodilution, 5.3 (1.7) L/min by bioimpedance, and 8.6 (4.5) L/min by the Fick method. Bias and precision (mean difference ± 2 SDs) were 0.7 ± 2.9 L/min between thermodilution and bioimpedance, 1.7 ± 3.8 L/min between the Fick method and thermodilution, and 2.4 ± 4.7 L/min between the Fick method and bioimpedance.• Conclusion Bioimpedance, thermodilution, and Fick determinations of cardiac outputs are not interchangeable in a heterogenous population of critically ill patients.
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Affiliation(s)
- Milo Engoren
- The departments of Anesthesiology (ME), Internal Medicine (ME), and Nursing (DB), St. Vincent Mercy Medical Center, Toledo, Ohio
| | - Daniel Barbee
- The departments of Anesthesiology (ME), Internal Medicine (ME), and Nursing (DB), St. Vincent Mercy Medical Center, Toledo, Ohio
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Vascular Access and Hemodynamic Monitoring. Crit Care 2005. [DOI: 10.1016/b978-0-323-02262-0.50007-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Moshkovitz Y, Kaluski E, Milo O, Vered Z, Cotter G. Recent developments in cardiac output determination by bioimpedance: comparison with invasive cardiac output and potential cardiovascular applications. Curr Opin Cardiol 2004; 19:229-37. [PMID: 15096956 DOI: 10.1097/00001573-200405000-00008] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To describe recent developments in bioimpedance technique and its application in cardiovascular diseases. Cardiac output determination has been used selectively during recent years because of the need for invasive right heart catheterization. Hence, experience with its application in patients with cardiovascular diseases and especially heart failure is limited. Bioimpedance is a novel noninvasive technique determining changes in instantaneous (during one heartbeat) conductance of a small electrical current transferred through the body. By using different algorithms correcting for various body composition constants, it calculates the change in instantaneous arterial blood volume (that is, stroke volume) and cardiac output. Traditionally, bioimpedance cardiac output is determined using either thoracic or whole body techniques according to the location of the electrodes transmitting and receiving the small electrical current. RECENT FINDINGS Significant progress was achieved in recent years in cardiac output determination by bioimpedance. Newer algorithms using thoracic and whole body bioimpedance have demonstrated better correlation with invasive cardiac output determination. In a few preliminary studies bioimpedance-determined cardiac output was found useful in the diagnosis, risk stratification, and treatment titration of some cardiovascular conditions. Further, larger prospective studies are required to determine the true independent value of cardiac output measurement by bioimpedance for the evaluation of cardiovascular diseases and especially heart failure. SUMMARY Recently, significant improvement was achieved in cardiac output measurement by bioimpedance with both newer thoracic and whole body techniques. Preliminary studies imply that this measure may be of value in managing some cardiovascular disorders.
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Affiliation(s)
- Yaron Moshkovitz
- Cardiac Surgery Department, Ramat Marpe Hospital, Petah Tikva, Israel
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Cotter G, Moshkovitz Y, Kaluski E, Cohen AJ, Miller H, Goor D, Vered Z. Accurate, Noninvasive Continuous Monitoring of Cardiac Output by Whole-Body Electrical Bioimpedance. Chest 2004; 125:1431-40. [PMID: 15078756 DOI: 10.1378/chest.125.4.1431] [Citation(s) in RCA: 125] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES Cardiac output (CO) is measured but sparingly due to limitations in its measurement technique (ie, right-heart catheterization). Yet, in recent years it has been suggested that CO may be of value in the diagnosis, risk stratification, and treatment titration of cardiac patients, especially those with congestive heart failure (CHF). We examine the use of a new noninvasive, continuous whole-body bioimpedance system (NICaS; NI Medical; Hod-Hasharon, Israel) for measuring CO. The aim of the present study was to test the validity of this noninvasive cardiac output system/monitor (NICO) in a cohort of cardiac patients. DESIGN Prospective, double-blind comparison of the NICO and thermodilution CO determinations. PATIENTS We enrolled 122 patients in three different groups: during cardiac catheterization (n = 40); before, during, and after coronary bypass surgery (n = 51); and while being treated for acute congestive heart failure (CHF) exacerbation (n = 31). MEASUREMENTS AND INTERVENTION: In all patients, CO measurements were obtained by two independent blinded operators. CO was measured by both techniques three times, and an average was determined for each time point. CO was measured at one time point in patients undergoing coronary catheterization; before, during, and after bypass surgery in patients undergoing coronary bypass surgery; and before and during vasodilator treatment in patients treated for acute heart failure. RESULTS Overall, 418 paired CO measurements were obtained. The overall correlation between the NICO cardiac index (CI) and the thermodilution CI was r = 0.886, with a small bias (0.0009 +/- 0.684 L) [mean +/- 2 SD], and this finding was consistent within each group of patients. Thermodilution readings were 15% higher than NICO when CI was < 1.5 L/min/m(2), and 5% lower than NICO when CI was > 3 L/min/m(2). The NICO has also accurately detected CI changes during coronary bypass operation and vasodilator administration for acute CHF. CONCLUSION The results of the present study indicate that whole-body bioimpedance CO measurements obtained by the NICO are accurate in rapid, noninvasive measurement and the follow-up of CO in a wide range of cardiac clinical situations.
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Affiliation(s)
- Gad Cotter
- Cardiology Department, Assaf-Harofeh Medical Center, Zerifin, Israel.
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Kaukinen S, Kööbi T, Bi Y, Turjanmaa VMH. Cardiac output measurement after coronary artery bypass grafting using bolus thermodilution, continuous thermodilution, and whole-body impedance cardiography. J Cardiothorac Vasc Anesth 2003; 17:199-203. [PMID: 12698402 DOI: 10.1053/jcan.2003.47] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To test the feasibility of continuous cardiac output (CO) monitoring with whole-body impedance cardiography after coronary artery bypass grafting and to compare the values obtained with those measured using the bolus and continuous thermodilution methods. DESIGN A prospective study. SETTING Intensive care unit in a university hospital. PATIENTS Twenty patients after coronary artery bypass grafting. INTERVENTIONS CO was measured intermittently using the bolus thermodilution method, and continuously using the continuous thermodilution method, and whole-body impedance cardiography immediately after transfer to the intensive care unit. MEASUREMENTS AND MAIN RESULTS Bolus thermodilution CO was measured in triplicate at up to 14 time points overnight. Continuous thermodilution CO and whole-body impedance cardiography CO values were recorded simultaneously. During the study period, the bias in CO values between bolus thermodilution and whole-body impedance cardiography ranged from 0.07 to 1.05 L/min and the precision (standard deviation of differences) ranged from 0.82 to 1.31 L/min. The bias between the bolus and continuous thermodilution methods ranged from 0.06 to 0.58 L/min and the precision from 0.43 to 1.02 L/min. Pulmonary artery temperature and CO level were the major determinants of the bias and precision in both comparisons. CONCLUSIONS Agreement between whole-body impedance cardiography and bolus thermodilution is slightly inferior to that between the bolus and continuous thermodilution methods but not to the extent that it hampers the use of whole-body impedance cardiography for the continuous monitoring of CO after coronary artery bypass surgery.
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Affiliation(s)
- Seppo Kaukinen
- Department of Anaesthesia and Intensive Care, Tampere University Hospital, Tampere, Finland.
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Affiliation(s)
- M Botero
- Department of Anesthesiology, University of Florida College of Medicine, and Gainesville Veterans Affairs Medical Center, Gainesville, FL, USA.
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