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Regression analysis and transfer function in estimating the parameters of central pulse waves from brachial pulse wave. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2017:1708-1711. [PMID: 29060215 DOI: 10.1109/embc.2017.8037171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This study mainly analyzed the parameters such as ascending branch slope (A_slope), dicrotic notch height (Hn), diastolic area (Ad) and systolic area (As) diastolic blood pressure (DBP), systolic blood pressure (SBP), pulse pressure (PP), subendocardial viability ratio (SEVR), waveform parameter (k), stroke volume (SV), cardiac output (CO) and peripheral resistance (RS) of central pulse wave invasively and non-invasively measured. These parameters extracted from the central pulse wave invasively measured were compared with the parameters measured from the brachial pulse waves by a regression model and a transfer function model. The accuracy of the parameters which were estimated by the regression model and the transfer function model was compared too. Our findings showed that in addition to the k value, the above parameters of the central pulse wave and the brachial pulse wave invasively measured had positive correlation. Both the regression model parameters including A_slope, DBP, SEVR and the transfer function model parameters had good consistency with the parameters invasively measured, and they had the same effect of consistency. The regression equations of the three parameters were expressed by Y'=a+bx. The SBP, PP, SV, CO of central pulse wave could be calculated through the regression model, but their accuracies were worse than that of transfer function model.
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Kutter APN, Bettschart-Wolfensberger R, Romagnoli N, Bektas RN. Evaluation of agreement and trending ability between transpulmonary thermodilution and calibrated pulse contour and pulse power cardiac output monitoring methods against pulmonary artery thermodilution in anesthetized dogs. J Vet Emerg Crit Care (San Antonio) 2016; 26:531-40. [PMID: 26754858 DOI: 10.1111/vec.12439] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Accepted: 12/21/2014] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To assess agreement and trending ability of transpulmonary thermodilution (TPTD), calibrated pulse contour (PiCCO), and pulse power (PulseCO) methods compared to pulmonary artery thermodilution (PATD) for determination of cardiac output (CO) in anesthetized dogs. DESIGN Experimental, prospective study. SETTING University teaching hospital. ANIMALS Six adult Beagle dogs. INTERVENTIONS Dogs were anesthetized with sevoflurane and instrumented with pulmonary and femoral artery thermodilution catheters. CO was measured at baseline and at 5, 15, 30, 45, 60, 120, 180, and 240 minutes after IV administration of ketamine or s-ketamine. Baseline PATD and TPTD calibrated PulseCO and PiCCO, respectively. Agreement and trending ability was analyzed with Bland-Altman, concordance, and polar plot methodology. MEASUREMENTS AND MAIN RESULTS Median (range) CO values of 2.27 (0.98-3.4) L/min were measured with PATD, and 2.8 (1.9-4.04) L/min with TPTD, which resulted in a mean bias (± standard deviation) of -0.66 (± 0.36) L/min. Concordance rate was 91% and radial limits of agreement (RLOA) were ±35°. PATD against PiCCO resulted in a mean bias of -0.71 (± 0.62) L/min and PATD against PulseCO in a mean bias of 0.13 (± 0.46) L/min. The continuous techniques resulted in concordance rates of 77% for PATD-PiCCO and 74% for PATD-PulseCO and RLOA of ±57° and ±60°, respectively. CONCLUSIONS Intermittent TPTD showed marginal trending ability, while continuous pulse contour and pulse power methods showed poor trending ability over a 4-hour period. The poor performance and possible side effects of the methods tested in this study suggest that they should not be recommended for use in critical patients.
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Affiliation(s)
- Annette P N Kutter
- Section of Anesthesiology, Equine Department, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | | | - Noemi Romagnoli
- Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy
| | - Rima N Bektas
- Section of Anesthesiology, Equine Department, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
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Accuracy and precision of transcardiopulmonary thermodilution in patients with cardiogenic shock. J Clin Monit Comput 2015; 30:849-856. [DOI: 10.1007/s10877-015-9782-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 09/22/2015] [Indexed: 11/30/2022]
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Kutter APN, Mosing M, Hartnack S, Raszplewicz J, Renggli M, Mauch JY, Hofer CK. The influence of acute pulmonary hypertension on cardiac output measurements: calibrated pulse contour analysis, transpulmonary and pulmonary artery thermodilution against a modified Fick method in an animal model. Anesth Analg 2015; 121:99-107. [PMID: 25742632 DOI: 10.1213/ane.0000000000000655] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND In critically ill patients with significant pulmonary hypertension (PH), close perioperative cardiovascular monitoring is mandatory, considering the increased morbidity and mortality in this patient group. Although the pulmonary artery catheter is still the standard for the diagnosis of PH, its use to monitor cardiac output (CO) in patients with PH is decreasing as a result of increased morbidity and possible influence of tricuspid regurgitation on the measurements. However, continuous CO measurement methods have never been evaluated under PH regarding their agreement and trending ability. In this study, we evaluated the influence of acute PH and different CO states on transpulmonary thermodilution (TPTD) and calibrated pulse contour analysis (PiCCO; both assessed with PiCCO plus™), intermittent pulmonary artery thermodilution (PATD), and continuous thermodilution (CCO) compared with a modified Fick method (FICK) in an animal model. METHODS Nine healthy pigs were studied under anesthesia. PH of 25 and 40 mm Hg (by administration of the thromboxane analog U46619), CO decreases, and CO increases were induced to test the different CO measurement techniques over a broad range of hemodynamic situations. Before each step, a new baseline data set was collected. CO values were compared using Bland-Altman analysis; trending abilities were assessed via concordance and polar plot analysis. The influence of pulmonary pressure on CO measurements was analyzed using linear mixed models. RESULTS A mean bias of -0.26 L/min with prediction intervals of -0.88 to 1.4 L/min was measured between TPTD and FICK. Their concordance rate was 100% (94%-100% confidence interval), and the mean polar angle -3° with radial limits of agreement of ±28° indicated good trending abilities. PATD compared with FICK also showed good trending ability. Comparisons of PiCCO and CCO versus FICK revealed low agreement and poor trending results with concordance rates of 84% (71%-93%) and 88% (74%-95%), mean polar angles from -17° and -19°, and radial limits of agreement of ±45° and 40°. Pulmonary pressures influenced only the difference between FICK and PiCCO, as assessed by linear mixed models. CONCLUSIONS TPTD compared with FICK was able to track all changes induced during the study period, including those by PH. It yielded better agreement than PATD both compared with FICK. PiCCO and CCO were not mapping all changes correctly, and when used clinically in unstable patients, regular controls with intermittent techniques are required. Acute pharmacologically induced PH did influence the difference between FICK and PiCCO.
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Affiliation(s)
- Annette P N Kutter
- From the Section of Anesthesiology, Equine Department and Section of Epidemiology, Vetsuisse Faculty of the University of Zurich, Zurich, Switzerland; Department of Anesthesiology, Kantonsspital Luzern, Luzern, Switzerland; and Institute of Anesthesiology and Intensive Care Medicine, Triemli City Hospital, Zurich, Switzerland
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5
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Critchley LAH, Zhang J. The Pulmonary Circulation. Anesth Analg 2015; 121:8-10. [DOI: 10.1213/ane.0000000000000657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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6
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Laight NS, Levin AI. Transcardiopulmonary Thermodilution-Calibrated Arterial Waveform Analysis: A Primer for Anesthesiologists and Intensivists. J Cardiothorac Vasc Anesth 2015; 29:1051-64. [PMID: 26279223 DOI: 10.1053/j.jvca.2015.03.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Indexed: 02/07/2023]
Affiliation(s)
- Nicola S Laight
- Department of Anesthesiology and Critical Care, University of Stellenbosch, Tygerberg Hospital, Cape Town, South Africa
| | - Andrew I Levin
- Department of Anesthesiology and Critical Care, University of Stellenbosch, Tygerberg Hospital, Cape Town, South Africa.
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Rovira L, Aguilar G, Cuñat A, Belda FJ. Late evaluation of upper limb arterial flow in patients after long radial (PiCCO™) catheter placement. Ann Intensive Care 2015; 5:1. [PMID: 25852961 PMCID: PMC4384993 DOI: 10.1186/s13613-014-0041-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 12/18/2014] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The purpose of the study was to assess blood flow in the upper limb arteries after prolonged catheterization with long radial artery catheters (LRC) which reach the subclavian artery compared to catheterization with standard short radial artery catheters (SRC) and a group of upper limb flow without any catheter placement (NOCATH), with both SRC and NOCATH as control groups. METHODS Prospective observational study with 20 patients admitted to ICU (40 upper limbs) with LRC and/or SRC inserted >48 h for hemodynamic monitoring. More than 45 days after catheter withdrawal, patients underwent a Doppler ultrasound study of both upper limbs. Arterial flows of arms with LRC (FlowLRC) were compared with arterial flows of arms with SRC (FlowSRC) and those without any catheter (FlowNOCATH). RESULTS Flow in the ulnar, brachial, and subclavian arteries did not show any significant difference between the two types of catheters. The only significant difference was in the radial arteries, showing a lower mean flow in the arms with LRC than in the arms with SRC (2.2 vs. 8.5 cc/min; p = 0.041). Flow reduction in the radial artery (74%) in the arms with LRC compared to the SRC arms showed a tendency to increase ulnar flow as a compensatory mechanism. None of the patients with LRC included in our study had any ischemic events, in spite of observing complete flow occlusion in three radial arteries (18%) from the Doppler study. CONCLUSIONS In this sample, the use of PiCCO long radial catheters reaching the subclavian artery did not produce chronic significant changes in brachial or subclavian flows. However, LRC produces a significant reduction in radial flow and a tendency to increase ulnar flow. When comparing these blood flow changes with those produced by SRC use, only the radial flow reduction was significantly lower, whereas the other arterial flow changes did not significantly differ.
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Affiliation(s)
- Lucas Rovira
- />Anesthesiology and Critical Care Department, Hospital Clínico Universitario, Avd. Blasco Ibañez n°17, Valencia, 46010 Spain
| | - Gerardo Aguilar
- />Anesthesiology and Critical Care Department, Hospital Clínico Universitario, Avd. Blasco Ibañez n°17, Valencia, 46010 Spain
| | - Alberto Cuñat
- />Radiology Department, Hospital Clínico Universitario, Avd. Blasco Ibañez n°17, Valencia, 46010 Spain
| | - Francisco J Belda
- />Anesthesiology and Critical Care Department, Hospital Clínico Universitario, Avd. Blasco Ibañez n°17, Valencia, 46010 Spain
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Calbet JAL, Boushel R. Assessment of cardiac output with transpulmonary thermodilution during exercise in humans. J Appl Physiol (1985) 2015; 118:1-10. [DOI: 10.1152/japplphysiol.00686.2014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
The accuracy and reproducibility of transpulmonary thermodilution (TPTd) to assess cardiac output (Q̇) in exercising men was determined using indocyanine green (ICG) dilution as a reference method. TPTd has been utilized for the assessment of Q̇ and preload indexes of global end-diastolic volume and intrathoracic blood volume, as well as extravascular lung water (EVLW) in resting humans. It remains unknown if this technique is also accurate and reproducible during exercise. Sixteen healthy men underwent catheterization of the right femoral vein (for iced saline injection), an antecubital vein (ICG injection), and femoral artery (thermistor) to determine their Q̇ by TPTd and ICG concentration during incremental one- and two-legged pedaling on a cycle ergometer and combined arm cranking with leg pedaling to exhaustion. There was a close relationship between TPTd-Q̇ and ICG-Q̇ ( r = 0.95, n = 151, standard error of the estimate: 1.452 l/min, P < 0.001; mean difference of 0.06 l/min; limits of agreement −2.98 to 2.86 l/min), and TPTd-Q̇ and ICG-Q̇ increased linearly with oxygen uptake with similar intercepts and slopes. Both methods had mean coefficients of variation close to 5% for Q̇, global end-diastolic volume, and intrathoracic blood volume. The mean coefficient of variation of EVLW, assessed with both indicators (ICG and thermal) was 17% and was sensitive enough to detect a reduction in EVLW of 107 ml when changing from resting supine to upright exercise. In summary, TPTd with bolus injection into the femoral vein is an accurate and reproducible method to assess Q̇ during exercise in humans.
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Affiliation(s)
- José A. L. Calbet
- Department of Physical Education, University of Las Palmas de Gran Canaria, Campus Universitario de Tafira, Las Palmas de Gran Canaria, Spain
- Research Institute of Biomedical and Health Sciences, IUIBS, University of Las Palmas de Gran Canaria, Canary Island, Spain
- Copenhagen Muscle Research Center, Heart & Circulatory Section, Department of Biomedical Sciences, University of Copenhagen, and Department of Anaesthesia, Bispebjerg Hospital, Copenhagen, Denmark; and
| | - Robert Boushel
- Copenhagen Muscle Research Center, Heart & Circulatory Section, Department of Biomedical Sciences, University of Copenhagen, and Department of Anaesthesia, Bispebjerg Hospital, Copenhagen, Denmark; and
- Åstrand Laboratory, The Swedish School of Sport and Health Sciences, Stockholm, Sweden
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Abstract
Cardiac output (CO) is the volume of blood pumped out by the heart in 1 minute. Monitoring of CO can guide therapy and improve clinical outcome in critically ill patients and during anesthesia. Although there is increasing research into clinically useful methods of monitoring CO in equine patients, there are limitations to the available methods. There are 4 basic methods of measuring CO: (1) indicator methods, (2) a derivation of the Fick principle, (3) arterial pulse wave analysis, and (4) imaging diagnostic techniques. This article discusses the importance of CO, available technology, and challenges of monitoring CO in equine medicine.
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Affiliation(s)
- Andre Shih
- Department of Large Animal Clinical Science, University of Florida College of Veterinary Medicine, 2015 Southwest 16th Avenue, Gainesville, FL 32610, USA.
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Petzoldt M, Riedel C, Braeunig J, Haas S, Goepfert MS, Treede H, Baldus S, Goetz AE, Reuter DA. Stroke volume determination using transcardiopulmonary thermodilution and arterial pulse contour analysis in severe aortic valve disease. Intensive Care Med 2013; 39:601-11. [DOI: 10.1007/s00134-012-2786-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Accepted: 10/24/2012] [Indexed: 01/29/2023]
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Rodríguez JM, Muñoz-Rascón P, Navarrete-Calvo R, Gómez-Villamandos RJ, Domínguez Pérez JM, Fernández Sarmiento JA, Quirós Carmona S, Granados Machuca MM. Comparison of the cardiopulmonary parameters after induction of anaesthesia with alphaxalone or etomidate in dogs. Vet Anaesth Analg 2012; 39:357-65. [PMID: 22405410 DOI: 10.1111/j.1467-2995.2011.00695.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To compare the cardiorespiratory effects and quality of induction of and recovery from anaesthesia following etomidate or alphaxalone-HPCD IV. STUDY DESIGN Randomized 'blinded' cross-over study. Twenty-four hours was allowed between phases. ANIMALS Eight healthy adult Beagles (four male, four female). METHODS Dogs were anaesthetized with sevoflurane for instrumentation, then allowed to awake. They then received etomidate (treatment E) or alphaxalone-HPCD (treatment A) intravenously to effect. Heart rate (HR), body temperature, invasive arterial pressures (AP), systemic vascular resistance index (SVRI), stroke volume index, cardiac index (CI), contractility, respiratory rate, central venous pressure, and capnometry were obtained before anaesthetic induction (baseline), 30 seconds and 1 minute after induction, after intubation, one minute after intubation, and for every 5 minutes afterwards until the dog began to swallow and the trachea was extubated. Arterial bloods were taken for analyses before induction, after intubation and every 10 minutes thereafter. The dogs breathed room air. The quality of induction of and recovery from anaesthesia were scored categorically. Statistical analyses used anova for repeated measures, paired t-tests or Wilcoxon signed rank-test as relevant. Significance was set at p < 0.05. RESULTS The induction doses required were (mean ± SD) 2.91 ± 0.41 mg kg(-1) and 4.15 ± 0.7 mg kg(-1) for treatment E and A respectively. No significant changes in cardiovascular parameters were observed with treatment E. Treatment A resulted in statistically significant increases in HR and CI and reductions of APs and SVRI. Time to extubation was longer with treatment A (25 ± 7 minutes) than with treatment E (17 ± 4 minutes). Dogs became hypoxic with both treatments. The quality of induction and recovery were excellent with treatment A, but significantly less satisfactory with treatment E (recovery score, treatment E median 1, range 0-2; treatment A median 0, range 0-1). CONCLUSIONS AND CLINICAL RELEVANCE Alphaxalone-HPCD caused significant tachycardia and increase in CI, and statistically (but not clinically) significant decreases in APs and SVRI. Etomidate caused no statistically significant cardiovascular changes. Quality of recovery was better with alfaxalone-HPCD. Both agents caused short-lived hypoxia, and oxygen supplementation is advisable.
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Tagami T, Kushimoto S, Tosa R, Omura M, Hagiwara J, Hirama H, Yokota H. The precision of PiCCO®measurements in hypothermic post-cardiac arrest patients. Anaesthesia 2012; 67:236-43. [DOI: 10.1111/j.1365-2044.2011.06981.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Shih A, Giguère S, Vigani A, Shih R, Thuramalla N, Bandt C. Determination of cardiac output by ultrasound velocity dilution in normovolemia and hypovolemia in dogs. Vet Anaesth Analg 2011; 38:279-85. [DOI: 10.1111/j.1467-2995.2011.00604.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Valverde A, Gianotti G, Rioja E, Hathway A. Comparison of cardiac output determined by arterial pulse pressure waveform analysis method (FloTrac/Vigileo) versus lithium dilution method in anesthetized dogs. J Vet Emerg Crit Care (San Antonio) 2011; 21:328-34. [DOI: 10.1111/j.1476-4431.2011.00650.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Shih A, Maisenbacher HW, Bandt C, Ricco C, Bailey J, Rivera J, Estrada A. Assessment of cardiac output measurement in dogs by transpulmonary pulse contour analysis. J Vet Emerg Crit Care (San Antonio) 2011; 21:321-7. [DOI: 10.1111/j.1476-4431.2011.00651.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Flow-regulated extracorporeal arteriovenous tubing loop for cardiac output measurements by ultrasound velocity dilution: validation in post-cardiac surgery intensive care unit patients. ASAIO J 2011; 56:522-6. [PMID: 21245798 DOI: 10.1097/mat.0b013e3181effdf8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Assessment of cardiac output (CO) is crucial in the management of the critically ill, especially in post cardiac surgery intensive care unit (ICU) patients. In this study, we validated CO measured by the novel ultrasound dilution (COUD) with those measured by pulmonary artery (PA) thermodilution (COTD) in 26 adult post cardiac surgery patients. For COUD, blood was circulated through an extracorporeal arteriovenous (AV) loop from the radial artery catheter to the introducer of PA catheter for 5-8 minutes. Three to four injections of 25 ml body temperature isotonic saline were performed into the venous limb of the AV loop. For COTD, five injections of 10 ml ice cold saline were performed. A total of 77 COUD and COTD measurement sets were compared. Cardiac output measured by thermodilution ranged from 3.28 to 9.4 L/min, whereas COUD ranged from 2.85 to 10.1 L/min. The correlation between the methods was found to be r = 0.91, COUD = 0.93(COTD) + 0.42 L/min. Bias and precision (mean difference ± 2SDs) was -0.004 ± 1.34 L/min between the two methods. The percentage error (2SD/mean) was 22.2%, which is below the clinically acceptable limit (<30%). Cardiac output measured by ultrasound dilution and thermodilution methods agreed well in post cardiac surgery ICU patients and hence can be interchangeably used.
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Belda FJ, Aguilar G, Teboul JL, Pestaña D, Redondo FJ, Malbrain M, Luis JC, Ramasco F, Umgelter A, Wendon J, Kirov M, Fernández-Mondéjar E. Complications related to less-invasive haemodynamic monitoring. Br J Anaesth 2010; 106:482-6. [PMID: 21205627 DOI: 10.1093/bja/aeq377] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate the type and incidence of complications during insertion, maintenance, and withdrawal of central arterial catheters used for transpulmonary thermodilution haemodynamic monitoring (PiCCO™). METHODS We conducted a prospective, observational, multicentre study in 14 European intensive care units (six countries). A total of 514 consecutive patients in whom haemodynamic monitoring by PiCCO™ was indicated were studied. RESULTS Five hundred and fourteen PiCCO catheters (475 in femoral, 26 in radial, nine in axillary, and four in brachial arteries) were inserted. Arterial access was obtained on the first attempt in 86.4% of the patients. Minor problems such as oozing after insertion (3.3%) or removal of the catheter (3.5%) were observed, but no episodes of serious bleeding (more than 50 ml) were recorded. Small local haematomas were observed after insertion (4.5%) and after removal (1.2%) of the catheter. These complications were not more frequent in patients with coagulation abnormalities. The incidence of site inflammation and catheter-related infection was 2% and 0.78%, respectively. Other complications such as ischaemia (0.4%), pulse loss (0.4%), or femoral artery thrombosis (0.2%) were rare, transient, and all resolved with catheter removal or embolectomy, respectively. CONCLUSIONS In this series of patients, central arterial catheters used for PiCCO™ monitoring were demonstrated to be a safe alternative for advanced haemodynamic monitoring.
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Affiliation(s)
- F J Belda
- Anesthesiology and Intensive Care Department, Hospital Clínico Universitario de Valencia, Valencia, Spain.
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Nishiyama T. Recent advance in patient monitoring. Korean J Anesthesiol 2010; 59:144-59. [PMID: 20877698 PMCID: PMC2946031 DOI: 10.4097/kjae.2010.59.3.144] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Revised: 07/23/2010] [Accepted: 07/23/2010] [Indexed: 11/10/2022] Open
Abstract
Recent advance in technology has developed a lot of new aspects of clinical monitoring. We can monitor sedation levels during anesthesia using various electroencephalographic (EEG) indices, while it is still not useful for anesthesia depth monitoring. Some attempts are made to monitor the changes in sympathetic nerve activity as one of the indicators of stress, pain/analgesia, or anesthesia. To know the balance of sympathetic and parasympathetic activity, heart rate or blood pressure variability is investigated. For trend of cardiac output, low invasive monitors have been investigated. Improvement of ultrasound enables us to see cardiac structure and function continuously and clearer, increases success rate and decreases complication of central venous puncture and various kinds of nerve blocks. Without inserting an arterial catheter, trends of arterial oxygen tension or carbon dioxide tension can be monitored. Indirect visualization of the airway decreases difficult intubation and makes it easier to teach tracheal intubation. The changes in blood volume can be speculated non-invasively. Cerebral perfusion and metabolism are not ordinary monitored yet, but some studies show their usefulness in management of critically ill. This review introduces recent advances in various monitors used in anesthesia and critical care including some studies of the author, especially focused on EEG and cardiac output. However, the most important is that these new monitors are not almighty but should be used adequately in a limited situation where their meaning is confirmed.
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Affiliation(s)
- Tomoki Nishiyama
- Department of Anesthesiology and Critical Care, Higashi Omiya General Hospital, Saitama, Japan
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Diaper J, Ellenberger C, Villiger Y, Robert J, Inan C, Tschopp JM, Licker M. Comparison of cardiac output as assessed by transesophageal echo-Doppler and transpulmonary thermodilution in patients undergoing thoracic surgery. J Clin Anesth 2010; 22:97-103. [DOI: 10.1016/j.jclinane.2009.03.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2008] [Revised: 02/26/2009] [Accepted: 03/01/2009] [Indexed: 10/19/2022]
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Tsutsui M, Matsuoka N, Ikeda T, Sanjo Y, Kazama T. Comparison of a New Cardiac Output Ultrasound Dilution Method With Thermodilution Technique in Adult Patients Under General Anesthesia. J Cardiothorac Vasc Anesth 2009; 23:835-40. [DOI: 10.1053/j.jvca.2009.03.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2008] [Indexed: 11/11/2022]
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Mayer J, Boldt J, Poland R, Peterson A, Manecke GR. RETRACTED: Continuous arterial pressure waveform-based cardiac output using the FloTrac/Vigileo: a review and meta-analysis. J Cardiothorac Vasc Anesth 2009; 23:401-406. [PMID: 19464625 DOI: 10.1053/j.jvca.2009.03.003] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2009] [Indexed: 12/11/2022]
Affiliation(s)
- Jochen Mayer
- Department of Anesthesiology and Intensive Care Medicine, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - Joachim Boldt
- Department of Anesthesiology and Intensive Care Medicine, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - Reagan Poland
- Department of Anesthesiology, University of California San Diego School of Medicine, San Diego, CA
| | - Amanda Peterson
- Department of Anesthesiology, University of California San Diego School of Medicine, San Diego, CA
| | - Gerard R Manecke
- Department of Anesthesiology, University of California San Diego School of Medicine, San Diego, CA.
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Shih AC, Giguère S, Sanchez LC, Valverde A, Jankunas HJ, Robertson SA. Determination of cardiac output in anesthetized neonatal foals by use of two pulse wave analysis methods. Am J Vet Res 2009; 70:334-9. [DOI: 10.2460/ajvr.70.3.334] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Comparison of pulmonary artery and aortic transpulmonary thermodilution for monitoring of cardiac output in patients with severe heart failure: validation of a novel method. Crit Care Med 2009; 37:119-23. [PMID: 19050622 DOI: 10.1097/ccm.0b013e31819290d5] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Hemodynamic monitoring with the pulmonary artery catheter is frequently used in the management of severe heart failure. For measurement of cardiac output (CO), transpulmonary thermodilution (TPTD) has recently been adopted into clinical practice as an alternative to pulmonary artery thermodilution. However, no data have been published on the comparability of the two methods for patients with severely reduced left ventricular function. Our objective was to evaluate the correlation between these two methods of CO determination in patients with severe left ventricular dysfunction. DESIGN Prospective observational clinical study. SETTING Cardiological intermediate care unit and medical intensive care unit of a university hospital. PATIENTS Twenty-nine patients with left ventricular ejection fraction <35% and symptoms of heart failure (New York Heart Association class III-IV). INTERVENTION None. MEASUREMENTS AND MAIN RESULTS The two methods of intermittent CO measurement were compared by simultaneously recording the results of pulmonary artery thermodilution and TPTD after injection of a cold saline bolus. Measurements were performed when clinically necessary. A total of 325 data pairs were analyzed. Mean CO of both methods was 4.4 L/min with a bias of 0.45 L/min (2 SD 1.20 L/min), resulting in a percentage error of 27.3%. CONCLUSION In patients with severely impaired left ventricular function, measurement of CO by TPTD provides valid results.
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Smith J, Camporota L, Beale R. Monitoring Arterial Blood Pressure and Cardiac Output using Central or Peripheral Arterial Pressure Waveforms. Intensive Care Med 2009. [DOI: 10.1007/978-0-387-92278-2_27] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Theory and in vitro validation of a new extracorporeal arteriovenous loop approach for hemodynamic assessment in pediatric and neonatal intensive care unit patients. Pediatr Crit Care Med 2008; 9:423-8. [PMID: 18496416 PMCID: PMC2574659 DOI: 10.1097/01.pcc.0b013e31816c71bc] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES No simple method exists for repeatedly measuring cardiac output in intensive care pediatric and neonatal patients. The purpose of this study is to present the theory and examine the in vitro accuracy of a new ultrasound dilution cardiac output measurement technology in which an extracorporeal arteriovenous tubing loop is inserted between existing arterial and venous catheters. DESIGN Laboratory experiments. SETTING Research laboratory. SUBJECTS None. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS In vitro validations of cardiac output, central blood volume, total end-diastolic volume, and active circulation volume were performed in a model mimicking pediatric (children 2-10 kg) and neonatal (0.5-3 kg) flows and volumes against flows and volumes measured volumetrically. Reusable sensors were clamped onto the arterial and venous limbs of the arteriovenous loop. A peristaltic pump was used to circulate liquid at 6-12 mL/min from the artery to the vein through the arteriovenous loop. Body temperature injections of isotonic saline (0.3-10 mL) were performed. In the pediatric setting, the absolute difference between cardiac output measured by dilution and cardiac output measured volumetrically was 3.97% +/- 2.97% (range 212-1200 mL/min); for central blood volume the difference was 4.59% +/- 3.14% (range 59-315 mL); for total end-diastolic volume the difference was 4.10% +/- 3.08% (range 24-211 mL); and for active circulation volume the difference was 3.30% +/- 3.07% (range 247-645 mL). In the neonatal setting the difference for cardiac output was 4.40% +/- 4.09% (range 106-370 mL/min); for central blood volume the difference was 4.90% +/- 3.69% (range 50-62 mL); and for active circulation volume the difference was 5.39% +/- 4.42% (range 104-247 mL). CONCLUSIONS In vitro validation confirmed the ability of the ultrasound dilution technology to accurately measure small flows and volumes required for hemodynamic assessments in small pediatric and neonatal patients. Clinical studies are in progress to assess the reliability of this technology under different clinical situations.
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McGee WT, Horswell JL, Calderon J, Janvier G, Van Severen T, Van den Berghe G, Kozikowski L. Validation of a continuous, arterial pressure-based cardiac output measurement: a multicenter, prospective clinical trial. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2008; 11:R105. [PMID: 17880692 PMCID: PMC2556749 DOI: 10.1186/cc6125] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2006] [Revised: 08/13/2007] [Accepted: 09/19/2007] [Indexed: 11/10/2022]
Abstract
Introduction The present study compared measurements of cardiac output by an arterial pressure-based cardiac output (APCO) analysis method with measurement by intermittent thermodilution cardiac output (ICO) via pulmonary artery catheter in a clinical setting. Methods The multicenter, prospective clinical investigation enrolled patients with a clinical indication for cardiac output monitoring requiring pulmonary artery and radial artery catheters at two hospitals in the United States, one hospital in France, and one hospital in Belgium. In 84 patients (69 surgical patients), the cardiac output was measured by analysis of the arterial pulse using APCO and was measured via pulmonary artery catheter by ICO; to establish a reference comparison, the cardiac output was measured by continuous cardiac output (CCO). Data were collected continuously by the APCO and CCO technologies, and at least every 4 hours by ICO. No clinical interventions were made as part of the study. Results For APCO compared with ICO, the bias was 0.20 l/min, the precision was ± 1.28 l/min, and the limits of agreement were -2.36 l/m to 2.75 l/m. For CCO compared with ICO, the bias was 0.66 l/min, the precision was ± 1.05 l/min, and the limits of agreement were -1.43 l/m to 2.76 l/m. The ability of APCO and CCO to assess changes in cardiac output was compared with that of ICO. In 96% of comparisons, APCO tracked the change in cardiac output in the same direction as ICO. The magnitude of change was comparable 59% of the time. For CCO, 95% of comparisons were in the same direction, with 58% of those changes being of similar magnitude. Conclusion In critically ill patients in the intensive care unit, continuous measurement of cardiac output using either APCO or CCO is comparable with ICO. Further study in more homogeneous populations may refine specific situations where APCO reliability is strongest.
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Affiliation(s)
- William T McGee
- Critical Care Division, Baystate Medical Center, 759 Chestnut Street, Springfield, MA, 01199, USA
| | - Jeffrey L Horswell
- Department of Cardiac Anesthesia, Medical City Dallas Hospital, 7777 Forest Lane, Dallas, TX, 75230, USA
| | - Joachim Calderon
- DAR II, CHU Bordeaux Group Hospitalier Sud, Avenue de Magellan, 33604 Pressac Cedex, France
| | - Gerard Janvier
- DAR II, CHU Bordeaux Group Hospitalier Sud, Avenue de Magellan, 33604 Pressac Cedex, France
| | - Tom Van Severen
- Department of Intensive Care Medicine, UZ Leuven Gasthuisberg, Catholic University of Leuven, B-3000 Leuven, Belgium
| | - Greet Van den Berghe
- Department of Intensive Care Medicine, UZ Leuven Gasthuisberg, Catholic University of Leuven, B-3000 Leuven, Belgium
| | - Lori Kozikowski
- Critical Care Division, Baystate Medical Center, 759 Chestnut Street, Springfield, MA, 01199, USA
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Abstract
Insertion of a central venous catheter and an arterial catheter would be indicated in hemodynamically unstable or severely hypoxic patients in critical care units. In this setting, cardiorespiratory monitoring by transpulmonary thermodilution (TPTD) can be considered minimally invasive given that only a single arterial thermodilution catheter and a single central venous catheter are required to be connected to a specific monitor (the PiCCO Plus, Pulsion Medical Systems, Munich, Germany). TDTP simultaneously measures cardiac output, preloading, and cardiac function in hemodynamically unstable patients and predicts the response to volume. The technique can be managed by any health care professional. In hypoxic patients, TDTP identifies cases of pulmonary edema that might benefit from a negative fluid balance, evaluates pulmonary vascular permeability, facilitates our understanding of pathophysiologic mechanisms of hypoxemia, and predicts the likelihood of deleterious hemodynamic effects of positive end-expiratory pressures.
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Higgins D, Townsend J. Failure of Draeger Infinity pulse contour monitoring system when used with 8-cm PiCCO catheters. Anaesthesia 2008; 63:105-6. [PMID: 18086093 DOI: 10.1111/j.1365-2044.2007.05394.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Belda FJ, Aguilar G, Perel A. Transpulmonary Thermodilution for Advanced Cardiorespiratory Monitoring. Intensive Care Med 2007. [DOI: 10.1007/978-0-387-49518-7_45] [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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Lorsomradee S, Lorsomradee S, Cromheecke S, De Hert SG. Uncalibrated Arterial Pulse Contour Analysis Versus Continuous Thermodilution Technique: Effects of Alterations in Arterial Waveform. J Cardiothorac Vasc Anesth 2007; 21:636-43. [PMID: 17905266 DOI: 10.1053/j.jvca.2007.02.003] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2006] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To compare an arterial pressure-derived cardiac output (APCO) (Vigileo software version 1.07; Edwards Lifesciences, Irvine, CA) and a thermodilution cardiac output (CCO) as methods for measuring cardiac output under different pathologic and experimental conditions that induce changes in arterial waveform morphology. DESIGN A prospective study. SETTING A university hospital, single institutional. PARTICIPANTS Fifty-two patients undergoing elective cardiac surgery. INTERVENTIONS Simultaneous APCO and CCO were compared in low-risk patients undergoing elective coronary artery surgery (without valvular disease) (control, n = 20), patients with aortic stenosis (AS, n = 10), aortic insufficiency (AI, n = 10), and intra-aortic balloon pump (IABP, n = 12). In the control group, additional data were registered before and after median sternotomy and phenylephrine administration. MEASUREMENTS AND MAIN RESULTS In the control group, Bland-Altman showed a bias of -3% (95% limits of agreement: -59% to +53%) before cardiopulmonary bypass (CPB) and of -1% (95% limits of agreement: -51% to +50%) after CPB. In the AS group, the bias was -5% (95% limits of agreement: -34% to +24%) before CPB and 1% (95% limits of agreement: -28 to +30%) after CPB. In the AI group bias was +32% (95% limits of agreement: -4% to +68%) before CPB and -2% (95% limits of agreement: -35% to +32%) after CPB. Median sternotomy decreased CCO by 10% +/- 10%, whereas it increased APCO by 56% +/- 28%. Phenylephrine administration decreased CCO by 11% +/- 16%, whereas it increased APCO by 55% +/- 34%. CONCLUSIONS Cardiac output measurement based on uncalibrated pulse contour analysis is able to reflect cardiac output measured with the continuous thermodilution method in patients undergoing uncomplicated coronary artery surgery. However, in situations in which the arterial pressure waveform is changed, agreement between techniques may be altered and data obtained with uncalibrated pulse contour analysis may become less reliable.
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Lorsomradee S, Lorsomradee SR, Cromheecke S, De Hert SG. Continuous cardiac output measurement: arterial pressure analysis versus thermodilution technique during cardiac surgery with cardiopulmonary bypass. Anaesthesia 2007; 62:979-83. [PMID: 17845647 DOI: 10.1111/j.1365-2044.2007.05194.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study compared cardiac output measured with an arterial pressure-based cardiac output measurement system and a thermodilution cardiac output measurement system. We studied 36 patients undergoing cardiac surgery with cardiopulmonary bypass. Simultaneous arterial pressure-based and thermodilution cardiac output measurements were compared before and after cardiopulmonary bypass, and after phenylephrine administration. Bland-Altman analysis showed good overall agreement between the two methods. Bias (limits of agreement) before and after cardiopulmonary bypass were - 0.21 (- 2.97-2.55) lxmin(-1) and 0.01 (- 3.79-3.81) lxmin(-1), respectively. Phenylephrine administration decreased thermodilution cardiac output by a mean (SD) of 11 (16)% and increased arterial pressure-based cardiac output by 55 (34)%. We conclude that arterial pressure-based cardiac output and thermodilution cardiac output measurement systems yield comparable results during cardiac surgery with cardiopulmonary bypass. However, after phenylephrine administration, the two measurement systems provided opposing results.
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Affiliation(s)
- S Lorsomradee
- Department of Anaesthesia, Chiangmai University Hospital, Thailand
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Abstract
As outlined in Table 1, the nonthermodilution techniques available to measure cardiac output are noninvasive and clinically applicable to a variable degree. The truly noninvasive monitors are bioimpedance and CO2 re-breathing. The latter, however, requires the patient to be intubated, and the former continues to be evaluated with regard to correlation with the thermodilution standard. Esophageal Doppler devices are relatively noninvasive in that they do not require vascular cannulation, but they do require an immobile patient and some user expertise. Pulse contour analysis requires an arterial catheter, and two of the three available monitors require external calibration, while the third has not been validated adequately. The reader can see that all four approaches continue to be refined, with new analysis algorithms and monitors continuing to appear on the market. In the absence of true tissue oxygenation monitors, it seems likely that some or all of these alternatives to thermodilution will play a greater role in the care of patients where measurement of cardiac output is desired.
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Affiliation(s)
- James Ramsay
- Anesthesiology Critical Care Medicine, Emory University School of Medicine, Emory University Hospital, 1364 Clifton Road, Atlanta, GA 30322, USA.
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Mayer J, Boldt J, Schöllhorn T, Röhm KD, Mengistu AM, Suttner S. Retracted: Semi-invasive monitoring of cardiac output by a new device using arterial pressure waveform analysis: a comparison with intermittent pulmonary artery thermodilution in patients undergoing cardiac surgery. Br J Anaesth 2007; 98:176-82. [PMID: 17218375 DOI: 10.1093/bja/ael341] [Citation(s) in RCA: 116] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Thermodilution technique using a pulmonary artery catheter (PAC) is a widely used method to determine cardiac output (CO). It is increasingly criticized because of its invasiveness and its unclear risk-benefit ratio. Thus, less invasive techniques for measuring CO are highly desirable. We compared a new, semi-invasive device (FloTrac/Vigileo) using arterial pressure waveform analysis for CO measurement in patients undergoing cardiac surgery with bolus thermodilution measurements. METHODS Forty patients undergoing coronary artery bypass grafting or valve repair were enrolled. A PAC was inserted and routine radial arterial access was used for semi-invasive determination of CO with the Vigileo. CO was measured simultaneously by bolus thermodilution and the Vigileo technique after induction of anaesthesia (T1), before cardiopulmonary bypass (CPB) (T2), after CPB (T3), after sternal closure (T4), on arrival in the intensive care unit (ICU) (T5), and 4 h (T6), 8 h (T7), and 24 h after surgery (T8). CO was indexed to the body surface area (cardiac index, CI). RESULTS A total of 244 pairs of CI measurements were analysed. Bias and precision (1.96 sd of the bias) were 0.46 litre min(-1) m(-2) and +/- 1.15 litre min(-1) m(-2) (r = 0.53) resulting in an overall percentage error of 46%. Subgroup analysis revealed a percentage error of 51% for data pairs obtained intraoperatively (T1-T4), 42% in ICU (T5-T8), and 56% for values obtained during low CI (T1-T8). CONCLUSIONS In cardiac surgery patients, CO measured by a new semi-invasive arterial pressure waveform analysis device showed only moderate agreement with intermittent pulmonary artery thermodilution measurement.
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Affiliation(s)
- J Mayer
- Department of Anaesthesiology and Intensive Care Medicine, Klinikum Ludwigshafen, Bremserstr. 79, 67063 Ludwigshafen, Germany.
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de Wilde RBP, van den Berg PCM, Jansen JRC. A reply. Anaesthesia 2007. [DOI: 10.1111/j.1365-2044.2006.04916_2.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Orme RML, Pigott DW. Monitoring cardiac output from the radial artery pressure waveform. Anaesthesia 2007; 62:90-1; author reply 91. [PMID: 17156236 DOI: 10.1111/j.1365-2044.2006.04916_1.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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de Wilde RBP, Breukers RBGE, van den Berg PCM, Jansen JRC. Monitoring cardiac output using the femoral and radial arterial pressure waveform. Anaesthesia 2006; 61:743-6. [PMID: 16867085 DOI: 10.1111/j.1365-2044.2006.04712.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study was performed to determine the interchangeability of femoral artery pressure and radial artery pressure measurements as the input for the PiCCO system (Pulsion Medical Systems, Munich, Germany). We studied 15 intensive care patients following cardiac surgery. Five-second averages of the cardiac output derived from the femoral artery pressure (COfem) were compared to 5-s averages derived from the radial artery pressure (COrad). One patient was excluded due to problems in the pattern recognition of the arterial pressure signal. In the remaining 14 patients, 14 734 comparative cardiac output values were analysed. The mean sample time was 88 min, range [30-119 min]. Mean (SD) COfem was 6.24 (1.1) l.min(-1) and mean COrad 6.23 (1.1) l.min(-1). Bland-Altman analysis showed an excellent agreement with a bias of - 0.01 l.min(-1), and limits of agreement from 0.60 to - 0.62 l.min(-1). If changes in CO were > 0.5 l.min(-1), the direction of changes in COfem and COrad were equal in 97% of instances. We conclude that femoral artery pressure and radial artery pressure are interchangeable as inputs for the PiCCO device.
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Affiliation(s)
- R B P de Wilde
- Department of Intensive Care, C6-k102, Leiden University Medical Center, Albinusdreef 2, PO Box 9600, 2300 RC Leiden, The Netherlands
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Singh S, Evans TW. Organ dysfunction during sepsis. Intensive Care Med 2006; 32:349-60. [PMID: 16474954 DOI: 10.1007/s00134-005-0038-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2005] [Accepted: 12/12/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Multiple organ dysfunction syndrome is the commonest reason for sepsis-associated mortality. DISCUSSION In the 40 years since it was first described understanding of its pathophysiology has improved, and novel methodologies for monitoring and severity of illness scoring have emerged. These, together with the development of systematic strategies for managing organ dysfunction in sepsis, and potentially effective new therapeutic interventions, should assist in reducing sepsis-associated mortality. CONCLUSION These historical developments are discussed, and the reader is directed to these references for further guidance.
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Affiliation(s)
- Suveer Singh
- Chelsea and Westminster Hospital, Department of Intensive Care Medicine, 369 Fulham Road, SW10 9NH, London, UK.
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Abstract
PURPOSE OF REVIEW Measuring stroke volume or cardiac output is of paramount importance for the management of critically ill patients in the intensive care unit, or 'high risk' surgical patients in the operating room. The new noninvasive techniques are gaining acceptance among intensivists and anesthesiologists who have been trained almost exclusively in the pulmonary artery catheter and the thermodilution technique. RECENT FINDINGS The present review focuses on the recent publications related to esophageal Doppler, Fick principle applied to carbon dioxide associated with partial rebreathing, and pulse contour analysis. Recent validation studies have confirmed the previous findings: all three methods provide reliable estimations of cardiac output and its variations. There is not a single method standing out and ruling out the others. Many investigators are now using one of the 'noninvasive' monitors to measure cardiac output in clinical or experimental studies. SUMMARY By making cardiac output easily measurable in various settings, these techniques should all contribute to improve hemodynamic management in critically ill or high-risk surgical patients.
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Affiliation(s)
- Bernard P Cholley
- Department of Anesthesiology and Critical Care Medicine, Hôpital Lariboisière, Paris, France.
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Hoffman GM, Ghanayem NS, Tweddell JS. Noninvasive assessment of cardiac output. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2005:12-21. [PMID: 15818353 DOI: 10.1053/j.pcsu.2005.01.005] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Improved outcome from shock depends on early detection and correction of circulatory abnormalities. Global cardiac output and oxygen delivery must be adequate and distributed appropriately to meet metabolic demands to prevent the development of multiple organ system dysfunction, prolonged morbidity, and death. Circulatory assessment using standard monitors gives incomplete and sometimes misleading information. This article focuses on the available and emerging technologies that emphasize assessment of blood flow and regional tissue oxygenation.
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Affiliation(s)
- George M Hoffman
- Department of Pediatric Anesthesiology, Children's Hospital of Wisconsin, Milwaukee 53226, USA
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