Pulse-contour-derived cardiac output is unreliable in septic shock: authors' reply

Flow-regulated extracorporeal arteriovenous tubing loop for cardiac output measurements by ultrasound velocity dilution: validation in post-cardiac surgery intensive care unit patients

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.