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Guha A, Arora D, Mehta Y. Comparative study of cardiac output measurement by regional impedance cardiography and thermodilution method in patients undergoing off pump coronary artery bypass graft surgery. Ann Card Anaesth 2022; 25:335-342. [PMID: 35799563 PMCID: PMC9387605 DOI: 10.4103/aca.aca_44_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background: An ideal CO monitor should be noninvasive, cost effective, reproducible, reliable during various physiological states. Limited literature is available regarding the noninvasive CO monitoring in open chest surgeries. Aim: The aim of this study was to compare the CO measurement by Regional Impedance Cardiography (RIC) and Thermodilution (TD) method in patients undergoing off pump coronary artery bypass graft surgery (OPCAB). Settings and Design: We conducted a prospective observational comparative study of CO measurement by the noninvasive RIC method using the NICaS Hemodynamic Navigator system and the gold standard TD method using pulmonary artery catheter in patients undergoing OPCAB. A total of 150 data pair from the two CO monitoring techniques were taken from 15 patients between 40-70 years at various predefined time intervals of the surgery. Patients and Methods: We have tried to find out the accuracy, precision and cost effectiveness of the newer RIC technique. Mean CO, bias and precision were compared for each pair i.e.TD-CO and RIC-CO as recommended by Bland and Altman. The Sensitivity and specificity of cutoff value to predict change in TD-CO was used to create a Receiver operating characteristic or ROC curve. Results: Mean TD-CO values were around 4.52 ± 1.09 L/min, while mean RIC- CO values were around 4.77± 1.84 L/min. The difference in CO change was found to be statistically not significant (p value 0.667). The bias was small (-0.25). The Bland Altman plot revealed a mean difference of -0.25 litres. The RIC method had a sensitivity of 55.56 % and specificity of 33.33 % in predicting 15% change in CO of TD method and the total diagnostic accuracy was 46.67%. Conclusion: A fair correlation was found between the two techniques. The RIC method may be considered as a promising noninvasive, potentially low cost alternative to the TD technique of hemodynamic measurement.
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Affiliation(s)
- Amrita Guha
- Department of Cardiac Anaesthesiology, Medanta the Medicity, Gurugram, Haryana, India
| | - Dheeraj Arora
- Department of Cardiac Anaesthesiology, Medanta the Medicity, Gurugram, Haryana, India
| | - Yatin Mehta
- Department of Cardiac Anaesthesiology, Medanta the Medicity, Gurugram, Haryana, India
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Tobushi T, Kasai T, Hirose M, Sakai K, Akamatsu M, Ohsawa C, Yoshioka Y, Suda S, Shiroshita N, Nakamura R, Kadokami T, Tohyama T, Funakoshi K, Hosokawa K, Ando SI. Lung-to-finger circulation time can be measured stably with high reproducibility by simple breath holding method in cardiac patients. Sci Rep 2021; 11:15913. [PMID: 34354137 PMCID: PMC8342428 DOI: 10.1038/s41598-021-95192-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 07/09/2021] [Indexed: 11/26/2022] Open
Abstract
Lung to finger circulation time (LFCT) has been used to estimate cardiac function. We developed a new LFCT measurement device using a laser sensor at fingertip. We measured LFCT by measuring time from re-breathing after 20 s of breath hold to the nadir of the difference of transmitted red light and infrared light, which corresponds to percutaneous oxygen saturation. Fifty patients with heart failure were enrolled. The intrasubject stability of the measurement was assessed by the intraclass correlation coefficient (ICC). The ICC calculated from 44 cases was 0.85 (95% confidence interval: 0.77–0.91), which means to have “Excellent reliability.” By measuring twice, at least one clear LFCT value was obtained in 89.1% of patients and the overall measurability was 95.7%. We conducted all LFCT measurements safely. High ICCs were obtained even after dividing patients according to age, cardiac index (CI); 0.85 and 0.84 (≥ 75 or < 75 years group, respectively), 0.81 and 0.84 (N = 26, ≥ or < 2.2 L/min/M2). These results show that our new method to measure LFCT is highly stable and feasible for any type of heart failure patients.
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Affiliation(s)
- Tomoyuki Tobushi
- Department of Cardiovascular Medicine, Saiseikai Futsukaichi Hospital, Chikushino, Japan
| | - Takatoshi Kasai
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Masayuki Hirose
- Center for Clinical and Translational Research, Kyushu University Hospital, Fukuoka, Japan
| | - Kazuhiro Sakai
- Imaging Device Development, Fuji Xerox Co., Ltd., Kanagawa, Japan
| | - Manabu Akamatsu
- Imaging Device Development, Fuji Xerox Co., Ltd., Kanagawa, Japan
| | - Chizuru Ohsawa
- Imaging Device Development, Fuji Xerox Co., Ltd., Kanagawa, Japan
| | - Yasuko Yoshioka
- Sleep Apnea Center, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Shoko Suda
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Nanako Shiroshita
- Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Ryo Nakamura
- Department of Cardiovascular Medicine, Saiseikai Futsukaichi Hospital, Chikushino, Japan
| | - Toshiaki Kadokami
- Department of Cardiovascular Medicine, Saiseikai Futsukaichi Hospital, Chikushino, Japan
| | - Takeshi Tohyama
- Center for Clinical and Translational Research, Kyushu University Hospital, Fukuoka, Japan
| | - Kouta Funakoshi
- Center for Clinical and Translational Research, Kyushu University Hospital, Fukuoka, Japan
| | - Kazuya Hosokawa
- Department of Cardiovascular Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Shin-Ichi Ando
- Sleep Apnea Center, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
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Aldhahi MI, Guccione AA, Chin LMK, Woolstenhulme J, Keyser RE. Modulation of left ventricular diastolic filling during exercise in persons with cervical motor incomplete spinal cord injury. Eur J Appl Physiol 2019; 119:2435-2447. [PMID: 31701273 PMCID: PMC10496443 DOI: 10.1007/s00421-019-04249-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 10/26/2019] [Indexed: 12/01/2022]
Abstract
PURPOSE To characterize left ventricular diastolic function during an exertional challenge in adults with incomplete cervical spinal cord Injury (icSCI). METHODS In this cross-sectional study, a two-group convenience sample was used to compare left ventricular LV diastolic performance during a 5-10 W·min-1 incremental arm ergometer exercise protocol, using bioimpedance cardiography. Subjects were eight males with cervical incomplete spinal cord injury (icSCI; C5-C7: age 39 ± 14 years) versus eight able-bodied males (CON: age 38 ± 13 years). Left ventricular (LV) diastolic indices included end-diastolic volume (EDV) and early diastolic filling ratio (EDFR). LV ejection time (LVET), inotropic index (dZ/dT2) and stroke volume (SV) were compared between the groups at peak exercise, and maximum workload for the icSCI group (isomax). RESULTS EDV (at peak exercise:131.4 ± 7.3 vs 188.78 ± 9.4, p < 0.001; at isomax: 131.4 ± 7.3 vs 169 ± 23, p = 0.0009) and EDFR (at peak exercise 73 ± 14% vs 119 ± 11%, p = 0.006; at isomax 94 ± 10; p = 0.009) were significantly reduced in icSCI compared to CON, respectively. Significant differences in LVET (icSCI: 273 ± 48 vs CON: 305 ± 68; p = 0.1) and dZ/dT2 (icSCI: 0.64 ± 0.11 vs CON: 0.85 ± 0.31; p = 0.1) were not observed at isomax, despite a significant decrease in SV in the subjects with icSCI (77.1 ± 6.05 mL vs 105.8 ± 9.2 mL, p < 0.00) CONCLUSION: Left ventricular filling was impaired in the subjects with icSCI as evidenced at both peak exercise and isomax. It is likely that restrictions on the skeletal muscle pump mechanized the impairment but increased left ventricular wall stiffness could not be excluded as a mediator.
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Affiliation(s)
- Monira I Aldhahi
- Department of Rehabilitation Science, George Mason University, 4400 University Drive, Fairfax, VA, 22030, USA
- Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, Kingdom of Saudi Arabia
| | - Andrew A Guccione
- Department of Rehabilitation Science, George Mason University, 4400 University Drive, Fairfax, VA, 22030, USA
| | - Lisa M K Chin
- Rehabilitation Medicine Department, National Institutes of Health, Bethesda, MD, USA
| | | | - Randall E Keyser
- Department of Rehabilitation Science, George Mason University, 4400 University Drive, Fairfax, VA, 22030, USA.
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Bogui P, Balayssac-Siransy E, Connes P, Tuo N, Ouattara S, Pichon A, Dah CS. The PhysioFlow thoracic impedancemeter is not valid for the measurements of cardiac hemodynamic parameters in chronic anemic patients. PLoS One 2013; 8:e79086. [PMID: 24167637 PMCID: PMC3805528 DOI: 10.1371/journal.pone.0079086] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Accepted: 09/26/2013] [Indexed: 11/18/2022] Open
Abstract
The aim of the present study was to test the validity of the transthoracic electrical bioimpedance method PhysioFlow® to measure stroke volume in patients with chronic anemia. Stroke volume index (SVI), as well as cardiac index (CI) obtained by transthoracic electrical bioimpedance method and doppler echocardiography were compared in healthy subjects (n = 25) and patients with chronic anemia (i.e. mainly with sickle cell anemia; n = 32), at rest. While doppler echocardiography was able to detect difference in SVI between the two populations, the Physioflow® failed to detect any difference. Bland & Altman analyses have demonstrated no interchangeability between the two methods to assess CI and SVI in anemic patients and healthy subjects. While doppler echocardiography displayed a good concordance for SVI results with those obtained in the literature for anemic patients, the Physioflow® did not. Finally, in contrast to doppler echocardiography: 1) the CI obtained with the Physioflow® was not correlated with the hemoglobin level and 2) the stroke volume determined by the Physioflow® was highly influenced by body surface area. In conclusion, our findings indicate that the Physioflow® device is inaccurate for the measurement of SVI and CI in patients with chronic anemia and has a poor accuracy for the measurement of these parameters in African healthy subjects.
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Affiliation(s)
- Pascal Bogui
- Laboratoire de Physiologie et d’Explorations Fonctionnelles, Unité de Formation et de Recherche en Sciences Médicales, Université Félix Houphouët Boigny, Abidjan, Côte d’Ivoire
- Service des explorations fonctionnelles et endoscopiques, Centre hospitalier universitaire de Yopougon, Abidjan, Côte d’Ivoire
- * E-mail:
| | - Edwige Balayssac-Siransy
- Laboratoire de Physiologie et d’Explorations Fonctionnelles, Unité de Formation et de Recherche en Sciences Médicales, Université Félix Houphouët Boigny, Abidjan, Côte d’Ivoire
- Service des explorations fonctionnelles et endoscopiques, Centre hospitalier universitaire de Yopougon, Abidjan, Côte d’Ivoire
| | - Philippe Connes
- UMR Inserm 665, Université des Antilles et de la Guyane, Pointe-à-Pitre, Guadeloupe
- Laboratoire ACTES (EA 3596), Département de Physiologie, Université des Antilles et de la Guyane, Pointe-à-Pitre, Guadeloupe
- Laboratory of Excellence GR-Ex « The red cell: from genesis to death », PRES Sorbonne, Paris, France
| | - Nalourgo Tuo
- Laboratoire de Physiologie et d’Explorations Fonctionnelles, Unité de Formation et de Recherche en Sciences Médicales, Université Félix Houphouët Boigny, Abidjan, Côte d’Ivoire
- Service des explorations fonctionnelles et endoscopiques, Centre hospitalier universitaire de Yopougon, Abidjan, Côte d’Ivoire
| | - Soualiho Ouattara
- Laboratoire de Physiologie et d’Explorations Fonctionnelles, Unité de Formation et de Recherche en Sciences Médicales, Université Félix Houphouët Boigny, Abidjan, Côte d’Ivoire
- Service des explorations fonctionnelles et endoscopiques, Centre hospitalier universitaire de Yopougon, Abidjan, Côte d’Ivoire
| | - Aurélien Pichon
- Laboratory of Excellence GR-Ex « The red cell: from genesis to death », PRES Sorbonne, Paris, France
- Laboratoire «Réponses cellulaires et fonctionnelles à l'hypoxie» EA2363, Université Paris 13 - PRES Sorbonne Paris Cité, Bobigny, France
| | - Cyrille Serges Dah
- Laboratoire de Physiologie et d’Explorations Fonctionnelles, Unité de Formation et de Recherche en Sciences Médicales, Université Félix Houphouët Boigny, Abidjan, Côte d’Ivoire
- Service des explorations fonctionnelles respiratoires, Centre hospitalier universitaire de Cocody, Abidjan, Côte d’Ivoire
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Moertl MG, Schlembach D, Papousek I, Hinghofer-Szalkay H, Weiss EM, Lang U, Lackner HK. Hemodynamic evaluation in pregnancy: limitations of impedance cardiography. Physiol Meas 2012; 33:1015-26. [DOI: 10.1088/0967-3334/33/6/1015] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Tsen LC. Neuraxial techniques for labor analgesia should be placed in the lateral position. Int J Obstet Anesth 2008; 17:146-9. [DOI: 10.1016/j.ijoa.2007.11.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2007] [Indexed: 10/22/2022]
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Nowak L, Nowak FG, Janko S, Dorwarth U, Hoffmann E, Botzenhardt F. Investigation of Various Types of Neurocardiogenic Response to Head-Up Tilting by Extended Hemodynamic and Neurohumoral Monitoring. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2007; 30:623-30. [PMID: 17461872 DOI: 10.1111/j.1540-8159.2007.00723.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The pathophysiology of neurocardiogenic syncope is heterogeneous. This study aim was to analyze whether extended monitoring during tilt-table testing provided additional information on the hemodynamic and vegetative state prior to neurocardiogenic syncope. METHODS This retrospective analysis is based on data of head-up tilt-table testing of 40 unselected consecutive patients with a history of unexplained syncope. For optimized characterization of the type of syncope, monitoring included electrocardiogram (ECG), blood pressure measurements and cardiac output, peripheral vascular resistance and contractility index measurements by impedance cardiography, as well as epinephrine and norepinephrine plasma levels in supine position and every 5 min during tilting. RESULTS Seven of 40 patients were unsuitable for analysis because of incomplete data sets. Tilt-table was positive in 26 patients, negative in 7. Groups did not differ in hemodynamic and catecholaminergic parameters at baseline. Responses to tilting were VASIS 1 (mix of cardioinhibitory and vasodepressor) in 5 patients, VASIS 2B (cardioinhibitory with asystole >3 sec) in 3, VASIS 3 (vasodepressor) in 16, orthostatic dysregulation in 2. In VASIS 1, the catecholamine measurement 4 min before syncope showed a proportionally larger increase of the epinephrine level than of norepinephrine. This disproportion was not observed in VASIS 2B and 3. In VASIS 2B, strong vasoconstriction and negative inotropy were evident in the presyncopal period. In VASIS 3, vascular resistance decreased continuously before syncope, while contractility index increased inadequately. Presyncopal epinephrine surge or norepinephrine loss was not observed in this group, suspecting other vasodilating factors. CONCLUSIONS Extended monitoring by impedance cardiography and plasma catecholamine measurements during tilt-table testing gave further insight into different hemodynamic and neurohumoral presyncopal patterns among the various types of neurocardiogenic syncope and may thereby help to develop individualized therapeutic concepts.
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Affiliation(s)
- Lorenz Nowak
- Staedtisches Klinikum Muenchen GmbH, Klinikum Bogenhausen, Department of Cardiology and Intensive Care Unit, Munich, Germany.
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Oginosawa Y, Abe H, Yasumasu T, Tsurugi T, Kohno R. Comparison of the effects of VVI versus DDD pacing on cardiac baroreflex function. J Cardiovasc Electrophysiol 2006; 17:526-31. [PMID: 16684027 DOI: 10.1111/j.1540-8167.2006.00363.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Conventional baroreceptor-heart rate (HR) reflex sensitivity cannot be examined in chronotropically incompetent patients or in pacemaker recipients. However, cardiac baroreceptor reflex sensitivity (BRS)-stroke volume (SV), which is closely and linearly correlated with BRS-HR, may be an alternative in that population. The aim of this study was to compare the BRS-SV in pacemaker recipients with a fixed HR paced in VVI versus DDD modes in the supine and upright positions. METHODS The pacing mode was set randomly to DDD or VVI with complete atrial and/or ventricular capture, then crossed over to the alternate mode in 9 recipients of dual-chamber pacemakers with atrioventricular (AV) block. Beat-to-beat mean blood pressure and SV were measured in the supine and upright positions, using a tilt table. The BRS-SV, expressed in %/mmHg, was the ratio of low-frequency (LF) power to total power (TP) of SV variability, measured by spectral analysis of spontaneous variations in mean blood pressure and SV. RESULTS BRS-SV was significantly lower in the VVI than in the DDD mode in the supine (37.2 +/- 26.7 vs 14.5 +/- 7.7%/mmHg) and upright (22.9 +/- 16.9 vs 10.6 +/- 6.6%/mmHg) positions (P < 0.05 for both comparisons). CONCLUSIONS VVI pacing is adverse from the standpoint of cardiac autonomic baroreflex function. A decreased BRS-SV may be one of the factors involved in the hemodynamic intolerance associated with VVI pacing.
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Affiliation(s)
- Yasushi Oginosawa
- Second Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
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Mitro P, Hijová E. Myocardial Contractility and Cardiac Filling Measured by Impedance Cardiography in Patients with Nitroglycerine-Induced Vasovagal Syncope. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2006; 29:1-8. [PMID: 16441710 DOI: 10.1111/j.1540-8159.2006.00299.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Increased myocardial contractility and inadequate cardiac filling leading to activation of the Bezold-Jarisch reflex were proposed as possible triggering mechanisms of vasovagal syncope (VVS). In the present study noninvasive hemodynamic measurements were performed in order to examine the role of myocardial contractility and cardiac filling in pathogenesis of VVS. METHODS Hemodynamic parameters were measured during head-up tilt test (HUT) by impedance cardiography in 46 patients with unexplained syncope. Myocardial contractility was measured as index of contractility (IC), acceleration index (ACI), and ejection fraction (EF). Afterload was measured as systemic vascular resistance index (SVRI) and preload was expressed as end-diastolic index (EDI). Serial measurements were done 1 minute before HUT, during HUT at 1-minute intervals, and 1 minute after completion of HUT. RESULTS HUT was positive in 30 patients (10 men, 20 women, mean age 36 +/- 16 years) and negative in 16 patients (8 men, 8 women, mean age 31 +/- 14 years). No significant differences were observed between HUT(+) and HUT(-) groups in hemodynamic parameters at supine rest and during HUT until the development of syncope. SVRI was lower in HUT(+) than in HUT(-) group at syncope (122.7 + 66.3 vs 185.6 + 51.4 dyn sec cm(-5)/m2, P = 0.002) and after syncope (117.0 + 61.1 vs 198.0 + 95.7 dyn sec cm(-5)/m2, P = 0.007). ACI, IC, EF, and EDI did not differ between groups at syncope. After syncope EF was higher in HUT(+) group compared to HUT(-) group (59.2 + 6.1 vs 52.7 + 9.4%, P = 0.02). CONCLUSION The role of increased myocardial contractility and decreased cardiac filling is not confirmed in the present study.
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Affiliation(s)
- Peter Mitro
- Third Clinic of Internal Medicine, Kossice, Slovakia.
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Levy RJ, Chiavacci RM, Nicolson SC, Rome JJ, Lin RJ, Helfaer MA, Nadkarni VM. An evaluation of a noninvasive cardiac output measurement using partial carbon dioxide rebreathing in children. Anesth Analg 2004; 99:1642-1647. [PMID: 15562047 DOI: 10.1213/01.ane.0000136952.85278.99] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Cardiac output (CO) is an important hemodynamic measure that helps to guide the therapy of critically ill patients. Invasive CO assessment in infants and children is often avoided because of the inherent risks. A noninvasive CO monitor that uses partial rebreathing has been recently developed to determine CO via the Fick principle for carbon dioxide. There have been no clinical studies confirming its accuracy in pediatric patients. This is a prospective observational study of 37 children <12 yr of age who underwent cardiac catheterization. Under general anesthesia via an endotracheal tube without a leak, we made multiple CO measurements using thermodilution and compared them with noninvasively determined CO measurements. Paired measurements were analyzed for bias, precision, and correlation via Bland-Altman plot and linear regression. Noninvasive measurements showed a linear correlation with thermodilution CO assessment with an r value of 0.83 (P < 0.03). Bland-Altman analysis yielded a bias of -0.27 L/min and a precision +/-1.49 L/min. Cardiac index measurements demonstrated a decreased r value of 0.67 (P = 0.15) and a bias of -0.18 L . min(-1) . m(-2) and precision of +/-2.13 L . min(-1) . m(-2). Differences between partial rebreathing measurements and thermodilution measurements were largest in children with a body surface area of </=0.6 m(2) ventilated with tidal volumes <300 mL. Based on these findings, noninvasive CO measurement using partial rebreathing may be clinically acceptable in children with >0.6 m(2) body surface area and >300 mL tidal volume.
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Affiliation(s)
- Richard J Levy
- *Department of Anesthesiology and Critical Care Medicine; and †Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Kabal J, Lagerman BK. A novel approach to measure cardiac output noninvasively: a comparison with the thermodilution method on critical care patients. J Clin Monit Comput 2004; 18:189-97. [PMID: 15562985 DOI: 10.1023/b:jocm.0000042917.59182.c5] [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: 11/12/2022]
Abstract
OBJECTIVE To compare the accuracy and reliability of cardiac output (CO) measurement by a Noninvasive Hemodynamic Analyzer (NHA) to the thermodilution cardiac output (COTD) technique in ICU patients of cardiac condition. METHOD ICU retrospective data collected in a 700-bed university-affiliated regional medical center. The data results from 203 patients who required invasive hemodynamic monitoring for clinical and/or surgical management. RESULTS The ranges of the two CO measurements were: CO(TD) = 2.06 to 8.8 l/min and CO(NHA) = 2.06 to 8.46 l/min, respectively. The Mean and SD of CO(NHA) = 4.819 l/min +/- 1.053 was near to CO(TD) = 4.902 l/min +/- 1.421. Variance was better for CO(NHA) = 1.110 l/min compared to CO(TD) = 1.421 l/min. Median of CO(NHA) showed 4.813 l/min and CO(TD) = 4.660 l/min. Bias was 0.083 l/min with 95% Confidence Interval (Precision): -0.26 to 0.040, and 95% Limits of Agreement was between -1.661 to 1.827 l/min. CONCLUSIONS The results of this retrospective study indicate that the CO(NHA) technique may be a promising screening method. Additional studies are needed to explore its diagnostic trending capability. This noninvasive CO technique has been proven to be clinically accurate and may be applicable for telemedicine applications.
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Affiliation(s)
- John Kabal
- Reston Noninvasive Hemodynamic Center 1712 Clubhouse Road, Suite 103 Reston, Virginia 20190, USA
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Leslie SJ, McKee S, Newby DE, Webb DJ, Denvir MA. Non-invasive measurement of cardiac output in patients with chronic heart failure. Blood Press Monit 2004; 9:277-80. [PMID: 15472501 DOI: 10.1097/00126097-200410000-00008] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The measurement of cardiac output by thoracic bioimpedance has been previously assessed in several studies. However, there continues to be disagreement as to whether this technique is sufficiently accurate for use in clinical practice or research. The current study aimed to compare thoracic bioimpedance (COTB) with thermodilution (COTD) in patients with stable chronic heart failure. METHODS AND RESULTS A total of 282 paired measurements of cardiac output from 11 patients were analysed. There was good correlation between COTB and COTD (r=0.76, P<0.0001). However, Bland-Altman analysis revealed an average difference between values of 0.3 (2.2) l/min (P=0.02), suggesting a small average bias but marked variability in results. There was no significant correlation when results were expressed as percentage change from baseline and a significant average difference between values of 10.1 (30.1)%. There was no difference in between-day repeatability between thermodilution and thoracic bioimpedance [-0.2 (1.2) versus 0.1 (1.0) l/min, P=0.7]. CONCLUSIONS This study demonstrates a correlation between the techniques but shows a poor level of agreement. The method of COTB underestimated cardiac output compared with COTD, and this difference appeared greater with higher cardiac outputs. Agreement was worse when results were expressed as change from baseline. The present study does not support the use of thoracic bioimpedance in its current form as an alternative to thermodilution in stable patients with chronic heart failure.
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Affiliation(s)
- Stephen J Leslie
- Department of Medical Sciences, The University of Edinburgh, Western General Hospital, Edinburgh EH4 2XU, Scotland, UK.
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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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Cooke CR, Wall BM, Huch KM, Mangold T. Cardiovascular effects of vasopressin following V(1) receptor blockade compared to effects of nitroglycerin. Am J Physiol Regul Integr Comp Physiol 2001; 281:R887-93. [PMID: 11507005 DOI: 10.1152/ajpregu.2001.281.3.r887] [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: 11/22/2022]
Abstract
Studies to more clearly determine the mechanisms associated with arginine vasopressin (AVP)-induced vasodilation were performed in normal subjects and in quadriplegic subjects with impaired efferent sympathetic responses. Studies to compare the effects of AVP with the hemodynamic effects of nitroglycerin, an agent that primarily affects venous capacitance vessels, were also performed in normal subjects. Incremental infusions of AVP following V(1)-receptor blockade resulted in equivalent reductions in systemic vascular resistance (SVRI) in normal and in quadriplegic subjects. However, there were major differences in the effect on mean arterial pressure (MAP), which was reduced in quadriplegic subjects but did not change in normal subjects. This difference in MAP can be attributed to a difference in the magnitude of increase in cardiac output (CI), which was twofold greater in normal than in quadriplegic subjects. These observations are consistent with AVP-induced vasodilation of arterial resistance vessels with reflex sympathetic enhancement of CI and are clearly different from the hemodynamic effects of nitroglycerin, i.e., reductions in MAP, CI, and indexes of cardiac preload, with only minor changes in SVRI.
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Affiliation(s)
- C R Cooke
- Nephrology Section (111 B), Department of Medicine, Veterans Affairs Medical Center, 1030 Jefferson Ave., Memphis, TN 38104, USA.
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Affiliation(s)
- M Singer
- UCL Medical School, Department of Medicine, London, UK.
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