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Minten L, Bennett J, McCutcheon K, Oosterlinck W, Algoet M, Otsuki H, Takahashi K, Fearon WF, Dubois C. Optimization of Absolute Coronary Blood Flow Measurements to Assess Microvascular Function: In Vivo Validation of Hyperemia and Higher Infusion Speeds. Circ Cardiovasc Interv 2024:e013860. [PMID: 38682331 DOI: 10.1161/circinterventions.123.013860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 03/15/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Reliable assessment of coronary microvascular function is essential. Techniques to measure absolute coronary blood flow are promising but need validation. The objectives of this study were: first, to validate the potential of saline infusion to generate maximum hyperemia in vivo. Second, to validate absolute coronary blood flow measured with continuous coronary thermodilution at high (40-50 mL/min) infusion speeds and asses its safety. METHODS Fourteen closed-chest sheep underwent absolute coronary blood flow measurements with increasing saline infusion speeds at different dosages under general anesthesia. An additional 7 open-chest sheep underwent these measurements with epicardial Doppler flow probes. Coronary flows were compared with reactive hyperemia after 45 s of coronary occlusion. RESULTS Twenty milliliters per minute of saline infusion induced a significantly lower hyperemic coronary flow (140 versus 191 mL/min; P=0.0165), lower coronary flow reserve (1.82 versus 3.21; P≤0.0001), and higher coronary resistance (655 versus 422 woods units; P=0.0053) than coronary occlusion. On the other hand, 30 mL/min of saline infusion resulted in hyperemic coronary flow (196 versus 192 mL/min; P=0.8292), coronary flow reserve (2.77 versus 3.21; P=0.1107), and coronary resistance (415 versus 422 woods units; P=0.9181) that were not different from coronary occlusion. Hyperemic coronary flow was 40.7% with 5 mL/min, 40.8% with 10 mL/min, 73.1% with 20 mL/min, 102.3% with 30 mL/min, 99.0% with 40 mL/min, and 98.0% with 50 mL/min of saline infusion when compared with postocclusive hyperemic flow. There was a significant bias toward flow overestimation (Bland-Altman: bias±SD, -73.09±30.52; 95% limits of agreement, -132.9 to -13.27) with 40 to 50 mL/min of saline. Occasionally, ischemic changes resulted in ventricular fibrillation (9.5% with 50 mL/min) at higher infusion rates. CONCLUSIONS Continuous saline infusion of 30 mL/min but not 20 mL/min induced maximal hyperemia. Absolute coronary blood flow measured with saline infusion speeds of 40 to 50 mL/min was not accurate and not safe.
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Affiliation(s)
- Lennert Minten
- Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Belgium (L.M., J.B., K.M.C., W.O., M.A., C.D.)
- Division of Cardiovascular Medicine, Stanford University, CA (L.M., H.O., K.T., W.F.F.)
| | - Johan Bennett
- Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Belgium (L.M., J.B., K.M.C., W.O., M.A., C.D.)
- Departments of Cardiovascular Medicine, UZ Leuven, Belgium. (J.B., C.D.)
| | - Keir McCutcheon
- Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Belgium (L.M., J.B., K.M.C., W.O., M.A., C.D.)
| | - Wouter Oosterlinck
- Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Belgium (L.M., J.B., K.M.C., W.O., M.A., C.D.)
- Cardiac Surgery, UZ Leuven, Belgium. (W.O., M.A.)
| | - Michiel Algoet
- Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Belgium (L.M., J.B., K.M.C., W.O., M.A., C.D.)
- Cardiac Surgery, UZ Leuven, Belgium. (W.O., M.A.)
| | - Hisao Otsuki
- Division of Cardiovascular Medicine, Stanford University, CA (L.M., H.O., K.T., W.F.F.)
| | - Kuniaki Takahashi
- Division of Cardiovascular Medicine, Stanford University, CA (L.M., H.O., K.T., W.F.F.)
| | - William F Fearon
- Division of Cardiovascular Medicine, Stanford University, CA (L.M., H.O., K.T., W.F.F.)
- VA Palo Alto Health Care System, CA (W.F.F.)
| | - Christophe Dubois
- Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Belgium (L.M., J.B., K.M.C., W.O., M.A., C.D.)
- Departments of Cardiovascular Medicine, UZ Leuven, Belgium. (J.B., C.D.)
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Zersen KM, Griffenhagen GM, Monnet EL. The Edwards Acumen IQ system using peripheral arterial catheter-based waveforms to estimate cardiac output is not accurate as compared to thermodilution in dogs. Am J Vet Res 2024; 85:ajvr.23.11.0249. [PMID: 38335725 DOI: 10.2460/ajvr.23.11.0249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 01/24/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVE To assess the agreement between cardiac output (CO) estimated via evaluation of the arterial pressure waveform by a novel monitoring system (Edwards Acumen IQ sensor and HemoSphere Advanced Monitor Platform [HS-IQ]; Edwards LifeSciences) and measured by thermodilution (TD) in anesthetized, normovolemic, and hypovolemic dogs. To assess the agreement between the HS-IQ CO measurements in the radial artery and dorsal metatarsal artery. ANIMALS 8 purpose-bred Beagles. METHODS Dogs were placed under general anesthesia. CO was measured via TD and via the HS-IQ at radial and dorsal metatarsal arterial catheters. CO measurements were obtained at 4 time points including normovolemic and multiple hypovolemic states. Paired measurements of CO were evaluated via the method of Bland and Altman with acceptable limits of agreement (LOA) defined as < 30%. RESULTS A total of 24 (dorsal metatarsal) and 21 (radial) paired measurements were collected in 8 dogs. The overall bias (CI) for comparison of TD to radial arterial HS-IQ CO measurements was -0.09 L/min. LOA and proportional LOA were -2.66 to 2.49 L/min and -140.72% to 104.94%. The overall bias (CI) for comparison of TD to dorsal metatarsal arterial HS-IQ CO measurements was -0.26 L/min. LOA and proportional LOA were -2.76 to 2.24 L/min and -135.96% to 93.25%. The overall proportional error for radial arterial was -17.9% and for dorsal metatarsal was -21.4%. CLINICAL RELEVANCE CO measurements with the HS-IQ were easy to obtain but did not produce results within a clinically acceptable range for either measurement site, with a very wide LOA. The CO estimations from the HS-IQ are not appropriate for clinical use at this time.
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Schurr JW, Genuardi MV. Direct VO 2 Measurement: Getting the Fick Right for Heart Transplant Eligibility. Circ Heart Fail 2024; 17:e011214. [PMID: 38073555 DOI: 10.1161/circheartfailure.123.011214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Affiliation(s)
- James W Schurr
- Division of Cardiology, Department of Medicine, Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia
| | - Michael V Genuardi
- Division of Cardiology, Department of Medicine, Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia
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Tebaldi M, Campo G, Ugo F, Guarracini S, Marrone A, Clò S, Abdirashid M, Di Mauro M, Rametta F, Di Marco M, Cocco M, Marchini F, Penzo C, Erriquez A, Banai S, Biscaglia S. Coronary Sinus Narrowing Improves Coronary Microcirculation Function in Patients With Refractory Angina: A Multicenter Prospective INROAD Study. Circ Cardiovasc Interv 2024; 17:e013481. [PMID: 38227697 DOI: 10.1161/circinterventions.123.013481] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/10/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND The underlying mechanisms responsible for the clinical benefits following coronary sinus narrowing and pressure elevation remain unclear. The present study aims to investigate whether coronary sinus narrowing improves the indexes of coronary microcirculatory function. METHODS Patients with refractory angina who had a clinical indication for reducer implantation underwent invasive physiological assessments before and 4 months after the procedure. The primary outcome was the change in the values of the index of microcirculatory resistance. Secondary end points included changes in coronary flow reserve and the resistive resistance ratio values. Angina status was assessed with the Canadian Cardiology Society class and the Seattle Angina Questionnaire. RESULTS Twenty-four patients with a history of obstructive coronary artery disease and prior coronary revascularization (surgical and percutaneous) treated with reducer implantation were enrolled, and 21 of them (87%) underwent repeated invasive coronary physiological assessment after 4 months. The index of microcirculatory resistance values decreased from 33.35±19.88 at baseline to 15.42±11.36 at 4-month follow-up (P<0.001; mean difference, -17.90 [95% CI, -26.16 to -9.64]). A significant (≥20% from baseline) reduction of the index of microcirculatory resistance was observed in 15 (71.4% [95% CI, 47.8%-88.7%]) patients. The number of patients with abnormal index of microcirculatory resistance (≥25) decreased from 12 (57%) to 4 (19%; P=0.016). Coronary flow reserve increased from 2.46±1.52 to 4.20±2.52 (mean difference, 1.73 [95% CI, 0.51-2.96]). Similar findings were observed for resistive resistance ratio values. Overall, 16 patients (76.1%) had an improvement of 1 Canadian Cardiology Society class. Seattle Angina Questionnaire summary score increase of around 3 points (3.01 [95% CI, 1.39-4.61]). CONCLUSIONS Coronary sinus reduction implantation is associated with a significant improvement in the parameters of coronary microcirculatory function. These findings provide insights into the improvement of angina symptoms and may have implications for the treatment of coronary microvascular dysfunction. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT05174572.
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Affiliation(s)
- Matteo Tebaldi
- Cardiology Unit, Ospedale degli Infermi, Faenza (RA), Italy (M.T.)
| | - Gianluca Campo
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona, Italy (G.C., A.M., S.C., M.C., F.M., C.P., A.E., S.B.)
| | - Fabrizio Ugo
- Cardiology Unit, Ospedale S. Andrea, Vercelli, VC, Italy (F.U., M.A., F.R.)
| | | | - Andrea Marrone
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona, Italy (G.C., A.M., S.C., M.C., F.M., C.P., A.E., S.B.)
| | - Stefano Clò
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona, Italy (G.C., A.M., S.C., M.C., F.M., C.P., A.E., S.B.)
| | - Mohamed Abdirashid
- Cardiology Unit, Ospedale S. Andrea, Vercelli, VC, Italy (F.U., M.A., F.R.)
| | - Michele Di Mauro
- Cardiology Unit, Casa di Cura Pierangeli, Pescara, Italy (S.G., M.D.M.)
| | - Francesco Rametta
- Cardiology Unit, Ospedale S. Andrea, Vercelli, VC, Italy (F.U., M.A., F.R.)
| | - Massimo Di Marco
- Cardiology Unit, Ospedale Santo Spirito, Pescara, Italy (M. Di Marco)
| | - Marta Cocco
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona, Italy (G.C., A.M., S.C., M.C., F.M., C.P., A.E., S.B.)
| | - Federico Marchini
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona, Italy (G.C., A.M., S.C., M.C., F.M., C.P., A.E., S.B.)
| | - Carlo Penzo
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona, Italy (G.C., A.M., S.C., M.C., F.M., C.P., A.E., S.B.)
| | - Andrea Erriquez
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona, Italy (G.C., A.M., S.C., M.C., F.M., C.P., A.E., S.B.)
| | - Shmuel Banai
- Division of Cardiology, Tel Aviv Medical Center, Israel (S. Banai)
| | - Simone Biscaglia
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona, Italy (G.C., A.M., S.C., M.C., F.M., C.P., A.E., S.B.)
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Heringlake M, Kouz K, Saugel B. A classification system for pulmonary artery catheters. Br J Anaesth 2023; 131:971-974. [PMID: 37714751 DOI: 10.1016/j.bja.2023.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 08/20/2023] [Accepted: 08/22/2023] [Indexed: 09/17/2023] Open
Abstract
Flow-directed, balloon-tipped pulmonary artery catheters allow measuring cardiac output and other haemodynamic variables including intracardiac pressures. We propose classifying pulmonary artery catheters by generations and specifying additional measurement modalities. Based on the method used to measure cardiac output, pulmonary artery catheters can be classified into three generations: first-generation using intermittent pulmonary artery thermodilution; second-generation using a thermal filament for automated pulmonary artery thermodilution; and third-generation combining thermal filament-based automated pulmonary artery thermodilution and pulmonary artery pulse wave analysis. Each of these pulmonary artery catheter generations can include additional measurements, such as continuous mixed venous oxygen saturation, right ventricular ejection fraction and end-diastolic volume, and right ventricular pressure. This classification should help define indications for pulmonary artery catheters in clinical practice and research.
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Affiliation(s)
- Matthias Heringlake
- Department of Anesthesiology and Intensive Care Medicine, Heart- and Diabetes Center Mecklenburg - Western Pomerania, Karlsburg Hospital, Karlsburg, Germany
| | - Karim Kouz
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Bernd Saugel
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA.
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Garcia-Garcia HM, De Maria GL. Bolus or Continuous Thermodilution: Which Is the Right Approach to Convert Assessment of CMD Into an "Atomic Habit"? JACC Cardiovasc Interv 2023; 16:2778-2781. [PMID: 38030362 DOI: 10.1016/j.jcin.2023.10.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 10/05/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023]
Affiliation(s)
| | - Giovanni Luigi De Maria
- Oxford Heart Centre, Oxford University Hospitals, National Health Service Trust, Oxford, United Kingdom; Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; National Institute for Health Research Oxford Biomedical Research Centre, Oxford, United Kingdom
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Aslam MI, Gruslova AB, Almomani A, Nolen D, Elliott JJ, Jani VP, Kottam A, Porterfield J, Heighten C, Anderson AS, Valvano JW, Feldman MD. Modification of a Transvalvular Microaxial Flow Pump for Instantaneous Determination of Native Cardiac Output and Volume. J Card Fail 2023; 29:1369-1379. [PMID: 37105397 DOI: 10.1016/j.cardfail.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 04/10/2023] [Accepted: 04/10/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND The current Impella cardiopulmonary (CP) pump, used for mechanical circulatory support in patients with cardiogenic shock (CS), cannot assess native cardiac output (CO) and left ventricular (LV) volumes. These data are valuable in facilitating device management and weaning. Admittance technology allows for accurate assessment of cardiac chamber volumes. OBJECTIVES This study tested the ability to engineer admittance electrodes onto an existing Impella CP pump to assess total and native CO as well as LV chamber volumes in an instantaneous manner. METHODS Impella CP pumps were fitted with 4 admittance electrodes and were placed in the LVs of adult swine (n = 9) that were subjected to 3 different hemodynamic conditions, including Impella CP speed adjustments, administration of escalating doses of dobutamine and microsphere injections into the left main artery to result in cardiac injury. CO, according to admittance electrodes, was calculated from LV volumes and heart rate. In addition, CO was calculated in each instance via thermodilution, continuous CO measurement, the Fick principle, and aortic velocity-time integral by means of echocardiography. RESULTS Modified Impella CP pumps were placed in swine LVs successfully. CO, as determined by admittance electrodes, was similar by trend to other methods of CO assessment. It was corrected for pump speed to calculate native CO, and calculated LV chamber volumes trended as expected in each experimental protocol. CONCLUSIONS We report, for the first time, that an Impella CP pump can be fitted with admittance electrodes and used to determine total and native CO in various hemodynamic situations. CONDENSED ABSTRACT Transvalvular mechanical circulatory support devices such as the Impella CP do not have the ability to provide real-time information on native cardiac output (CO) and left ventricular (LV) volumes. This information is critical in device management and in weaning in patients with cardiogenic shock. We demonstrate, for the first time, that Impella CP pumps coupled with admittance electrodes are able to determine native CO and LV chamber volumes in multiple hemodynamic situations such as Impella pump speed adjustments, escalating dobutamine administration and cardiac injury from microsphere injection.
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Affiliation(s)
- M Imran Aslam
- Department of Medicine, Division of Cardiology, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Aleksandra B Gruslova
- Department of Medicine, Division of Cardiology, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Ahmed Almomani
- Department of Medicine, Division of Cardiology, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Drew Nolen
- Department of Medicine, Division of Cardiology, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - James J Elliott
- Department of Laboratory Animal Resources, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Vivek P Jani
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Anil Kottam
- BridgeSource Medical Corporation, Austin, Texas
| | | | | | - Allen S Anderson
- Department of Medicine, Division of Cardiology, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Jonathan W Valvano
- Department of Electrical Engineering, University of Texas at Austin, Austin, Texas
| | - Marc D Feldman
- Department of Medicine, Division of Cardiology, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
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Sabbah M, Engstrøm T, Olsen NT, Lønborg J. Variation in left and right coronary artery physiology in patients with severe aortic stenosis. Front Cardiovasc Med 2023; 10:1227532. [PMID: 37600056 PMCID: PMC10435874 DOI: 10.3389/fcvm.2023.1227532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/17/2023] [Indexed: 08/22/2023] Open
Affiliation(s)
- Muhammad Sabbah
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Engstrøm
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Niels Thue Olsen
- Department of Cardiology, Copenhagen University Hospital—Herlev and Gentofte, Gentofte, Denmark
| | - Jacob Lønborg
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Genecand L, Simian G, Desponds R, Wacker J, Ulrich S, Lechartier B, Fellrath JM, Sitbon O, Beghetti M, Lador F. The Influence of Methods for Cardiac Output Determination on the Diagnosis of Precapillary Pulmonary Hypertension: A Mathematical Model. J Clin Med 2023; 12. [PMID: 36675338 DOI: 10.3390/jcm12020410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 12/26/2022] [Accepted: 12/29/2022] [Indexed: 01/06/2023] Open
Abstract
Background: precapillary pulmonary hypertension (PH, PcPH) is now defined as a mean pulmonary artery pressure (mPAP) > 20 mmHg, a pulmonary artery wedge pressure (PAWP) ≤ 15 mmHg and a pulmonary vascular resistance (PVR) > 2 WU. For PVR calculation, the measurement of cardiac output (CO) is necessary. It is generally measured using thermodilution. However, recent data showed that the agreement with direct Fick method, historically the gold standard, is less than previously reported. We aimed to create a mathematical model that calculated the probability of being classified differently (PcPH or unclassified PH) if CO measured by direct Fick was used instead of thermodilution for any individual patients with a mPAP > 20 mmHg and a PAWP ≤ 15 mmHg. Methods: The model is based on Bland and Altman analysis with a normally distributed difference of cardiac output, fixed 1.96 standard deviation of bias, bias and physiological cardiac output limits. Results: Following a literature review of the studies comparing CO measured with direct Fick and thermodilution, we fixed the 1.96 standard deviation of bias at 2 L/min, bias at 0 L/min and physiological resting CO limits between 1.3 L/min and 10.2 L/min. Conclusions: This model can help the clinician to evaluate the potential benefit of measuring CO using direct Fick during the diagnostic work-up and its utility in confirming or ruling out a diagnosis of PcPH in any given patient with a mPAP > 20 mmHg and a PAWP ≤ 15 mmHg.
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Oh C, Lee S, Oh P, Chung W, Ko Y, Yoon SH, Kim YH, Ji SM, Hong B. Comparison between Fourth-Generation FloTrac/Vigileo System and Continuous Thermodilution Technique for Cardiac Output Estimation after Time Adjustment during Off-Pump Coronary Artery Bypass Graft Surgery: A Retrospective Cohort Study. J Clin Med 2022; 11:jcm11206093. [PMID: 36294414 PMCID: PMC9605331 DOI: 10.3390/jcm11206093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/11/2022] [Accepted: 10/13/2022] [Indexed: 12/01/2022] Open
Abstract
(1) Background: Previous studies reported limited performance of arterial pressure waveform-based cardiac output (CO) estimation (FloTrac/Vigileo system; CO-FloTrac) compared with the intermittent thermodilution technique (COint). However, errors due to bolus maneuver and intermittent measurements of COint could limit its use as a reference. The continuous thermodilution technique (COcont) may relieve such limitations. (2) Methods: The performance of CO-FloTrac was retrospectively assessed using continuous recordings of intraoperative physiological data acquired from patients who underwent off-pump coronary artery bypass graft (OPCAB) surgery with CO monitoring using both CO-FloTrac and COcont. Optimal time adjustments between the two measurements were determined based on R-squared values. (3) Results: A total of 134.2 h of data from 30 patients was included in the final analysis. The mean bias was -0.94 (95% CI, -1.35 to -0.52) L/min and the limits of agreements were -3.64 (95% CI, -4.44 to -3.08) L/min and 1.77 (95% CI, 1.21 to 2.57) L/min. The percentage error was 66.1% (95% CI, 52.4 to 85.8%). Depending on the time scale and the size of the exclusion zone, concordance rates ranged from 61.0% to 75.0%. (4) Conclusion: Despite the time adjustments, CO-FloTrac showed non-negligible overestimation, clinically unacceptable precision, and poor trending ability during OPCAB surgery.
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Affiliation(s)
- Chahyun Oh
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon 35015, Korea
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon 34134, Korea
| | - Soomin Lee
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon 35015, Korea
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon 34134, Korea
| | - Pyeonghwa Oh
- Department of Anesthesiology and Pain Medicine, Dankook University Hospital, Cheonan 31116, Korea
| | - Woosuk Chung
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon 35015, Korea
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon 34134, Korea
| | - Youngkwon Ko
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon 35015, Korea
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon 34134, Korea
| | - Seok-Hwa Yoon
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon 35015, Korea
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon 34134, Korea
| | - Yoon-Hee Kim
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon 35015, Korea
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon 34134, Korea
| | - Sung-Mi Ji
- Department of Anesthesiology and Pain Medicine, Dankook University Hospital, Cheonan 31116, Korea
- Correspondence: (S.-M.J.); (B.H.)
| | - Boohwi Hong
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon 35015, Korea
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon 34134, Korea
- Big Data Center, Biomedical Research Institute, Chungnam National University Hospital, Daejeon 35015, Korea
- Correspondence: (S.-M.J.); (B.H.)
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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12
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Hamaya R, van de Hoef TP, Lee JM, Hoshino M, Kanaji Y, Murai T, Boerhout CKM, de Waard GA, Jung JH, Lee SH, Mejia Renteria H, Echavarria-Pinto M, Meuwissen M, Matsuo H, Madera-Cambero M, Eftekhari A, Effat MA, Marques K, Doh JH, Christiansen EH, Banerjee R, Nam CW, Niccoli G, Nakayama M, Tanaka N, Shin ES, Sasano T, Chamuleau SAJ, Knaapen P, Escaned J, Koo BK, Piek JJ, Kakuta T. Differential Impact of Coronary Revascularization on Long-Term Clinical Outcome According to Coronary Flow Characteristics: Analysis of the International ILIAS Registry. Circ Cardiovasc Interv 2022; 15:e011948. [PMID: 35603622 DOI: 10.1161/circinterventions.121.011948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Coronary pressure indices such as fractional flow reserve are the standard for guiding elective revascularization. However, considering additional coronary flow parameters could further individualize and optimize the decision on revascularization. We aimed to investigate the potentially differential prognostic associations of elective percutaneous coronary intervention (PCI) according to coronary flow properties represented by coronary flow reserve (CFR), coronary flow capacity (CFC), and baseline CFC (bCFC). METHODS From the ILIAS Registry (Inclusive Invasive Physiological Assessment in Angina Syndromes) composed of 16 hospitals globally from 7 countries, patients with obstructive coronary artery disease who underwent invasive coronary physiological assessment were included (N=2370 vessels). We assessed effect measure modifications of the association of PCI and 5-year target vessel failure according to CFR, CFC, and bCFC either assessed by Doppler-technique or thermodilution-method. RESULTS The mean age of the population was 63.3 years, and there were 1322 (73.6%) males. Median fractional flow reserve was 0.85, and PCI was performed in 600 (25.3%) vessels. Reduced CFR, CFC, and abnormal bCFC were defined in 988 (41.7%), 542 (22.9%), and 600 (25.3%) vessels, respectively. Significant effect measure modifications were observed by CFC either in odds ratio (P=0.0018), additive (P=0.029), and hazard ratio scale (P=0.0002). The absolute risk of 5-year target-vessel failure was higher if treated by PCI in vessels with normal CFC by 1.8 (-1.7 to 5.3) percent, while that was lower by -5.9 (-12 to -0.1) percent in those with reduced CFC. CFR and bCFC were not significant effect modifiers in any scales. Similar associations were observed in per-patient analyses, whereas the findings were less robust. CONCLUSIONS We observed qualitative effect measure modification of PCI and 5-year clinical outcomes according to CFC status in additive scale. CFR and bCFC were not robust effect modifiers. Therefore, CFC could be potentially used to optimize the patient selection for elective PCI treatment combined with fractional flow reserve.
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Affiliation(s)
- Rikuta Hamaya
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (R.H.).,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (R.H.)
| | - Tim P van de Hoef
- Department of Cardiology, Amsterdam UMC - location AMC, the Netherlands (T.P.v.d.H., C.K.M.B., S.A.J.C., J.J.P.).,Department of Cardiology, Amsterdam UMC - location VUmc, Amsterdam, the Netherlands (T.P.v.d.H., K.M., S.A.J.C., P.K.).,Department of Cardiology, NoordWest Ziekenhuisgroep, the Netherlands (T.P.v.d.H., G.A.d.W.)
| | - Joo Myung Lee
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Seoul, Republic of Korea (J.M.L.)
| | - Masahiro Hoshino
- Department of Cardiology, Tsuchiura Kyodo General Hospital, Japan (M.H., Y.K., T.K.)
| | - Yoshihisa Kanaji
- Department of Cardiology, Tsuchiura Kyodo General Hospital, Japan (M.H., Y.K., T.K.)
| | - Tadashi Murai
- Cardiovascular Center, Yokosuka Kyosai Hospital, Japan (T.M.)
| | - Coen K M Boerhout
- Department of Cardiology, Amsterdam UMC - location AMC, the Netherlands (T.P.v.d.H., C.K.M.B., S.A.J.C., J.J.P.)
| | - Guus A de Waard
- Department of Cardiology, NoordWest Ziekenhuisgroep, the Netherlands (T.P.v.d.H., G.A.d.W.)
| | - Ji-Hyun Jung
- Sejong General Hospital, Sejong Heart Institute, Bucheon, Korea (J.-H.J.)
| | - Seung Hun Lee
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea (S.H.L.)
| | - Hernan Mejia Renteria
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Spain (H.M.R., J.E.)
| | - Mauro Echavarria-Pinto
- Hospital General ISSSTE Querétaro - Facultad de Medicina, Universidad Autónoma de Querétaro, México (M.E.-P.)
| | - Martijn Meuwissen
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (R.H.)
| | - Hitoshi Matsuo
- Department of Cardiovascular Medicine, Gifu Heart Center, Japan (H.M., M.N.)
| | | | - Ashkan Eftekhari
- Department of Cardiology, Aarhus University Hospital, Denmark (A.E., E.H.C.)
| | - Mohamed A Effat
- Division of Cardiovascular Health and Diseases, Department of Internal Medicine (M.A.E.), University of Cincinnati, OH
| | - Koen Marques
- Department of Cardiology, Amsterdam UMC - location VUmc, Amsterdam, the Netherlands (T.P.v.d.H., K.M., S.A.J.C., P.K.)
| | - Joon-Hyung Doh
- Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, South Korea (J.-H.D.)
| | | | - Rupak Banerjee
- Mechanical and Materials Engineering Department (R.B.), University of Cincinnati, OH.,Research Services, Veteran Affairs Medical Center, Cincinnati, OH (R.B.)
| | - Chang-Wook Nam
- Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, South Korea (C.-W.N.)
| | - Giampaolo Niccoli
- Catholic University of the Sacred Heart, Department of Cardiovascular Medicine, Institute of Cardiology, Rome, Italy (G.N.)
| | - Masafumi Nakayama
- Department of Cardiovascular Medicine, Gifu Heart Center, Japan (H.M., M.N.).,Toda Central General Hospital, Cardiovascular Center, Japan (M.N.)
| | - Nobuhiro Tanaka
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Japan (N.T.)
| | - Eun-Seok Shin
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, South Korea (E.-S.S.)
| | - Tetsuo Sasano
- Department of Cardiology, Tokyo Medical and Dental University, Japan (T.S.)
| | - Steven A J Chamuleau
- Department of Cardiology, Amsterdam UMC - location AMC, the Netherlands (T.P.v.d.H., C.K.M.B., S.A.J.C., J.J.P.).,Department of Cardiology, Amsterdam UMC - location VUmc, Amsterdam, the Netherlands (T.P.v.d.H., K.M., S.A.J.C., P.K.)
| | - Paul Knaapen
- Department of Cardiology, Amsterdam UMC - location VUmc, Amsterdam, the Netherlands (T.P.v.d.H., K.M., S.A.J.C., P.K.)
| | - Javier Escaned
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Spain (H.M.R., J.E.)
| | - Bon Kwon Koo
- Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Republic of Korea (B.K.K.)
| | - Jan J Piek
- Department of Cardiology, Amsterdam UMC - location AMC, the Netherlands (T.P.v.d.H., C.K.M.B., S.A.J.C., J.J.P.)
| | - Tsunekazu Kakuta
- Department of Cardiology, Tsuchiura Kyodo General Hospital, Japan (M.H., Y.K., T.K.)
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13
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Koo BK, Yang S. Doppler vs Thermodilution for Coronary Flow Reserve: Does the End Justify the Means? JACC Cardiovasc Interv 2022; 15:1071-3. [PMID: 35589237 DOI: 10.1016/j.jcin.2022.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 04/08/2022] [Indexed: 11/15/2022]
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14
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Crowe LA, Genecand L, Hachulla AL, Noble S, Beghetti M, Vallée JP, Lador F. Non-Invasive Cardiac Output Determination Using Magnetic Resonance Imaging and Thermodilution in Pulmonary Hypertension. J Clin Med 2022; 11:2717. [PMID: 35628843 DOI: 10.3390/jcm11102717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 04/30/2022] [Accepted: 05/09/2022] [Indexed: 12/10/2022] Open
Abstract
Magnetic resonance imaging (MRI) can be used to measure cardiac output (CO) non-invasively, which is a paramount parameter in pulmonary hypertension (PH) patients. We retrospectively compared stroke volume (SV) obtained with MRI (SVMRI) in six localisations against SV measured with thermodilution (TD) (SVTD) and against each other in 24 patients evaluated in our PH centre using Bland and Altman (BA) agreement analyses, linear correlation, and intraclass correlation (ICC). None of the six tested localisations for SVMRI reached the predetermined criteria for interchangeability with SVTD, with two standard deviations (2SD) of bias between 24.1 mL/beat and 31.1 mL/beat. The SVMRI methods yielded better agreement when compared against each other than the comparison between SVMRI and SVTD, with the best 2SD of bias being 13.8 mL/beat. The inter-observer and intra-observer ICCs for COMRI were excellent (inter-observer ICC between 0.889 and 0.983 and intra-observer ICC between 0.991 and 0.999). We could not confirm the interchangeability of SVMRI with SVTD based on the predetermined interchangeability criteria. The lack of agreement between MRI and TD might be explained because TD is less precise than previously thought. We evaluated a new method to estimate CO through the pulmonary circulation (COp) in PH patients that may be more precise than the previously tested methods.
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15
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Russ M, Steiner E, Boemke W, Busch T, Melzer-Gartzke C, Taher M, Badulak J, Weber-Carstens S, Swenson ER, Francis RC, Pickerodt PA. Extracorporeal Membrane Oxygenation Blood Flow and Blood Recirculation Compromise Thermodilution-Based Measurements of Cardiac Output. ASAIO J 2022; 68:721-729. [PMID: 34860710 PMCID: PMC9067097 DOI: 10.1097/mat.0000000000001592] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The contribution of veno-venous (VV) extracorporeal membrane oxygenation (ECMO) to systemic oxygen delivery is determined by the ratio of total extracorporeal blood flow () to cardiac output (). Thermodilution-based measurements of may be compromised by blood recirculating through the ECMO (recirculation fraction; Rf). We measured the effects of and Rf on classic thermodilution-based measurements of in six anesthetized pigs. An ultrasound flow probe measured total aortic blood flow () at the aortic root. Rf was quantified with the ultrasound dilution technique. was set to 0-125% of and was measured using a pulmonary artery catheter (PAC) in healthy and lung injured animals. PAC overestimated () at all settings compared to . The mean bias between both methods was 2.1 L/min in healthy animals and 2.7 L/min after lung injury. The difference between and increased with an of 75-125%/ compared to QEC <50%/. Overestimation of was highest when resulted in a high Rf. Thus, thermodilution-based measurements can overestimate cardiac output during VV ECMO. The degree of overestimation of depends on the EC/ ratio and the recirculation fraction.
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Affiliation(s)
- Martin Russ
- From the Department of Anesthesiology and Intensive Care Medicine (CCM, CVK); Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Elvira Steiner
- From the Department of Anesthesiology and Intensive Care Medicine (CCM, CVK); Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Willehad Boemke
- From the Department of Anesthesiology and Intensive Care Medicine (CCM, CVK); Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Thilo Busch
- From the Department of Anesthesiology and Intensive Care Medicine (CCM, CVK); Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Christoph Melzer-Gartzke
- From the Department of Anesthesiology and Intensive Care Medicine (CCM, CVK); Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Mahdi Taher
- From the Department of Anesthesiology and Intensive Care Medicine (CCM, CVK); Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Jenelle Badulak
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, Washington
| | - Steffen Weber-Carstens
- From the Department of Anesthesiology and Intensive Care Medicine (CCM, CVK); Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Erik R. Swenson
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, Washington
- VA Puget Sound Health Care System, Seattle, Washington
| | - Roland C.E. Francis
- From the Department of Anesthesiology and Intensive Care Medicine (CCM, CVK); Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Philipp A. Pickerodt
- From the Department of Anesthesiology and Intensive Care Medicine (CCM, CVK); Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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16
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Sabbah M, Olsen NT, Minkkinen M, Holmvang L, Tilsted H, Pedersen F, Joshi FR, Ahtarovski K, Sørensen R, Linde JJ, Søndergaard L, Pijls N, Lønborg J, Engstrøm T. Microcirculatory Function in Nonhypertrophic and Hypertrophic Myocardium in Patients With Aortic Valve Stenosis. J Am Heart Assoc 2022; 11:e025381. [PMID: 35470693 PMCID: PMC9238586 DOI: 10.1161/jaha.122.025381] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Left ventricular hypertrophy (LVH) has often been supposed to be associated with abnormal myocardial blood flow and resistance. The aim of this study was to evaluate and quantify the physiological and pathological changes in myocardial blood flow and microcirculatory resistance in patients with and without LVH attributable to severe aortic stenosis. Methods and Results Absolute coronary blood flow and microvascular resistance were measured using a novel technique with continuous thermodilution and infusion of saline. In addition, myocardial mass was assessed with cardiac magnetic resonance imaging. Fifty-three patients with aortic valve stenosis were enrolled in the study. In 32 patients with LVH, hyperemic blood flow per gram of tissue was significantly decreased compared with 21 patients without LVH (1.26±0.48 versus 1.66±0.65 mL·min-1·g-1; P=0.018), whereas minimal resistance indexed for left ventricular mass was significantly increased in patients with LVH (63 [47-82] versus 43 [35-63] Wood Units·kg; P=0.014). Conclusions Patients with LVH attributable to severe aortic stenosis had lower hyperemic blood flow per gram of myocardium and higher minimal myocardial resistance compared with patients without LVH.
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Affiliation(s)
- Muhammad Sabbah
- Department of CardiologyCopenhagen University Hospital–RigshospitaletCopenhagenDenmark
| | - Niels Thue Olsen
- Department of CardiologyCopenhagen University Hospital–Herlev and GentofteGentofteDenmark
- Department of Clinical MedicineUniversity of CopenhagenDenmark
| | - Mikko Minkkinen
- Department of CardiologyCopenhagen University Hospital–RigshospitaletCopenhagenDenmark
| | - Lene Holmvang
- Department of CardiologyCopenhagen University Hospital–RigshospitaletCopenhagenDenmark
| | - Hans‐Henrik Tilsted
- Department of CardiologyCopenhagen University Hospital–RigshospitaletCopenhagenDenmark
| | - Frants Pedersen
- Department of CardiologyCopenhagen University Hospital–RigshospitaletCopenhagenDenmark
| | - Francis R. Joshi
- Department of CardiologyCopenhagen University Hospital–RigshospitaletCopenhagenDenmark
| | - Kiril Ahtarovski
- Department of CardiologyCopenhagen University Hospital–RigshospitaletCopenhagenDenmark
| | - Rikke Sørensen
- Department of CardiologyCopenhagen University Hospital–RigshospitaletCopenhagenDenmark
| | - Jesper James Linde
- Department of CardiologyCopenhagen University Hospital–RigshospitaletCopenhagenDenmark
| | - Lars Søndergaard
- Department of CardiologyCopenhagen University Hospital–RigshospitaletCopenhagenDenmark
- Department of Clinical MedicineUniversity of CopenhagenDenmark
| | - Nico Pijls
- Department of CardiologyCatharina HospitalEindhoventhe Netherlands
| | - Jacob Lønborg
- Department of CardiologyCopenhagen University Hospital–RigshospitaletCopenhagenDenmark
| | - Thomas Engstrøm
- Department of CardiologyCopenhagen University Hospital–RigshospitaletCopenhagenDenmark
- Department of Clinical MedicineUniversity of CopenhagenDenmark
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17
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Konstantinou K, Keeble TR, Davies JR, Gamma RA, Tang KH, Alsanjari O, Kelly PA, Clesham GJ, Karamasis GV. Discordance Between Coronary Flow Reserve and the Index of Microcirculatory Resistance Post-Revascularization for ST-Segment-Elevation Myocardial Infarction. Circ Cardiovasc Interv 2021; 14:e010529. [PMID: 34749517 DOI: 10.1161/circinterventions.121.010529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Klio Konstantinou
- Department of Cardiology, Essex Cardiothoracic Centre, Basildon, United Kingdom (K.K., T.R.K., J.R.D., R.A.G., K.H.T., O.A., P.A.K., G.J.C., G.V.K.).,School of Medicine, Anglia Ruskin University, United Kingdom (K.K., T.R.K., O.A., G.J.C., G.V.K.)
| | - Thomas R Keeble
- Department of Cardiology, Essex Cardiothoracic Centre, Basildon, United Kingdom (K.K., T.R.K., J.R.D., R.A.G., K.H.T., O.A., P.A.K., G.J.C., G.V.K.).,School of Medicine, Anglia Ruskin University, United Kingdom (K.K., T.R.K., O.A., G.J.C., G.V.K.)
| | - John R Davies
- Department of Cardiology, Essex Cardiothoracic Centre, Basildon, United Kingdom (K.K., T.R.K., J.R.D., R.A.G., K.H.T., O.A., P.A.K., G.J.C., G.V.K.)
| | - Reto A Gamma
- Department of Cardiology, Essex Cardiothoracic Centre, Basildon, United Kingdom (K.K., T.R.K., J.R.D., R.A.G., K.H.T., O.A., P.A.K., G.J.C., G.V.K.)
| | - Kare H Tang
- Department of Cardiology, Essex Cardiothoracic Centre, Basildon, United Kingdom (K.K., T.R.K., J.R.D., R.A.G., K.H.T., O.A., P.A.K., G.J.C., G.V.K.)
| | - Osama Alsanjari
- Department of Cardiology, Essex Cardiothoracic Centre, Basildon, United Kingdom (K.K., T.R.K., J.R.D., R.A.G., K.H.T., O.A., P.A.K., G.J.C., G.V.K.).,School of Medicine, Anglia Ruskin University, United Kingdom (K.K., T.R.K., O.A., G.J.C., G.V.K.)
| | - Paul A Kelly
- Department of Cardiology, Essex Cardiothoracic Centre, Basildon, United Kingdom (K.K., T.R.K., J.R.D., R.A.G., K.H.T., O.A., P.A.K., G.J.C., G.V.K.)
| | - Gerald J Clesham
- Department of Cardiology, Essex Cardiothoracic Centre, Basildon, United Kingdom (K.K., T.R.K., J.R.D., R.A.G., K.H.T., O.A., P.A.K., G.J.C., G.V.K.).,School of Medicine, Anglia Ruskin University, United Kingdom (K.K., T.R.K., O.A., G.J.C., G.V.K.)
| | - Grigoris V Karamasis
- Department of Cardiology, Essex Cardiothoracic Centre, Basildon, United Kingdom (K.K., T.R.K., J.R.D., R.A.G., K.H.T., O.A., P.A.K., G.J.C., G.V.K.).,School of Medicine, Anglia Ruskin University, United Kingdom (K.K., T.R.K., O.A., G.J.C., G.V.K.)
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18
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Yahagi M, Omi K, Tabata K, Yaguchi Y, Maeda T. Noninvasive cardiac output measurement is inaccurate in patients with severe aortic valve stenosis undergoing transcatheter aortic valve implantation. Korean J Anesthesiol 2021; 75:151-159. [PMID: 34673743 PMCID: PMC8980286 DOI: 10.4097/kja.21324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 10/17/2021] [Indexed: 11/29/2022] Open
Abstract
Background Noninvasive cardiac output (CO) measured using ClearSight™ eliminates the need for intra-arterial catheter insertion. The purpose of this study was to examine the accuracy of non-invasive CO measurement in patients with severe aortic stenosis (AS). Methods Twenty-eight patients undergoing elective transcatheter aortic valve implantation were prospectively enrolled in this study. The CO was simultaneously measured twice before and twice after valve deployment (total of four times) per patient, and the CO was compared between the ClearSight (COClearSight) system and the pulmonary artery catheter (PAC) thermodilution (COTD) method as a reference. The Bland-Altman analysis was used to compare the percentage errors between the methods. Results A total of 112 paired data points were obtained. The percentage error between the COClearSight and COTD was 43.1%. The paired datasets were divided into the following groups according to the systemic vascular resistance index (SVRI): low (< 1,200 dyne s/cm5/m2) and normal (1,200–2,500 dyne s/cm5/m2). The percentage errors were 44.9% and 49.4%, respectively. The discrepancy of CO between COClearSight and COTD was not significantly correlated with SVRI (r = −0.06, P < 0.001). The polar plot analysis showed the trending ability of the COClearSight after artificial valve deployment was 51.1% which below the acceptable cut-off (92%). Conclusions The accuracy and the trending ability of the ClearSight CO measurements were not acceptable in patients with severe AS. Therefore, the ClearSight system is not interchangeable with the PAC thermodilution for determining CO in this population.
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Affiliation(s)
- Musashi Yahagi
- Department of Anesthesiology Hitachi General Hospital, Hitachi, Ibaraki, Japan
| | - Kyuma Omi
- Department of Anesthesiology Hitachi General Hospital, Hitachi, Ibaraki, Japan
| | - Koya Tabata
- Department of Anesthesiology Hitachi General Hospital, Hitachi, Ibaraki, Japan
| | - Yuichi Yaguchi
- Department of Anesthesiology Hitachi General Hospital, Hitachi, Ibaraki, Japan
| | - Takuma Maeda
- Department of Anesthesiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
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19
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Reshetnik A, Gjolli J, van der Giet M, Compton F. Non-invasive Oscillometry-Based Estimation of Cardiac Output - Can We Use It in Clinical Practice? Front Physiol 2021; 12:704425. [PMID: 34413788 PMCID: PMC8369501 DOI: 10.3389/fphys.2021.704425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 07/16/2021] [Indexed: 11/29/2022] Open
Abstract
While invasive thermodilution techniques remain the reference methods for cardiac output (CO) measurement, there is a currently unmet need for non-invasive techniques to simplify CO determination, reduce complications related to invasive procedures required for indicator dilution CO measurement, and expand the application field toward emergency room, non-intensive care, or outpatient settings. We evaluated the performance of a non-invasive oscillometry-based CO estimation method compared to transpulmonary thermodilution. To assess agreement between the devices, we used Bland–Altman analysis. Four-quadrant plot analysis was used to visualize the ability of Mobil-O-Graph (MG) to track CO changes after a fluid challenge. Trending analysis of CO trajectories was used to compare MG and PiCCO® calibrated pulse wave analysis over time (6 h). We included 40 patients from the medical intensive care unit at the Charité – Universitätsmedizin Berlin, Campus Benjamin Franklin between November 2019 and June 2020. The median age was 73 years. Forty percent of the study population was male; 98% was ventilator-dependent and 75% vasopressor-dependent at study entry. The mean of the observed differences for the cardiac output index (COI) was 0.7 l∗min–1*m–2 and the lower, and upper 95% limits of agreement (LOA) were -1.9 and 3.3 l∗min–1*m–2, respectively. The 95% confidence interval for the LOA was ± 0.26 l∗min–1*m–2, the percentage error 83.6%. We observed concordant changes in CO with MG and PiCCO® in 50% of the measurements after a fluid challenge and over the course of 6 h. Cardiac output calculation with a novel oscillometry-based pulse wave analysis method is feasible and replicable in critically ill patients. However, we did not find clinically applicable agreement between MG and thermodilution or calibrated pulse wave analysis, respectively, assessed with established evaluation routine using the Bland–Altman approach and with trending analysis methods. In summary, we do not recommend the use of this method in critically ill patients at this time. As the basic approach is promising and the CO determination with MG very simple to perform, further studies should be undertaken both in hemodynamically stable patients, and in the critical care setting to allow additional adjustments of the underlying algorithm for CO estimation with MG.
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Affiliation(s)
- Alexander Reshetnik
- Department of Nephrology and Intensive Care Medicine, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jonida Gjolli
- Department of Nephrology and Intensive Care Medicine, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Markus van der Giet
- Department of Nephrology and Intensive Care Medicine, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Friederike Compton
- Department of Nephrology and Intensive Care Medicine, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
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20
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Kovács E, Gyarmathy VA, Pilecky D, Fekete-Győr A, Szakál-Tóth Z, Gellér L, Hauser B, Gál J, Merkely B, Zima E. An Interaction Effect Analysis of Thermodilution-Guided Hemodynamic Optimization, Patient Condition, and Mortality after Successful Cardiopulmonary Resuscitation. Int J Environ Res Public Health 2021; 18:ijerph18105223. [PMID: 34068997 PMCID: PMC8156244 DOI: 10.3390/ijerph18105223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/19/2021] [Accepted: 05/08/2021] [Indexed: 01/03/2023]
Abstract
Proper hemodynamic management is necessary among post-cardiac arrest patients to improve survival. We aimed to investigate the effects of PiCCO™-guided (pulse index contour cardiac output) hemodynamic management on mortality in post-resuscitation therapy. In this longitudinal analysis of 63 comatose patients after successful cardiopulmonary resuscitation cooled to 32–34 °C, 33 patients received PiCCO™, and 30 were not monitored with PiCCO™. Primary and secondary outcomes were 30 day and 1 year mortality. Kaplan–Meier curves and log-rank tests were used to assess differences in mortality among the groups. Interaction effects to disentangle the relationship between patient’s condition, PiCCO™ application, and mortality were assessed by means of Chi-square tests and logistic regression models. A 30 day mortality was significantly higher among PiCCO™ patients, while 1 year mortality was marginally higher. More severe patient condition per se was not the cause of higher mortality rate in the PiCCO™ group. Patients in better health conditions (without ST-elevation myocardial infarction, without cardiogenic shock, without intra-aortic balloon pump device, or without stroke in prior history) had worse outcomes with PiCCO™-guided therapy. Catecholamine administration worsened both 30 day and 1 year mortality among all patients. Our analysis showed that there was a complex interaction relationship between PiCCO™-guided therapy, patients’ condition, and 30 day mortality for most conditions.
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Affiliation(s)
- Enikő Kovács
- Department of Anaesthesiology and Intensive Therapy, Semmelweis University, H-1428 Budapest, Hungary; (B.H.); (J.G.)
- Correspondence:
| | - Valéria Anna Gyarmathy
- Medical Department, EpiConsult Biomedical Consulting and Medical Communication Agency, Dover, DE 19901, USA;
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Dávid Pilecky
- Department of Internal Medicine III, Klinikum Passau, 94032 Passau, Germany;
| | | | - Zsófia Szakál-Tóth
- Heart and Vascular Center, Semmelweis University, H-1428 Budapest, Hungary; (Z.S.-T.); (L.G.); (B.M.); (E.Z.)
| | - László Gellér
- Heart and Vascular Center, Semmelweis University, H-1428 Budapest, Hungary; (Z.S.-T.); (L.G.); (B.M.); (E.Z.)
| | - Balázs Hauser
- Department of Anaesthesiology and Intensive Therapy, Semmelweis University, H-1428 Budapest, Hungary; (B.H.); (J.G.)
| | - János Gál
- Department of Anaesthesiology and Intensive Therapy, Semmelweis University, H-1428 Budapest, Hungary; (B.H.); (J.G.)
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, H-1428 Budapest, Hungary; (Z.S.-T.); (L.G.); (B.M.); (E.Z.)
| | - Endre Zima
- Heart and Vascular Center, Semmelweis University, H-1428 Budapest, Hungary; (Z.S.-T.); (L.G.); (B.M.); (E.Z.)
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21
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Okwose NC, Bouzas-Cruz N, Fernandez OG, Koshy A, Green T, Woods A, Robinson-Smith N, Tovey S, Mcdiarmid A, Parry G, Schueler S, Macgowan GA, Jakovljevic DG. Validity of Hemodynamic Monitoring Using Inert Gas Rebreathing Method in Patients With Chronic Heart Failure and Those Implanted With a Left Ventricular Assist Device. J Card Fail 2020; 27:414-418. [PMID: 33035686 DOI: 10.1016/j.cardfail.2020.09.479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 08/24/2020] [Accepted: 09/29/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The present study assessed agreement between resting cardiac output estimated by inert gas rebreathing (IGR) and thermodilution methods in patients with heart failure and those implanted with a left ventricular assist device (LVAD). METHODS AND RESULTS Hemodynamic measurements were obtained in 42 patients, 22 with chronic heart failure and 20 with implanted continuous flow LVAD (34 males, aged 50 ± 11 years). Measurements were performed at rest using thermodilution and IGR methods. Cardiac output derived by thermodilution and IGR were not significantly different in LVAD (4.4 ± 0.9 L/min vs 4.7 ± 0.8 L/min, P = .27) or patients with heart failure (4.4 ± 1.4 L/min vs 4.5 ± 1.3 L/min, P = .75). There was a strong relationship between thermodilution and IGR cardiac index (r = 0.81, P = .001) and stroke volume index (r = 0.75, P = .001). Bland-Altman analysis showed acceptable limits of agreement for cardiac index derived by thermodilution and IGR, namely, the mean difference (lower and upper limits of agreement) for patients with heart failure -0.002 L/min/m2 (-0.65 to 0.66 L/min/m2), and -0.14 L/min/m2 (-0.78 to 0.49 L/min/m2) for patients with LVAD. CONCLUSIONS IGR is a valid method for estimating cardiac output and should be used in clinical practice to complement the evaluation and management of chronic heart failure and patients with an LVAD.
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Affiliation(s)
- Nduka C Okwose
- Cardiovascular Research, Clinical and Translational and Biosciences Research Institutes, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Noelia Bouzas-Cruz
- Departments of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Oscar Gonzalez Fernandez
- Departments of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Aaron Koshy
- Departments of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Thomas Green
- Departments of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Andrew Woods
- Departments of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Nicola Robinson-Smith
- Departments of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Sian Tovey
- Departments of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Adam Mcdiarmid
- Departments of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Gareth Parry
- Departments of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Stephan Schueler
- Departments of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Guy A Macgowan
- Cardiovascular Research, Clinical and Translational and Biosciences Research Institutes, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK; Departments of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Djordje G Jakovljevic
- Cardiovascular Research, Clinical and Translational and Biosciences Research Institutes, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK; Departments of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK; Cardiovascular Research Division, Faculty of Health and Life Sciences, Coventry University, Coventry, UK.
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22
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Pandhita BAW, Okwose NC, Koshy A, Fernández ÓG, Cruz NB, Eggett C, Velicki L, Popovic D, MacGowan GA, Jakovljevic DG. Noninvasive Assessment of Cardiac Output in Advanced Heart Failure and Heart Transplant Candidates Using the Bioreactance Method. J Cardiothorac Vasc Anesth 2020; 35:1776-1781. [PMID: 33059979 DOI: 10.1053/j.jvca.2020.09.109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 08/18/2020] [Accepted: 09/16/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The aim of the present study was to assess the validity and trending ability of the bioreactance method in estimating cardiac output at rest and in response to stress in advanced heart failure patients and heart transplant candidates. DESIGN This was a prospective single-center study. SETTING This study was conducted at the heart transplant center at the Freeman Hospital, Newcastle upon Tyne, UK. PARTICIPANTS Eighteen patients with advanced chronic heart failure due to reduced left ventricular ejection fraction (19 ± 7%), and peak oxygen consumption 12.3 ± 3.9 mL/kg/min. INTERVENTIONS Participants underwent right heart catheterization using the Swan-Ganz catheter. MEASUREMENTS AND MAIN RESULTS Cardiac output was measured simultaneously using thermodilution and bioreactance at rest and during active straight leg raise test to volitional exertion. There was no significant difference in cardiac index values obtained by the thermodilution and bioreactance methods (2.26 ± 0.59 v 2.38 ± 0.50 L/min, p > 0.05) at rest and peak straight leg raise test (2.92 ± 0.77 v 3.01 ± 0.66 L/min, p > 0.05). In response to active leg raise test, thermodilution cardiac output increased by 22% and bioreactance by 21%. There was also a strong relationship between cardiac outputs from both methods at rest (r = 0.88, p < 0.01) and peak straight leg raise test (r = 0.92, p < 0.01). Cartesian plot analysis showed good trending ability of bioreactance compared with thermodilution (concordance rate = 93%) CONCLUSIONS: `Cardiac output measured by the bioreactance method is comparable to that from the thermodilution method. Bioreactance method may be used in clinical practice to assess hemodynamics and improve management of advanced heart failure patients undergoing heart transplant assessment.
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Affiliation(s)
- Bashar A W Pandhita
- Cardiovascular Research, Clinical and Translational and Biosciences Research Institutes, Faculty of Medical Sciences, Newcastle University and Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Nduka C Okwose
- Cardiovascular Research, Clinical and Translational and Biosciences Research Institutes, Faculty of Medical Sciences, Newcastle University and Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Aaron Koshy
- Cardiovascular Research, Clinical and Translational and Biosciences Research Institutes, Faculty of Medical Sciences, Newcastle University and Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Óscar G Fernández
- Cardiovascular Research, Clinical and Translational and Biosciences Research Institutes, Faculty of Medical Sciences, Newcastle University and Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Noelia B Cruz
- Cardiovascular Research, Clinical and Translational and Biosciences Research Institutes, Faculty of Medical Sciences, Newcastle University and Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Christopher Eggett
- Cardiovascular Research, Clinical and Translational and Biosciences Research Institutes, Faculty of Medical Sciences, Newcastle University and Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Lazar Velicki
- Faculty of Medicine, University of Novi Sad, and Department of Cardiovascular Surgery, Institute of Cardiovascular Diseases Vojvodina, Novi Sad, Serbia
| | - Dejana Popovic
- Division of Cardiology, University Clinical Centre Serbia, Faculty of Pharmacy University of Belgrade, Belgrade, Serbia
| | - Guy A MacGowan
- Cardiovascular Research, Clinical and Translational and Biosciences Research Institutes, Faculty of Medical Sciences, Newcastle University and Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Djordje G Jakovljevic
- Cardiovascular Research, Clinical and Translational and Biosciences Research Institutes, Faculty of Medical Sciences, Newcastle University and Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom.
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23
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Hardin EA, Stoller D, Lawley J, Howden EJ, Hieda M, Pawelczyk J, Jarvis S, Prisk K, Sarma S, Levine BD. Noninvasive Assessment of Cardiac Output: Accuracy and Precision of the Closed-Circuit Acetylene Rebreathing Technique for Cardiac Output Measurement. J Am Heart Assoc 2020; 9:e015794. [PMID: 32851906 PMCID: PMC7660774 DOI: 10.1161/jaha.120.015794] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Background Accurate assessment of cardiac output is critical to the diagnosis and management of various cardiac disease states; however, clinical standards of direct Fick and thermodilution are invasive. Noninvasive alternatives, such as closed‐circuit acetylene (C2H2) rebreathing, warrant validation. Methods and Results We analyzed 10 clinical studies and all available cardiopulmonary stress tests performed in our laboratory that included a rebreathing method and direct Fick or thermodilution. Studies included healthy individuals and patients with clinical disease. Simultaneous cardiac output measurements were obtained under normovolemic, hypovolemic, and hypervolemic conditions, along with submaximal and maximal exercise. A total of 3198 measurements in 519 patients were analyzed (mean age, 59 years; 48% women). The C2H2 method was more precise than thermodilution in healthy individuals with half the typical error (TE; 0.34 L/min [r=0.92] and coefficient of variation, 7.2%) versus thermodilution (TE=0.67 [r=0.70] and coefficient of variation, 13.2%). In healthy individuals during supine rest and upright exercise, C2H2 correlated well with thermodilution (supine: r=0.84, TE=1.02; exercise: r=0.82, TE=2.36). In patients with clinical disease during supine rest, C2H2 correlated with thermodilution (r=0.85, TE=1.43). C2H2 was similar to thermodilution and nitrous oxide (N2O) rebreathing technique compared with Fick in healthy adults (C2H2 rest: r=0.85, TE=0.84; C2H2 exercise: r=0.87, TE=2.39; thermodilution rest: r=0.72, TE=1.11; thermodilution exercise: r=0.73, TE=2.87; N2O rest: r=0.82, TE=0.94; N2O exercise: r=0.84, TE=2.18). The accuracy of the C2H2 and N2O methods was excellent (r=0.99, TE=0.58). Conclusions The C2H2 rebreathing method is more precise than, and as accurate as, the thermodilution method in a variety of patients, with accuracy similar to an N2O rebreathing method approved by the US Food and Drug Administration.
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Affiliation(s)
- E Ashley Hardin
- Division of Cardiology Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX.,Institute for Exercise and Environmental Medicine Texas Health Presbyterian Hospital Dallas TX
| | - Douglas Stoller
- Division of Cardiology Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX.,Institute for Exercise and Environmental Medicine Texas Health Presbyterian Hospital Dallas TX
| | - Justin Lawley
- Division of Cardiology Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX.,Institute for Exercise and Environmental Medicine Texas Health Presbyterian Hospital Dallas TX
| | - Erin J Howden
- Division of Cardiology Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX.,Institute for Exercise and Environmental Medicine Texas Health Presbyterian Hospital Dallas TX
| | - Michinari Hieda
- Division of Cardiology Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX.,Institute for Exercise and Environmental Medicine Texas Health Presbyterian Hospital Dallas TX
| | - James Pawelczyk
- Department of Physiology Pennsylvania State University University Park and Hershey PA
| | - Sara Jarvis
- Department of Biological Sciences Northern Arizona University Flagstaff AZ
| | - Kim Prisk
- Department of Medicine University of California at San Diego La Jolla CA
| | - Satyam Sarma
- Division of Cardiology Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX.,Institute for Exercise and Environmental Medicine Texas Health Presbyterian Hospital Dallas TX
| | - Benjamin D Levine
- Division of Cardiology Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX.,Institute for Exercise and Environmental Medicine Texas Health Presbyterian Hospital Dallas TX
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24
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Nakamura T, Kawaji T, Harada T, Kato Y, Moriyama K, Hasegawa D, Komura H, Shibata J, Yamashita C, Kuriyama N, Hara Y, Nishida O. Lower blood return temperature than core temperature as a causal factor of decreased cardiac output assessed by transpulmonary thermodilution during blood purification. Ther Apher Dial 2020; 24:476-481. [PMID: 32524763 DOI: 10.1111/1744-9987.13543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We aimed to evaluate whether cardiac output assessed by transpulmonary thermodilution during blood purification is affected by the difference between the blood return temperature and core temperature. We applied different blood return temperatures using a thermostat bath during blood purification in four pigs. After the blood return temperature stabilized and blood purification process stopped, the cardiac output assessed by transpulmonary thermodilution was measured. The thermostat bath was set at 35°C, 40°C, 45°C, and 50°C, with the order changed at random; four measurements were made at each temperature. Cardiac function was evaluated by echocardiography when ice-cold saline was administered in a pig. A decrease in the blood return temperature resulted in decreased cardiac output assessed by transpulmonary thermodilution, whereas an increase resulted in increased cardiac output assessed by transpulmonary thermodilution. Echocardiography revealed that the change in the blood return temperature did not affect the left ventricular ejection fraction.
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Affiliation(s)
- Tomoyuki Nakamura
- Department of Anesthesiology and Critical Care Medicine, Fujita Health University School of Medicine, Toyoake, Japan
| | - Takahiro Kawaji
- Department of Anesthesiology and Critical Care Medicine, Fujita Health University School of Medicine, Toyoake, Japan
| | - Tatsuhiko Harada
- Department of Anesthesiology and Critical Care Medicine, Fujita Health University School of Medicine, Toyoake, Japan
| | - Yu Kato
- Department of Anesthesiology and Critical Care Medicine, Fujita Health University School of Medicine, Toyoake, Japan
| | - Kazuhiro Moriyama
- Laboratory for Immune Response and Regulatory Medicine, Fujita Health University School of Medicine, Toyoake, Japan
| | - Daisuke Hasegawa
- Department of Anesthesiology and Critical Care Medicine, Fujita Health University School of Medicine, Toyoake, Japan
| | - Hidefumi Komura
- Department of Anesthesiology and Critical Care Medicine, Fujita Health University School of Medicine, Toyoake, Japan
| | - Junpei Shibata
- Department of Anesthesiology and Critical Care Medicine, Fujita Health University School of Medicine, Toyoake, Japan
| | - Chizuru Yamashita
- Department of Anesthesiology and Critical Care Medicine, Fujita Health University School of Medicine, Toyoake, Japan
| | - Naohide Kuriyama
- Department of Anesthesiology and Critical Care Medicine, Fujita Health University School of Medicine, Toyoake, Japan
| | - Yoshitaka Hara
- Department of Anesthesiology and Critical Care Medicine, Fujita Health University School of Medicine, Toyoake, Japan
| | - Osamu Nishida
- Department of Anesthesiology and Critical Care Medicine, Fujita Health University School of Medicine, Toyoake, Japan
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25
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Khirfan G, Ahmed MK, Almaaitah S, Almoushref A, Agmy GM, Dweik RA, Tonelli AR. Comparison of Different Methods to Estimate Cardiac Index in Pulmonary Arterial Hypertension. Circulation 2019; 140:705-707. [PMID: 31424987 DOI: 10.1161/circulationaha.119.041614] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ghaleb Khirfan
- Department of Pulmonary, Allergy, and Critical Care Medicine (G.K., R.A.D., A.R.T.), Respiratory Institute
| | - Mostafa K Ahmed
- Department of Pulmonary and Critical Care Medicine (M.K.A.), Respiratory Institute.,Department of Chest Diseases, Faculty of Medicine, Assiut University, Egypt (M.K.A., G.M.A.)
| | - Saja Almaaitah
- Department of Internal Medicine (S.A.), Medicine Institute
| | | | - Gamal M Agmy
- Department of Chest Diseases, Faculty of Medicine, Assiut University, Egypt (M.K.A., G.M.A.)
| | - Raed A Dweik
- Department of Pulmonary, Allergy, and Critical Care Medicine (G.K., R.A.D., A.R.T.), Respiratory Institute
| | - Adriano R Tonelli
- Department of Pulmonary, Allergy, and Critical Care Medicine (G.K., R.A.D., A.R.T.), Respiratory Institute
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26
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Kim GE, Kim SY, Kim SJ, Yun SY, Jung HH, Kang YS, Koo BN. Accuracy and Efficacy of Impedance Cardiography as a Non-Invasive Cardiac Function Monitor. Yonsei Med J 2019; 60:735-741. [PMID: 31347328 PMCID: PMC6660442 DOI: 10.3349/ymj.2019.60.8.735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 05/09/2019] [Accepted: 06/16/2019] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The most common method of monitoring cardiac output (CO) is thermodilution using pulmonary artery catheter (PAC), but this method is associated with complications. Impedance cardiography (ICG) is a non-invasive CO monitoring technique. This study compared the accuracy and efficacy of ICG as a non-invasive cardiac function monitoring technique to those of thermodilution and arterial pressure contour. MATERIALS AND METHODS Sixteen patients undergoing liver transplantation were included. Cardiac index (CI) was measured by thermodilution using PAC, arterial waveform analysis, and ICG simultaneously in each patient. Statistical analysis was performed using intraclass correlation coefficient (ICC) and Bland-Altman analysis to assess the degree of agreement. RESULTS The difference by thermodilution and ICG was 1.13 L/min/m², and the limits of agreement were -0.93 and 3.20 L/min/m². The difference by thermodilution and arterial pressure contour was 0.62 L/min/m², and the limits of agreement were -1.43 and 2.67 L/min/m². The difference by arterial pressure contour and ICG was 0.50 L/min/m², and the limits of agreement were -1.32 and 2.32 L/min/m². All three percentage errors exceeded the 30% limit of acceptance. Substantial agreement was observed between CI of thermodilution with PAC and ICG at preanhepatic and anhepatic phases, as well as between CI of thermodilution and arterial waveform analysis at preanhepatic phase. Others showed moderate agreement. CONCLUSION Although neither method was clinically equivalent to thermodilution, ICG showed more substantial correlation with thermodilution method than with arterial waveform analysis. As a non-invasive cardiac function monitor, ICG would likely require further studies in other settings.
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Affiliation(s)
- Go Eun Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - So Yeon Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Seon Ju Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Soon Young Yun
- Department of Anesthesiology and Pain Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Hwan Ho Jung
- Department of Anesthesiology and Pain Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Yhen Seung Kang
- Department of Anesthesiology and Pain Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Bon Nyeo Koo
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea.
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27
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Xaplanteris P, Fournier S, Keulards DCJ, Adjedj J, Ciccarelli G, Milkas A, Pellicano M, Van't Veer M, Barbato E, Pijls NHJ, De Bruyne B. Catheter-Based Measurements of Absolute Coronary Blood Flow and Microvascular Resistance: Feasibility, Safety, and Reproducibility in Humans. Circ Cardiovasc Interv 2019; 11:e006194. [PMID: 29870386 DOI: 10.1161/circinterventions.117.006194] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 01/29/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND The principle of continuous thermodilution can be used to calculate absolute coronary blood flow and microvascular resistance (R). The aim of the study is to explore the safety, feasibility, and reproducibility of coronary blood flow and R measurements as measured by continuous thermodilution in humans. METHODS AND RESULTS Absolute coronary flow and R can be calculated by thermodilution by infusing saline at room temperature through a dedicated monorail catheter. The temperature of saline as it enters the vessel, the temperature of blood and saline mixed in the distal part of the vessel, and the distal coronary pressure were measured by a pressure/temperature sensor-tipped guidewire. The feasibility and safety of the method were tested in 135 patients who were referred for coronary angiography. No significant adverse events were observed; in 11 (8.1%) patients, bradycardia and concomitant atrioventricular block appeared transiently and were reversed immediately on interruption of the infusion. The reproducibility of measurements was tested in a subgroup of 80 patients (129 arteries). Duplicate measurements had a strong correlation both for coronary blood flow (ρ=0.841, P<0.001; intraclass correlation coefficient=0.89, P<0.001) and R (ρ=0.780, P<0.001; intraclass correlation coefficient=0.89, P<0.001). In Bland-Altman plots, there was no significant bias or asymmetry. CONCLUSIONS Absolute coronary blood flow (in L/min) and R (in mm Hg/L/min or Wood units) can be safely and reproducibly measured with continuous thermodilution. This approach constitutes a new opportunity for the study of the coronary microcirculation.
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Affiliation(s)
- Panagiotis Xaplanteris
- From the Cardiovascular Center Aalst, Belgium (P.X., S.F., J.A., G.C., A.M., M.P., E.B., B.D.B.); Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands (D.K., M.v.V., N.H.J.P.); Department of Biomedical Engineering, Eindhoven University of Technology, the Netherlands (D.K., M.v.V., N.H.J.P.); and Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy (E.B.)
| | - Stephane Fournier
- From the Cardiovascular Center Aalst, Belgium (P.X., S.F., J.A., G.C., A.M., M.P., E.B., B.D.B.); Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands (D.K., M.v.V., N.H.J.P.); Department of Biomedical Engineering, Eindhoven University of Technology, the Netherlands (D.K., M.v.V., N.H.J.P.); and Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy (E.B.)
| | - Daniëlle C J Keulards
- From the Cardiovascular Center Aalst, Belgium (P.X., S.F., J.A., G.C., A.M., M.P., E.B., B.D.B.); Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands (D.K., M.v.V., N.H.J.P.); Department of Biomedical Engineering, Eindhoven University of Technology, the Netherlands (D.K., M.v.V., N.H.J.P.); and Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy (E.B.)
| | - Julien Adjedj
- From the Cardiovascular Center Aalst, Belgium (P.X., S.F., J.A., G.C., A.M., M.P., E.B., B.D.B.); Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands (D.K., M.v.V., N.H.J.P.); Department of Biomedical Engineering, Eindhoven University of Technology, the Netherlands (D.K., M.v.V., N.H.J.P.); and Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy (E.B.)
| | - Giovanni Ciccarelli
- From the Cardiovascular Center Aalst, Belgium (P.X., S.F., J.A., G.C., A.M., M.P., E.B., B.D.B.); Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands (D.K., M.v.V., N.H.J.P.); Department of Biomedical Engineering, Eindhoven University of Technology, the Netherlands (D.K., M.v.V., N.H.J.P.); and Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy (E.B.)
| | - Anastasios Milkas
- From the Cardiovascular Center Aalst, Belgium (P.X., S.F., J.A., G.C., A.M., M.P., E.B., B.D.B.); Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands (D.K., M.v.V., N.H.J.P.); Department of Biomedical Engineering, Eindhoven University of Technology, the Netherlands (D.K., M.v.V., N.H.J.P.); and Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy (E.B.)
| | - Mariano Pellicano
- From the Cardiovascular Center Aalst, Belgium (P.X., S.F., J.A., G.C., A.M., M.P., E.B., B.D.B.); Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands (D.K., M.v.V., N.H.J.P.); Department of Biomedical Engineering, Eindhoven University of Technology, the Netherlands (D.K., M.v.V., N.H.J.P.); and Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy (E.B.)
| | - Marcel Van't Veer
- From the Cardiovascular Center Aalst, Belgium (P.X., S.F., J.A., G.C., A.M., M.P., E.B., B.D.B.); Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands (D.K., M.v.V., N.H.J.P.); Department of Biomedical Engineering, Eindhoven University of Technology, the Netherlands (D.K., M.v.V., N.H.J.P.); and Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy (E.B.)
| | - Emanuele Barbato
- From the Cardiovascular Center Aalst, Belgium (P.X., S.F., J.A., G.C., A.M., M.P., E.B., B.D.B.); Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands (D.K., M.v.V., N.H.J.P.); Department of Biomedical Engineering, Eindhoven University of Technology, the Netherlands (D.K., M.v.V., N.H.J.P.); and Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy (E.B.)
| | - Nico H J Pijls
- From the Cardiovascular Center Aalst, Belgium (P.X., S.F., J.A., G.C., A.M., M.P., E.B., B.D.B.); Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands (D.K., M.v.V., N.H.J.P.); Department of Biomedical Engineering, Eindhoven University of Technology, the Netherlands (D.K., M.v.V., N.H.J.P.); and Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy (E.B.)
| | - Bernard De Bruyne
- From the Cardiovascular Center Aalst, Belgium (P.X., S.F., J.A., G.C., A.M., M.P., E.B., B.D.B.); Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands (D.K., M.v.V., N.H.J.P.); Department of Biomedical Engineering, Eindhoven University of Technology, the Netherlands (D.K., M.v.V., N.H.J.P.); and Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy (E.B.).
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Bruce RM, Crockett DC, Morgan A, Tran MC, Formenti F, Phan PA, Farmery AD. Noninvasive cardiac output monitoring in a porcine model using the inspired sinewave technique: a proof-of-concept study. Br J Anaesth 2019; 123:126-134. [PMID: 30954237 PMCID: PMC6676057 DOI: 10.1016/j.bja.2019.02.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 01/10/2019] [Accepted: 02/11/2019] [Indexed: 11/25/2022] Open
Abstract
Background Cardiac output (Q˙) monitoring can support the management of high-risk surgical patients, but the pulmonary artery catheterisation required by the current ‘gold standard’—bolus thermodilution (Q˙T)—has the potential to cause life-threatening complications. We present a novel noninvasive and fully automated method that uses the inspired sinewave technique to continuously monitor cardiac output (Q˙IST). Methods Over successive breaths the inspired nitrous oxide (N2O) concentration was forced to oscillate sinusoidally with a fixed mean (4%), amplitude (3%), and period (60 s). Q˙IST was determined in a single-compartment tidal ventilation lung model that used the resulting amplitude/phase of the expired N2O sinewave. The agreement and trending ability of Q˙IST were compared with Q˙T during pharmacologically induced haemodynamic changes, before and after repeated lung lavages, in eight anaesthetised pigs. Results Before lung lavage, changes in Q˙IST and Q˙T from baseline had a mean bias of –0.52 L min−1 (95% confidence interval [CI], –0.41 to –0.63). The concordance between Q˙IST and Q˙T was 92.5% as assessed by four-quadrant analysis, and polar plot analysis revealed a mean angular bias of 5.98° (95% CI, –24.4°–36.3°). After lung lavage, concordance was slightly reduced (89.4%), and the mean angular bias widened to 21.8° (–4.2°, 47.6°). Impaired trending ability correlated with shunt fraction (r=0.79, P<0.05). Conclusions The inspired sinewave technique provides continuous and noninvasive monitoring of cardiac output, with a ‘marginal–good’ trending ability compared with cardiac output based on thermodilution. However, the trending ability can be reduced with increasing shunt fraction, such as in acute lung injury.
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Affiliation(s)
- Richard M Bruce
- Centre for Human and Applied Physiological Sciences, School of Basic and Medical Sciences, King's College London, London, UK; Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
| | - Douglas C Crockett
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Anna Morgan
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Minh Cong Tran
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Federico Formenti
- Centre for Human and Applied Physiological Sciences, School of Basic and Medical Sciences, King's College London, London, UK; Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK; Department of Biomechanics, University of Nebraska, Omaha, NE, USA
| | - Phi Anh Phan
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Andrew D Farmery
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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Everaars H, de Waard GA, Driessen RS, Danad I, van de Ven PM, Raijmakers PG, Lammertsma AA, van Rossum AC, Knaapen P, van Royen N. Doppler Flow Velocity and Thermodilution to Assess Coronary Flow Reserve: A Head-to-Head Comparison With [ 15O]H 2O PET. JACC Cardiovasc Interv 2018; 11:2044-2054. [PMID: 30268877 DOI: 10.1016/j.jcin.2018.07.011] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 07/09/2018] [Accepted: 07/10/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVES This study sought to compare Doppler flow velocity reserve (CFRDoppl) and thermodilution-derived coronary flow reserve (CFRthermo) head-to-head with the gold standard for quantification of myocardial perfusion, [15O]H2O positron emission tomography (PET). BACKGROUND Coronary flow reserve (CFR) is an important parameter for assessing coronary vascular function. To date, 2 techniques are available for invasive assessment of CFR: Doppler flow velocity and thermodilution. Although these techniques have been compared with each other, neither has been compared with [15O]H2O PET perfusion imaging. METHODS CFR was assessed in 98 vessels of 40 consecutive stable patients with suspected coronary artery disease. Patients underwent [15O]H2O PET, followed by invasive angiography in conjunction with simultaneous measurements of fractional flow reserve, CFRDoppl, and CFRthermo. Both normal and obstructed arteries were included. RESULTS The quality of Doppler flow velocity traces was significantly lower than that of thermodilution curves (p < 0.001). A moderate correlation was observed between CFRDoppl and CFRthermo (r = 0.59; p < 0.001). CFRDoppl correlated well with PET-derived CFR (CFRPET) (r = 0.82; p < 0.001). In contrast, the correlation between CFRthermo and CFRPET was only modest (r = 0.55; p < 0.001). This difference in correlation with CFRPET was significant (t = 4.9; df = 95; p < 0.001). Bland-Altman analysis revealed a tendency of CFRthermo to overestimate flow reserve at higher values. CONCLUSIONS Coronary flow reserve, determined using Doppler flow velocity, has superior agreement with [15O]H2O PET in comparison with CFRthermo.
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Affiliation(s)
- Henk Everaars
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Guus A de Waard
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Roel S Driessen
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Ibrahim Danad
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Peter M van de Ven
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands
| | - Pieter G Raijmakers
- Department of Radiology & Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | - Adriaan A Lammertsma
- Department of Radiology & Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | - Albert C van Rossum
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Paul Knaapen
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Niels van Royen
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands; Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands.
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Abstract
Since 1968, when Baxter and Shires developed the Parkland formula, little progress has been made in the field of fluid therapy for burn resuscitation, despite advances in haemodynamic monitoring, establishment of the 'goal-directed therapy' concept, and the development of new colloid and crystalloid solutions. Burn patients receive a larger amount of fluids in the first hours than any other trauma patients. Initial resuscitation is based on crystalloids because of the increased capillary permeability occurring during the first 24 h. After that time, some colloids, but not all, are accepted. Since the emergence of the Pharmacovigilance Risk Assessment Committee alert from the European Medicines Agency concerning hydroxyethyl starches, solutions containing this component are not recommended for burns. But the question is: what do we really know about fluid resuscitation in burns? To provide an answer, we carried out a non-systematic review to clarify how to quantify the amount of fluids needed, what the current evidence says about the available solutions, and which solution is the most appropriate for burn patients based on the available knowledge.
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Affiliation(s)
| | - G Usúa
- Anesthesia and Critical Care Department
| | - N Martín
- Anesthesia and Critical Care Department
| | - L Abarca
- Anesthesia and Critical Care Department
| | - J P Barret
- Plastic Surgery Department and Burn Centre, Hospital Universitari Vall d'Hebron, Barcelona 08035, Spain
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31
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Teefy P, Bagur R, Phillips C, Karimi-Shahri K, Teefy J, Sule R, Dempsey AA, Norozi K. Impact of Obesity on Noninvasive Cardiac Hemodynamic Measurement by Electrical Cardiometry in Adults With Aortic Stenosis. J Cardiothorac Vasc Anesth 2018; 32:2505-2511. [PMID: 29903682 DOI: 10.1053/j.jvca.2018.04.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVES There are substantial potential benefits to noninvasive cardiac monitoring methods, such as electrical cardiometry (EC), over more invasive methods, including significantly reduced risk of complications, lower up-front and operational costs, ease of use, and continuous monitoring. To take advantage of these technologies, clinical equivalence to currently established methods must be determined. The authors sought to determine if the noninvasive measurement of cardiac index (CI) by EC was clinically equivalent to thermodilution (TD) in adult patients with aortic stenosis (AS). DESIGN This is a cross-sectional study comparing measurement devices in a single patient group. SETTING Single-center, university teaching hospital. PARTICIPANTS The study included 52 adult patients with aortic stenosis undergoing right heart catheterization. INTERVENTIONS Cardiac output (CO) was measured concurrently using EC with an ICON device and TD in 52 participants with AS. CI values were to determine the accuracy and precision of EC in reference to TD. Percentage error (PE) was used to assess their clinical equivalence. The participants were divided further into groups (normal and overweight/obese) based on body mass index and the analysis was repeated. MEASUREMENTS AND MAIN RESULTS CO measurement made by EC in adult patients with obesity or overweight was reduced significantly relative to TD. This was not observed in normal-weight adult AS patients. EC provided clinically equivalent measurements to TD for measuring CI in normal-weight adult AS patients (PE = 25.0%), but not for those adult AS patients with overweight or obesity (PE = 42.3%). CONCLUSION Overall, the ICON device produced lower CO and index measurements relative to TD in adult patients with AS. Overweight and obesity also significantly affected the relative precision and accuracy of the ICON electrical cardiometric device to measure CI in these patients.
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Affiliation(s)
- Patrick Teefy
- Department of Paediatrics, Division of Paediatric Cardiology, Western University, London, Canada
| | - Rodrigo Bagur
- Department of Paediatrics, Division of Paediatric Cardiology, Western University, London, Canada
| | - Chantal Phillips
- Department of Paediatrics, Division of Paediatric Cardiology, Western University, London, Canada
| | - Kourosh Karimi-Shahri
- Department of Paediatrics, Division of Paediatric Cardiology, Western University, London, Canada
| | - John Teefy
- Department of Paediatrics, Division of Paediatric Cardiology, Western University, London, Canada
| | - Raksha Sule
- Department of Paediatrics, Division of Paediatric Cardiology, Western University, London, Canada
| | - Adam A Dempsey
- Department of Paediatrics, Division of Paediatric Cardiology, Western University, London, Canada; Children's Health Research Institute, London, Canada; Paediatric Cardiopulmonary Research Laboratory, London Health Sciences Centre, London, Canada
| | - Kambiz Norozi
- Department of Paediatrics, Division of Paediatric Cardiology, Western University, London, Canada; Children's Health Research Institute, London, Canada; Paediatric Cardiopulmonary Research Laboratory, London Health Sciences Centre, London, Canada; Department of Paediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany; Department of Paediatric Cardiology and Intensive Care Medicine, University of Goettingen, Goettingen, Germany.
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Tran-Dinh A, Augustin P, Dufour G, Lasocki S, Allou N, Thabut G, Castier Y, Montravers P, Desmard M. Evaluation of Cardiac Index and Extravascular Lung Water After Single-Lung Transplantation Using the Transpulmonary Thermodilution Technique by the PiCCO2 Device. J Cardiothorac Vasc Anesth 2017; 32:1731-1735. [PMID: 29203299 DOI: 10.1053/j.jvca.2017.10.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Indexed: 11/11/2022]
Abstract
OBJECTIVES First evaluation of the transpulmonary thermodilution technique by the PiCCO2 device to assess cardiac index and pulmonary edema during the postoperative course after single-lung transplantation. DESIGN Prospective observational study. SETTINGS Intensive care unit, university hospital (single center). PARTICIPANTS Single-lung transplant patients. INTERVENTIONS The authors compared cardiac index measured by PiCCO2 and pulmonary artery catheter and assessed pulmonary edema using extravascular lung water index and pulmonary vascular permeability index measured by PiCCO2. MEASUREMENTS AND MAIN RESULTS A Bland-Altman method was used to compare cardiac index measured by PiCCO2 and pulmonary artery catheter. Extravascular lung water index and pulmonary vascular permeability index were compared according to the PaO2/FiO2 ratio with a threshold value of 150 mmHg. Ten single-lung transplant patients were included. Cardiac index measured by PiCCO2 and pulmonary artery catheter were 3.3 L/min/m2 (2.9-3.6) and 2.5 L/min/m2 (2.2-3.0). Bias for cardiac index was 0.71 L/min/m2 (-0.03; 1.44) and limit of agreements were -0.03 and 1.44 L/min/m2. Extravascular lung water index was 12 mL/kg (11-16) and pulmonary vascular permeability index was 2.3 (2.0-3.1), consistent with pulmonary edema. Extravascular lung water index was higher in the group of PaO2/FiO2 ratio ≤150 mmHg compared with the group of PaO2/FiO2 ratio >150 mmHg (17 v 12 mL/kg, p = 0.04), whereas pulmonary vascular permeability index only tended to be higher (3.1 v 2.1, p = 0.06). CONCLUSION PiCCO2 device systematically overestimated cardiac index compared with pulmonary artery catheter. However, it might be useful to assess pulmonary edema in acute respiratory failure after single-lung transplantation.
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Affiliation(s)
- Alexy Tran-Dinh
- Département d'AnesthésieRéanimation, Université Paris Diderot Sorbonne Cite, APHP, CHU Bichat-Claude Bernard, Paris, France; LVTS Inserm U1148, Hôpital Bichat-Claude Bernard, Paris, France.
| | - Pascal Augustin
- Département d'AnesthésieRéanimation, Université Paris Diderot Sorbonne Cite, APHP, CHU Bichat-Claude Bernard, Paris, France
| | - Guillaume Dufour
- Département d'AnesthésieRéanimation, Université Paris Diderot Sorbonne Cite, APHP, CHU Bichat-Claude Bernard, Paris, France
| | - Sigismond Lasocki
- Département d'AnesthésieRéanimation, Université Paris Diderot Sorbonne Cite, APHP, CHU Bichat-Claude Bernard, Paris, France
| | - Nicolas Allou
- Département d'AnesthésieRéanimation, Université Paris Diderot Sorbonne Cite, APHP, CHU Bichat-Claude Bernard, Paris, France
| | - Gabriel Thabut
- Service de Pneumologie B et Transplantation Pulmonaire, Université Paris Diderot Sorbonne Cite, APHP, CHU Bichat-Claude Bernard, Paris, France
| | - Yves Castier
- Inserm UMR 1152, Hôpital Bichat-Claude Bernard, Paris, France; Service de Chirurgie Thoracique et Vasculaire, Université Paris Diderot Sorbonne Cite, APHP(,) CHU Bichat-Claude Bernard, Paris, France
| | - Philippe Montravers
- Département d'AnesthésieRéanimation, Université Paris Diderot Sorbonne Cite, APHP, CHU Bichat-Claude Bernard, Paris, France; Inserm UMR 1152, Hôpital Bichat-Claude Bernard, Paris, France
| | - Mathieu Desmard
- Département d'AnesthésieRéanimation, Université Paris Diderot Sorbonne Cite, APHP, CHU Bichat-Claude Bernard, Paris, France
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Bootsma IT, de Lange F, Koopmans M, Haenen J, Boonstra PW, Symersky T, Boerma EC. Right Ventricular Function After Cardiac Surgery Is a Strong Independent Predictor for Long-Term Mortality. J Cardiothorac Vasc Anesth 2017. [PMID: 28416392 DOI: 10.1053/j.jvca.2017.02.00] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To establish the all-cause mortality of right ventricular dysfunction after cardiac surgery in a heterogeneous group of cardiac surgery patients. DESIGN Retrospective analysis of a heterogeneous group of 1,109 cardiac surgery patients in a 4-year period. SETTING Single-center study in a tertiary teaching hospital. PARTICIPANTS One thousand one hundred nine cardiac surgery patients. By protocol, patients were monitored with a pulmonary artery catheter, enabling continuous right ventricular ejection fraction (RVEF) measurements. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Measurements were performed once per minute for the first 24 postoperative hours and expressed as average over the complete period. Primary outcome was 2-year all-cause mortality. RVEF was categorized into 3 subgroups: <20%, 20-30%, and >30%. Median follow-up time was 739 days. Two-year mortality was significantly different across groups: 4.1% for patients with RVEF >30%, 8.2% in the group with RVEF 20-30%, and 16.7% for patients with RVEF <20%, p < 0.001. Additional risk factors for a poor RVEF were age, body weight, New York Heart Association class, chronic obstructive pulmonary disease, poor left ventricular function, and higher risk scores (Acute Physiology and Chronic Health Evaluation and European System for Cardiac Operative Risk Evaluation). In a multivariate analysis, RVEF as a continuous variable was associated independently with the primary outcome (odds ratio 0.95 confidence interval 0.91-0.99, p = 0.011.) Odds ratios for RVEF <20% were 1.88 (confidence interval 1.18-3.00, p = 0.008). CONCLUSIONS Right ventricular function is associated independently with 2-year all-cause mortality in a heterogenic cardiac surgery population.
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Affiliation(s)
- Inge T Bootsma
- Department of Intensive Care, Medical Centre Leeuwarden, Leeuwarden, The Netherlands.
| | - Fellery de Lange
- Department of Intensive Care, Medical Centre Leeuwarden, Leeuwarden, The Netherlands; Department of Cardiothoracic Anaesthesiology, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - Matty Koopmans
- Department of Intensive Care, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - Johannes Haenen
- Department of Cardiothoracic Anaesthesiology, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - Piet W Boonstra
- Department of Cardiothoracic Surgery, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - Tomas Symersky
- Department of Cardiology, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - E Christiaan Boerma
- Department of Intensive Care, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
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Vignon P, Begot E, Mari A, Silva S, Chimot L, Delour P, Vargas F, Filloux B, Vandroux D, Jabot J, François B, Pichon N, Clavel M, Levy B, Slama M, Riu-Poulenc B. Hemodynamic Assessment of Patients With Septic Shock Using Transpulmonary Thermodilution and Critical Care Echocardiography: A Comparative Study. Chest 2017; 153:55-64. [PMID: 28866112 DOI: 10.1016/j.chest.2017.08.022] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 06/28/2017] [Accepted: 08/01/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND To assess the agreement between transpulmonary thermodilution (TPT) and critical care echocardiography (CCE) in ventilated patients with septic shock. METHODS Ventilated patients in sinus rhythm requiring advanced hemodynamic assessment for septic shock were included in this prospective multicenter descriptive study. Patients were assessed successively using TPT and CCE in random order. Data were interpreted independently at bedside by two investigators who proposed therapeutic changes on the basis of predefined algorithms. TPT and CCE hemodynamic assessments were reviewed offline by two independent experts who identified potential sources of discrepant results by consensus. Lactate clearance and outcome were studied. RESULTS A total of 137 patients were studied (71 men; age, 61 ± 15 years; Simplified Acute Physiologic Score, 58 ± 18; Sequential Organ Failure Assessment, 10 ± 3). TPT and CCE interpretations at bedside were concordant in 87/132 patients (66%) without acute cor pulmonale (ACP), resulting in a moderate agreement (kappa, 0.48; 95% CI, 0.37-0.60). Experts' adjudications were concordant in 100/129 patients without ACP (77.5%), resulting in a good intertechnique agreement (kappa, 0.66; 95% CI, 0.55-0.77). In addition to ACP (n = 8), CCE depicted a potential source of TPT inaccuracy in 8/29 patients (28%). Lactate clearance at H6 was similar irrespective of the concordance of online interpretations of TPT and CCE (55/84 [65%] vs 32/45 [71%], P = .55). ICU and day 28 mortality rates were similar between patients with concordant and discordant interpretations (29/87 [36%] vs 13/45 [29%], P = .60; and 31/87 [36%] vs 16/45 [36%], P = .99, respectively). CONCLUSIONS Agreement between TPT and CCE was moderate when interpreted at bedside and good when adjudicated offline by experts, but without impact on lactate clearance and mortality.
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Affiliation(s)
- Philippe Vignon
- Medical-surgical Intensive Care Unit, Teaching Hospital of Limoges, Limoges, France; INSERM CIC 1435, Teaching Hospital of Limoges, Limoges, France.
| | - Emmanuelle Begot
- Medical-surgical Intensive Care Unit, Teaching Hospital of Limoges, Limoges, France; INSERM CIC 1435, Teaching Hospital of Limoges, Limoges, France
| | - Arnaud Mari
- Medical-Surgical Intensive Care Unit, Teaching Hospital of Toulouse, Toulouse, France
| | - Stein Silva
- Medical-Surgical Intensive Care Unit, Teaching Hospital of Toulouse, Toulouse, France
| | - Loïc Chimot
- Medical Intensive Care Unit, Hospital of Périgueux, Périgueux, France
| | - Pierre Delour
- Medical Intensive Care Unit, Hospital of Périgueux, Périgueux, France
| | - Frédéric Vargas
- Medical Intensive Care Unit, Teaching Hospital of Bordeaux, Bordeaux, France
| | - Bruno Filloux
- Medical Intensive Care Unit, Teaching Hospital of Bordeaux, Bordeaux, France
| | - David Vandroux
- Medical-Surgical Intensive Care Unit, Teaching Hospital of La Réunion, La Réunion, France
| | - Julien Jabot
- Medical-Surgical Intensive Care Unit, Teaching Hospital of La Réunion, La Réunion, France
| | - Bruno François
- Medical-surgical Intensive Care Unit, Teaching Hospital of Limoges, Limoges, France; INSERM CIC 1435, Teaching Hospital of Limoges, Limoges, France
| | - Nicolas Pichon
- Medical-surgical Intensive Care Unit, Teaching Hospital of Limoges, Limoges, France; INSERM CIC 1435, Teaching Hospital of Limoges, Limoges, France
| | - Marc Clavel
- Medical-surgical Intensive Care Unit, Teaching Hospital of Limoges, Limoges, France; INSERM CIC 1435, Teaching Hospital of Limoges, Limoges, France
| | - Bruno Levy
- Medical Intensive Care Unit, Teaching Hospital of Nancy, Nancy, France
| | - Michel Slama
- Medical Intensive Care Unit, Teaching Hospital of Amiens, Amiens, France
| | - Béatrice Riu-Poulenc
- Medical-Surgical Intensive Care Unit, Teaching Hospital of Toulouse, Toulouse, France
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Bhattacharjee A, Pradhan D, Bhattacharyya P, Dey S, Chhunthang D, Handique A, Barman A, Yunus M. How Useful is Extravascular Lung Water Measurement in Managing Lung Injury in Intensive Care Unit? Indian J Crit Care Med 2017; 21:494-499. [PMID: 28904478 PMCID: PMC5588483 DOI: 10.4103/ijccm.ijccm_40_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Context: The primary goal of septic shock management is optimization of organ perfusion, often at the risk of overloading the interstitium and causing pulmonary edema. The conventionally used end points of resuscitation do not generally include volumetric parameters such as extravascular lung water index (EVLWI) and pulmonary vascular permeability index (PVPI). Aims: This study aimed to assess the prognostic value of EVLWI and PVPI by calculating their correlation with the severity of lung injury. Settings and Design: This prospective observational study included twenty mechanically ventilated critically ill patients with Acute Physiology and Chronic Health Evaluation score (APACHE II) >20. Subjects and Methods: EVLWI and PVPI were measured using transpulmonary thermodilution, and simultaneously, PaO2:FiO2 ratio, alveolar-arterial gradient of oxygen (AaDO2), and chest radiograph scores from two radiologists were obtained. Statistical Analysis: The correlation of EVLWI and PVPI with chest radiograph scores, PaO2:FiO2 ratio, and AaDO2 were calculated. The inter-observer agreement between the two radiologists was tested using kappa test. Results: EVLWI and PVPI correlated modestly with PaO2:FiO2 (r = −0.32, P = 0.0004; r = −0.39, P = 0.0001). There was a better correlation of EVLWI and PVPI with PaO2:FiO2 ratio (r = −0.71, P < 0.0001; r = −0.58, P = 0.0001) in the acute respiratory distress syndrome (ARDS) subgroup. The EVLWI values correlated significantly with corresponding chest radiograph scores (r = 0.71, P < 0.0001 for observer 1 and r = 0.68, P < 0.0001 for observer 2). Conclusions: EVLWI and PVPI may have a prognostic significance in the assessment of lung injury in septic shock patients with ARDS. Further research is required to reveal the usefulness of EVLWI as an end point of fluid resuscitation in the management of septic shock with ARDS.
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Affiliation(s)
- Anirban Bhattacharjee
- Department of Anaesthesiology and Critical Care, NEIGRIHMS, Shillong, Meghalaya, India
| | - Debasis Pradhan
- Department of Anaesthesiology and Critical Care, NEIGRIHMS, Shillong, Meghalaya, India
| | | | - Samarjit Dey
- Department of Anaesthesiology and Critical Care, NEIGRIHMS, Shillong, Meghalaya, India
| | - Daniala Chhunthang
- Department of Radiology and Imaging, NEIGRIHMS, Shillong, Meghalaya, India
| | - Akash Handique
- Department of Radiology and Imaging, NEIGRIHMS, Shillong, Meghalaya, India
| | - Angkita Barman
- Department of Anaesthesiology and Critical Care, NEIGRIHMS, Shillong, Meghalaya, India
| | - Mohd Yunus
- Department of Anaesthesiology and Critical Care, NEIGRIHMS, Shillong, Meghalaya, India
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Shih PY, Lin WY, Hung MH, Cheng YJ, Chan KC. Evaluation of cardiac output by bioreactance technique in patients undergoing liver transplantation. ACTA ACUST UNITED AC 2016; 54:57-61. [PMID: 27461188 DOI: 10.1016/j.aat.2016.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 06/07/2016] [Accepted: 06/13/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND This study compared the cardiac output (CO) obtained from PiCCO with that obtained from the noninvasive NICOM method. METHODS Twenty-one cirrhotic patients receiving liver transplantation were enrolled. During the operation, their CO was measured by the PiCCO system via the thermodilution method as the standard and by the NICOM method. Two parameters including cardiac index (CI) and stroke volume index (SVI) were collected simultaneously at three phases during the surgery including the dissection phase (T1), the anhepatic phase (T2), and the reperfusion phase (T3). Correlation, Bland and Altman methods, and linear mixed model were used to evaluate the monitoring ability of both systems. RESULTS Poor correlation was noted between the data measured by NICOM and PiCCO; the correlation coefficients for CI and SVI measured between the two systems were 0.32 and 0.39, respectively. Bland and Altman analysis showed the percentage error of CI as 63.7%, and that of SVI as 66.6% for NICOM compared to PiCCO. Using the linear mixed model, the CI and SVI measured using NICOM were significantly higher than those using PiCCO (estimated regression coefficient 0.92 and 10.77, both p < 0.001). Mixed model analysis showed no differences between the trends of CI and SVI measured by the two methods. CONCLUSIONS NICOM provided a comparable CI and SVI trend when compared to the gold standard PiCCO, but it raises concerns as an effective CO monitor because of its tendency to overestimate CI and SVI especially during the state of high cardiac output.
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Affiliation(s)
- Po-Yuan Shih
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Wen-Ying Lin
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-Hui Hung
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Ya-Jung Cheng
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Kuang-Cheng Chan
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan.
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Crossingham IR, Nethercott DR, Columb MO. Comparing cardiac output monitors and defining agreement: A systematic review and meta-analysis. J Intensive Care Soc 2016; 17:302-313. [PMID: 28979515 DOI: 10.1177/1751143716644457] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Measuring cardiac output is common in critical care and perioperative medicine. Different monitoring systems are often judged against others in comparative studies. There is no agreed standard or definition on which to base the conclusions of such studies. OBJECTIVES To review comparative studies of cardiac output monitors using an agreement:tolerability index (ATI) as a measure of monitor precision. To compare the ATI of a monitor with the conclusions of authors regarding agreement and clinical utility. DESIGN Systematic review of comparative studies of cardiac output monitoring systems. The precision of each monitor was standardised against an ATI using a tolerability interval based on the normal range for cardiac index. The conclusions of each study were described as positive, neutral or negative, depending on whether authors reported the monitor to be acceptably precise and/or clinically useful. Comparison was made between the precision of a monitor and the likelihood of it being favoured by authors. DATA SOURCES PubMed was searched up to March 2012. ELIGIBILITY CRITERIA Studies published in English that compared two or more methods for measuring cardiac output in adult humans. RESULTS A total of 213 papers documenting 409 separate comparisons of two methods of measuring cardiac output were included. ATIs for the different comparisons varied from 0.07 to 6.84 (where an ATI < 1 indicates acceptable agreement, 1-2 marginal and >2 unacceptable agreement). Thirty-one percent of authors defined their own terms for acceptable agreement. ATI was only moderately correlated with the conclusions of the authors (Spearman rho = 0.47, P < 0.0001). CONCLUSIONS Authors should define what constitutes acceptable agreement a priori when reporting comparative studies of cardiac output monitors. The ATI and the tolerability interval may be a useful basis for helping define acceptable precision.
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Affiliation(s)
| | | | - Malachy O Columb
- Intensive Care Unit, University Hospital of South Manchester, Manchester, UK
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Grindheim G, Eidet J, Bentsen G. Transpulmonary thermodilution (PiCCO) measurements in children without cardiopulmonary dysfunction: large interindividual variation and conflicting reference values. Paediatr Anaesth 2016; 26:418-24. [PMID: 26857433 DOI: 10.1111/pan.12859] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/11/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND The PiCCO system, based on transpulmonary thermodilution, is one of the few tools available for continuous hemodynamic monitoring in children. However, published data for some of the derived variables reveal indexed values that seem questionable. AIMS The aim of this study was to collect data from hemodynamically normal children and compare these to existing reference values. Furthermore, we sought to explore if indexing some of the variables differently could improve the clinical application of the obtained values. METHODS This is a prospective observational study in a tertiary university hospital including 31 children without cardiopulmonary disease scheduled for major neurosurgery. Measurements were performed after induction of general anesthesia. RESULTS Median age was 8 months. PiCCO-derived median Cardiac Index (CI) was 3.8 l · min(-1) · m(-2) (range 2.6-6.6), reference range 3.0-5.0, median Global End-Diastolic Volume Index (GEDVI) was 366 ml · m(-2) (range 269-685), reference range 680-800, whereas median Extravascular Lung Water Index (EVLWI) was 12 ml · kg(-1) (range 7-31), reference range 3-7. All measured variables had a high interindividual variation, especially in children weighing less than 15 kg. CONCLUSIONS Values obtained by the PiCCO system in children have a wide range, and should therefore be interpreted with caution. Current reference values published for GEDVI and EVLWI are not applicable in children; the former is too high and the latter too low, and should not guide clinical practice. Indexing by other physiological indices may reduce this problem. Using current variables, we find GEDVI 280-590 ml · m(-2) and ELWI 7-27 ml · kg(-1) to be typical ranges for children.
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Affiliation(s)
- Guro Grindheim
- Division of Emergencies and Critical Care, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Jo Eidet
- Division of Emergencies and Critical Care, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Gunnar Bentsen
- Division of Emergencies and Critical Care, Oslo University Hospital - Rikshospitalet, Oslo, Norway
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Shi H, Wang Z, Wei H, Ge Y, Chen X. Transesophageal Echocardiographic Measurement of Cardiac Index by the Prosthetic Mitral Valve Method Is Not Similar to the Continuous Thermodilution Method Via a Pulmonary Artery Catheter. J Cardiothorac Vasc Anesth 2016; 30:398-405. [PMID: 26830650 DOI: 10.1053/j.jvca.2015.10.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To compare the agreement of cardiac index measurements between transesophageal echocardiography across the prosthetic mitral valve and the continuous thermodilution method through a pulmonary artery catheter (PAC-TD) in patients undergoing double-valve replacement. DESIGN Observational prospective study. SETTING University hospital. PARTICIPANTS Twenty-five patients undergoing double-valve replacement (12 men and 13 women, age 25-78 years, ASA III-IV, NYHA II-III, LVEF≥45%). Patients were grouped according to their prosthesis (mechanical prosthesis v bioprosthesis). INTERVENTIONS All patients underwent cardiac index assessment during double-valve replacement. MEASUREMENTS AND MAIN RESULTS Cardiac index across the prosthetic mitral valve was measured simultaneously using transesophageal echocardiography (CI(MV)) and PAC-TD (CI(PAC)) at 15, 30, 45, and 60 minutes after weaning from cardiopulmonary bypass, and at 0, 15, and 30 minutes after incision closure. A correlation was present between CI(MV) and CI(PAC) in both groups (mechanical prosthesis: r = 0.47, p<0.01; bioprosthesis: r = 0.60, p<0.01). In the mechanical prosthesis group, the bias between techniques (CI(PAC) v CI(MV)) was-0.5 L/min/m(2) (95% CI:-1.97 to 0.97), and error was 55%. In the bioprosthesis group, the bias between both techniques was-1.3 L/min/m(2) (95% CI:-3.1 to 0.5), and error was 56%. CONCLUSIONS A relatively weak correlation and lack of agreement between values of CI(PAC) and CI(MV) were observed in patients undergoing double-valve replacement. Therefore, transesophageal echocardiography might not be interchangeable with PAC-TD for measuring cardiac output or cardiac index. A regression equation is needed to correct the probable value of CI(PAC). CI(MV) might be useful as a quantitative or semi-quantitative cardiac output measurement.
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Affiliation(s)
| | | | | | - Yali Ge
- Department of Anesthesiology
| | - Xin Chen
- Cardiothoracic and Vascular Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China.
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Itami T, Endo Y, Hanazono K, Ishizuka T, Tamura J, Miyoshi K, Sano T, Yamashita K. Comparison of cardiac output measurements using transpulmonary thermodilution and conventional thermodilution techniques in anaesthetized dogs with fluid overload. Vet Anaesth Analg 2015; 43:388-96. [PMID: 26671761 DOI: 10.1111/vaa.12331] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Accepted: 10/26/2015] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To evaluate the agreement between cardiac output (CO) values obtained using a transpulmonary thermodilution technique (TPTDCO) and conventional thermodilution technique (TDCO) in anaesthetized dogs with fluid overload. STUDY DESIGN Prospective experimental study. ANIMALS Six healthy Beagle dogs aged 7-8 years. METHODS Dogs were anaesthetized with sevoflurane in oxygen, and catheters were inserted for TPTDCO and TDCO measurement. After instrumentation, baseline CO was measured using each technique at a central venous pressure (CVP) of 3-7 mmHg. Dogs were subsequently administered lactated Ringer's solution and 6% hydroxyethyl starch to induce fluid overload. CO measurements were obtained using each technique at CVP values of 8-12 mmHg, 13-17 mmHg, 18-22 mmHg and 23-27 mmHg. Agreements between CO measurements obtained with the respective techniques were analysed using Dunnett's test, Pearson's correlation coefficient and Bland-Altman analysis. RESULTS Thirty pairs of CO values were obtained, ranging from 1.45 L minute(-1) to 4.69 L minute(-1) for TPTDCO and from 1.30 L minute(-1) to 4.61 L minute(-1) for TDCO. TPTDCO and TDCO values correlated strongly (r(2) = 0.915, p < 0.001). The bias and mean relative bias between TPTDCO and TDCO were 0.26 ± 0.30 L minute(-1) (limits of agreement - 0.29 to 0.81 L minute(-1) ) and 9.7%, respectively. CONCLUSIONS AND CLINICAL RELEVANCE TPTDCO and TDCO measurements obtained in anaesthetized dogs during fluid overload exhibited good agreement. Accordingly, transpulmonary thermodilution provides an accurate measurement of CO in dogs with fluid overload.
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Affiliation(s)
- Takaharu Itami
- Veterinary Teaching Hospital, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Yusuke Endo
- Department of Small Animal Clinical Sciences, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Hokkaido, Japan
| | - Kiwamu Hanazono
- Veterinary Teaching Hospital, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Tomohito Ishizuka
- Veterinary Teaching Hospital, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Jun Tamura
- Department of Small Animal Clinical Sciences, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Hokkaido, Japan
| | - Kenjiro Miyoshi
- Department of Small Animal Clinical Sciences, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Hokkaido, Japan
| | - Tadashi Sano
- Department of Small Animal Clinical Sciences, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Hokkaido, Japan
| | - Kazuto Yamashita
- Department of Small Animal Clinical Sciences, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Hokkaido, Japan
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Obata Y, Takeda J, Sato Y, Ishikura H, Matsui T, Isotani E. A multicenter prospective cohort study of volume management after subarachnoid hemorrhage: circulatory characteristics of pulmonary edema after subarachnoid hemorrhage. J Neurosurg 2015; 125:254-63. [PMID: 26613172 DOI: 10.3171/2015.6.jns1519] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECT Subarachnoid hemorrhage (SAH) is often accompanied by pulmonary complications, which may lead to poor outcomes and death. This study investigated the incidence and cause of pulmonary edema in patients with SAH by using hemodynamic monitoring with PiCCO-plus pulse contour analysis. METHODS A total of 204 patients with SAH were included in a multicenter prospective cohort study to investigate hemodynamic changes after surgical clipping or coil embolization of ruptured cerebral aneurysms by using a PiCCO-plus device. Changes in various hemodynamic parameters after SAH were analyzed statistically. RESULTS Fifty-two patients (25.5%) developed pulmonary edema. Patients with pulmonary edema (PE group) were significantly older than those without pulmonary edema (non-PE group) (p = 0.017). The mean extravascular lung water index was significantly higher in the PE group than in the non-PE group throughout the study period. The pulmonary vascular permeability index (PVPI) was significantly higher in the PE group than in the non-PE group on Day 6 (p = 0.029) and Day 10 (p = 0.011). The cardiac index of the PE group was significantly decreased biphasically on Days 2 and 10 compared with that of the non-PE group. In the early phase (Days 1-5 after SAH), the daily water balance of the PE group was slightly positive. In the delayed phase (Days 6-14 after SAH), the serum C-reactive protein level and the global end-diastolic volume index were significantly higher in the PE group than in the non-PE group, whereas the PVPI tended to be higher in the PE group. CONCLUSIONS Pulmonary edema that occurs in the early and delayed phases after SAH is caused by cardiac failure and inflammatory (i.e., noncardiogenic) conditions, respectively. Measurement of the extravascular lung water index, cardiac index, and PVPI by PiCCO-plus monitoring is useful for identifying pulmonary edema in patients with SAH.
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Affiliation(s)
- Yoshiki Obata
- Department of Neurosurgery, Tokyo Medical and Dental University;,SAH PiCCO Study Group
| | - Junichi Takeda
- Department of Neurosurgery, Kansai Medical University Takii Hospital, Osaka;,SAH PiCCO Study Group
| | - Yohei Sato
- Department of Neurosurgery, Tokyo Medical and Dental University;,SAH PiCCO Study Group
| | - Hiroyasu Ishikura
- Department of Emergency and Critical Care Medicine, Fukuoka University Hospital, Fukuoka;,SAH PiCCO Study Group
| | - Toru Matsui
- Department of Neurosurgery, Saitama Medical Center, Saitama;,SAH PiCCO Study Group
| | - Eiji Isotani
- Emergency and Critical Care Center, Tokyo Women's Medical University Medical Center East, Japan; and.,SAH PiCCO Study Group
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Bernards J, Mekeirele M, Hoffmann B, Peeters Y, De Raes M, Malbrain MLNG. Hemodynamic monitoring: To calibrate or not to calibrate? Part 2--Non-calibrated techniques. Anaesthesiol Intensive Ther 2015; 47:501-16. [PMID: 26578395 DOI: 10.5603/ait.a2015.0076] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 11/03/2015] [Indexed: 11/25/2022] Open
Abstract
There is much evidence that fluid overload leads to adverse outcomes in perioperative and critically ill patients. Cardiac output monitoring can help us guiding initial and ongoing fluid resuscitation and can help us to assess whether a patient will be responsive to fluids when hypotensive. In recent years, many sophisticated devices that measure a variety of hemodynamic parameters have evolved on the market. We wanted to provide an overview of the different techniques available today, including their validation in different patient populations. In this second part of the review, we focus on non-calibrated techniques, both invasive and non-invasive. For each technique a short overview of the working principle, together with the advantages, disadvantages and the available validation literature is listed. Many promising minimal invasive monitoring devices can help us to further optimize our hemodynamic treatment in both the perioperative and critical care setting. However, the validation data are scarce for many of these techniques, especially in complex circumstances with changing hemodynamics (preload, afterload and contractility), as with the use of fluids and vasoactive medication. The measurements made by these devices, therefore, need to be interpreted with caution. Further improvements and more validation data are needed before these techniques can be implemented in common day practice. Moreover, in severely shocked hemodynamic unstable patients, calibrated techniques are to be preferred over those which are uncalibrated. Hence, the new techniques not only need to be accurate, but also need to be precise in order to keep track of changes.
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Affiliation(s)
| | | | | | | | | | - Manu L N G Malbrain
- Intensive Care Unit and High Care Burn Unit, Ziekenhuis Netwerk Antwerpen, ZNA Stuivenberg, Antwerpen, Belgium.
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Peeters Y, Bernards J, Mekeirele M, Hoffmann B, De Raes M, Malbrain MLNG. Hemodynamic monitoring: To calibrate or not to calibrate? Part 1--Calibrated techniques. Anaesthesiol Intensive Ther 2015; 47:487-500. [PMID: 26578399 DOI: 10.5603/ait.a2015.0073] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 11/03/2015] [Indexed: 11/25/2022] Open
Abstract
Over recent decades, hemodynamic monitoring has evolved from basic cardiac output monitoring techniques to a broad variety of sophisticated monitoring devices with extra parameters. In order to reduce morbidity and mortality and optimize therapeutic strategies, different monitoring techniques can be used to guide fluid resuscitation and other medical management. Generally, they can be divided in calibrated and non-calibrated techniques. In the first part of this review, the available calibrated techniques, ranging from invasive to non-invasive, will be discussed. We performed a review of the literature in order to give an overview of the current hemodynamic monitoring devices. For each monitoring system, a short overview of the physical principles, the advantages and disadvantages and the available literature with regard to validation is given. Currently, many promising hemodynamic monitoring devices are readily available in order to optimize therapeutic management in both perioperative and ICU settings. Although several of these calibrated techniques have been validated in the literature, not all techniques have been shown to reduce morbidity and mortality. Many new techniques, especially some non-calibrated devices, lack good validation data in different clinical settings (sepsis, trauma, burns, etc.). The cardiac output values obtained with these techniques need therefore to be interpreted with caution as will be discussed in the second part of this concise review. Transthoracic echocardiography forms a good initial choice to assess hemodynamics in critically ill patients after initial stabilisation. However in complex situations or in patients not responding to fluid resuscitation alone, advanced hemodynamic monitoring is recommended with the use of calibrated techniques like transpulmonary thermodilution. Calibrated techniques are preferred in patients with severe shock and changing conditions of preload, afterload and contractility. The use of the pulmonary artery catheter should be reserved for patients with right ventricular failure in order to assess the effect of medical treatment.
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Affiliation(s)
| | | | | | | | | | - Manu L N G Malbrain
- Intensive Care Unit and High Care Burn Unit, Ziekenhuis Netwerk Antwerpen, ZNA Stuivenberg, Antwerpen, Belgium.
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Cherpanath TGV, Lagrand WK, Binnekade JM, Schneider AJ, Schultz MJ, Groeneveld JAB. Impact of Positive End-Expiratory Pressure on Thermodilution-Derived Right Ventricular Parameters in Mechanically Ventilated Critically Ill Patients. J Cardiothorac Vasc Anesth 2015; 30:632-8. [PMID: 26703971 DOI: 10.1053/j.jvca.2015.09.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To examine the effect of positive end-expiratory pressure (PEEP) on right ventricular stroke volume variation (SVV), with possible implications for the number and timing of pulmonary artery catheter thermodilution measurements. DESIGN Prospective, clinical pilot study. SETTING Academic medical center. PARTICIPANTS Patients who underwent volume-controlled mechanical ventilation and had a pulmonary artery catheter. INTERVENTION PEEP was increased from 5-to-10 cmH2O and from 10-to-15 cmH2O with 10-minute intervals, with similar decreases in PEEP, from 15-to-10 cmH2O and 10-to-5 cmH2O. MEASUREMENTS AND MAIN RESULTS In 15 patients, right ventricular parameters were measured using thermodilution at 10% intervals of the ventilatory cycle at each PEEP level with a rapid-response thermistor. Mean right ventricular stroke volume and end-diastolic volume declined during incremental PEEP and normalized on return to 5 cmH2O PEEP (p = 0.01 and p = 0.001, respectively). Right ventricular SVV remained unaltered by changes in PEEP (p = 0.26), regardless of incremental PEEP (p = 0.15) or decreased PEEP (p = 0.12). The coefficients of variation in the ventilatory cycle of all other thermodilution-derived right ventricular parameters also were unaffected by changes in PEEP. CONCLUSIONS This study showed that increases in PEEP did not affect right ventricular SVV in critically ill patients undergoing mechanical ventilation despite reductions in mean right ventricular stroke volume and end-diastolic volume. This could be explained by cyclic counteracting changes in right ventricular preloading and afterloading during the ventilatory cycle, independent of PEEP. Changes in PEEP did not affect the number and timing of pulmonary artery catheter thermodilution measurements.
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Affiliation(s)
| | - Wim K Lagrand
- Department of Intensive Care Medicine, Academic Medical Center, Amsterdam
| | - Jan M Binnekade
- Department of Intensive Care Medicine, Academic Medical Center, Amsterdam
| | - Anton J Schneider
- Department of Clinical Pharmacology, VU University Medical Center, Amsterdam
| | - Marcus J Schultz
- Laboratory of Experimental Intensive Care and Anaesthesiology (LEICA), Academic Medical Center, Amsterdam
| | - Johan A B Groeneveld
- Department of Intensive Care Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
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Calbet JAL, Mortensen SP, Munch GDW, Curtelin D, Boushel R. Constant infusion transpulmonary thermodilution for the assessment of cardiac output in exercising humans. Scand J Med Sci Sports 2015; 26:518-27. [PMID: 25919489 DOI: 10.1111/sms.12473] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2015] [Indexed: 12/29/2022]
Abstract
To determine the accuracy and precision of constant infusion transpulmonary thermodilution cardiac output (CITT-Q) assessment during exercise in humans, using indocyanine green (ICG) dilution and bolus transpulmonary thermodilution (BTD) as reference methods, cardiac output (Q) was determined at rest and during incremental one- and two-legged pedaling on a cycle ergometer, and combined arm cranking with leg pedaling to exhaustion in 15 healthy men. Continuous infusions of iced saline in the femoral vein (n = 41) or simultaneously in the femoral and axillary (n = 66) veins with determination of temperature in the femoral artery were used for CITT-Q assessment. CITT-Q was linearly related to ICG-Q (r = 0.82, CITT-Q = 0.876 × ICG-Q + 3.638, P < 0.001; limits of agreement ranging from -1.43 to 3.07 L/min) and BTD-Q (r = 0.91, CITT-Q = 0.822 × BTD + 4.481 L/min, P < 0.001; limits of agreement ranging from -1.01 to 2.63 L/min). Compared with ICG-Q and BTD-Q, CITT-Q overestimated cardiac output by 1.6 L/min (≈ 10% of the mean ICG and BTD-Q values, P < 0.05). For Q between 20 and 28 L/min, we estimated an overestimation < 5%. The coefficient of variation of 23 repeated CITT-Q measurements was 6.0% (CI: 6.1-11.1%). In conclusion, cardiac output can be precisely and accurately determined with constant infusion transpulmonary thermodilution in exercising humans.
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Affiliation(s)
- J A L Calbet
- Department of Physical Education, Research Institute of Biomedical and Health Sciences, IUIBS, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain.,Copenhagen Muscle Research Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - S P Mortensen
- Copenhagen Muscle Research Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,The Centre of Inflammation and Metabolism, Centre for Physical Activity Research, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Cardiovascular and Renal Research, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - G D W Munch
- Copenhagen Muscle Research Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,The Centre of Inflammation and Metabolism, Centre for Physical Activity Research, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - D Curtelin
- Department of Physical Education, Research Institute of Biomedical and Health Sciences, IUIBS, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain.,Emergency Medicine Department, Insular Universitary Hospital of Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - R Boushel
- Copenhagen Muscle Research Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Åstrand Laboratory, The Swedish School of Sport and Health Sciences, Stockholm, Sweden
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Abstract
The last decades have been characterized by a continuous evolution of hemodynamic monitoring techniques from intermittent toward continuous and real-time measurements and from an invasive towards a less invasive approach. The latter approach uses ultrasounds and pulse contour analysis techniques that have been developed over the last 15 years. During the same period, the concept of prediction of fluid responsiveness has also been developed and dynamic indices such as pulse pressure variation, stroke volume variation, and the real-time response of cardiac output to passive leg raising or to end-expiration occlusion, can be easily obtained and displayed with the minimally invasive techniques. In this article, we review the main hemodynamic monitoring devices currently available with their respective advantages and drawbacks. We also present the current viewpoint on how to choose a hemodynamic monitoring device in the most severely ill patients and especially in patients with circulatory shock.
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Affiliation(s)
- Olfa Hamzaoui
- Intensive Care Unit, Antoine Beclere Hospital, Clamart, France
| | - Xavier Monnet
- Medical Intensive Care Unit, Bicetre Hospital, Le Kremlin-Bicetre, France ; Paris-South University, Inserm U999, Le Kremlin-Bicetre, France
| | - Jean-Louis Teboul
- Medical Intensive Care Unit, Bicetre Hospital, Le Kremlin-Bicetre, France ; Paris-South University, Inserm U999, Le Kremlin-Bicetre, France
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47
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Chen S, Lin P, Du Z, Lan F, Wu S, Zhong T, Liang X, Liu H, Zeng C, Zhang C. Comparison of the accuracy of transpulmonary thermodilution measurement using indicators of different temperatures. Int J Clin Exp Med 2014; 7:5711-5714. [PMID: 25664096 PMCID: PMC4307543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 11/15/2014] [Indexed: 06/04/2023]
Abstract
Transpulmonary thermodilution measurement is a convenient method for hemodynamic monitoring. However, the previously reported indicator temperature was not consistent. This study aimed to compare the accuracy of Pulse index Continuous Cardiac Output (PiCCO) monitoring using indicators of different temperatures. A total of 104 critically ill patients received PiCCO monitoring using indicators of either 0°C or 8°C. The PiCCO measurements, including general ejection fraction, global end-diastolic index, and cardiac index, were compared between the two temperatures, and were also correlated with that of transesophageal echocardiography (TEE). The two indicator temperatures differed significantly in hemodynamic measurements (P<0.01). PiCCO measurements with either indicator temperatures showed positive correlation with TEE results (P<0.05). The 0°C indicator had universally higher correlation coefficients than the 8°C indicator. So, PiCCO monitoring with the 0°C indicator might have better accuracy than the 8°C indicator.
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Affiliation(s)
- Shulan Chen
- Department of General Surgery, PLA 180 Hospital Quanzhou 362000, China
| | - Pingdong Lin
- Department of General Surgery, PLA 180 Hospital Quanzhou 362000, China
| | - Zhenshuang Du
- Department of General Surgery, PLA 180 Hospital Quanzhou 362000, China
| | - Fangchen Lan
- Department of General Surgery, PLA 180 Hospital Quanzhou 362000, China
| | - Shanshan Wu
- Department of General Surgery, PLA 180 Hospital Quanzhou 362000, China
| | - Tiegang Zhong
- Department of General Surgery, PLA 180 Hospital Quanzhou 362000, China
| | - Xiaohua Liang
- Department of General Surgery, PLA 180 Hospital Quanzhou 362000, China
| | - Hongyu Liu
- Department of General Surgery, PLA 180 Hospital Quanzhou 362000, China
| | - Cuiping Zeng
- Department of General Surgery, PLA 180 Hospital Quanzhou 362000, China
| | - Chenghua Zhang
- Department of General Surgery, PLA 180 Hospital Quanzhou 362000, China
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48
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Kirkeby-Garstad I, Trønnes H, Stenseth R, Sellevold OFM, Aadahl P, Skogvoll E. The Precision of Pulmonary Artery Catheter Bolus Thermodilution Cardiac Output Measurements Varies With the Clinical Situation. J Cardiothorac Vasc Anesth 2014; 29:881-8. [PMID: 25976600 DOI: 10.1053/j.jvca.2014.12.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To investigate the effects of ventilatory mode, injectate temperature, and clinical situation on the precision of cardiac output measurements. DESIGN Randomized, prospective observational study. SETTING Single university hospital. PARTICIPANTS Forty patients undergoing planned cardiac surgery, receiving a pulmonary artery catheter according to institutional routine. INTERVENTIONS Cardiac output was measured at 4 predefined time points during the perioperative patient course, twice during controlled and twice during spontaneous ventilation, using 2 blocks of 8 measurement replications with cold and tepid injectate in random order. MEASUREMENTS AND MAIN RESULTS The data were analyzed using a hierarchical linear mixed model. Clinical precision was determined as half the width of the 95% confidence interval for the underlying true value. The single-measurement precision measured in 2 different clinical situations for each temperature/ventilation combination was 8% to 10%, 11% to 13%, 13% to 15%, and 23% to 24% in controlled ventilation with cold injectate, controlled ventilation with tepid injectate, spontaneous breathing with cold injectate, and spontaneous breathing with tepid injectate, respectively. Tables are provided for the number of replications needed to achieve a certain precision and for how to identify significant changes in cardiac output. CONCLUSIONS Clinical precision of cardiac output measurements is reduced significantly during spontaneous relative to controlled ventilation. The differences in precision between repeated measurement series within the temperature/ventilation combinations indicate influence of other situation-specific factors not related to ventilatory mode. Compared with tepid injectate in patients breathing spontaneously, the precision is 3-fold better with cold injectate and controlled ventilation.
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Affiliation(s)
- Idar Kirkeby-Garstad
- Department of Anesthesiology and Intensive Care, St. Olav University Hospital, Trondheim, Norway.
| | - Håkon Trønnes
- Department of Anesthesiology and Intensive Care, St. Olav University Hospital, Trondheim, Norway
| | - Roar Stenseth
- Department of Anesthesiology and Intensive Care, St. Olav University Hospital, Trondheim, Norway; Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Olav F M Sellevold
- Department of Anesthesiology and Intensive Care, St. Olav University Hospital, Trondheim, Norway; Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Petter Aadahl
- Department of Anesthesiology and Intensive Care, St. Olav University Hospital, Trondheim, Norway; Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Eirik Skogvoll
- Department of Anesthesiology and Intensive Care, St. Olav University Hospital, Trondheim, Norway; Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
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49
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Morgaz J, Granados MDM, Muñoz-Rascón P, Dominguez JM, Fernández-Sarmiento JA, Gómez-Villamandos RJ, Navarrete R. Comparison of thermodilution, lithium dilution, and pulse contour analysis for the measurement of cardiac output in 3 different hemodynamic states in dogs. J Vet Emerg Crit Care (San Antonio) 2014; 24:562-70. [PMID: 25142925 DOI: 10.1111/vec.12219] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 07/14/2014] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To (1) evaluate lithium dilution (LiDCO) and transpulmonary thermodilution (PiCCOTD ) in relation to traditional thermodilution (PAC-TD) for determining cardiac output (CO) in 3 different hemodynamic states in dogs and to (2) compare the continuous CO values obtained using power analysis (PulseCO) with continuous PiCCO (PiCCOc). DESIGN Prospective randomized study. SETTING University research laboratory. ANIMALS Fourteen healthy Beagles. INTERVENTIONS CO was measured using PAC-TD, LiDCO, and PiCCOTD in 3 different hemodynamic states induced in random order and defined on the basis of the mean arterial pressure (MAP). Normodynamic state was defined as the baseline MAP and 1 MAC sevoflurane. The hypodynamic state was induced with a deep level of sevoflurane anesthesia. The hyperdynamic state was induced with noradrenaline. After these measurements were obtained in each hemodynamic state, CO was monitored continuously for 30 min using PulseCO and PiCCOc. Agreement was assessed using Bland-Altman analysis and intraclass correlation coefficients, and a trend score was determined for the continuous CO measurements. MEASUREMENTS AND MAIN RESULTS There was good agreement among the 3 modalities of CO measurement in each hemodynamic state. The mean CIPAC-TD /CIPICCOTD bias was -0.04 ± 1.19 L/min/m(2) (limits of agreement, -2.37/1.93 L/min/m(2) ), and the mean CIPAC-TD /CILiDCO bias was -0.11 ± 1.55 L/min/m(2) (limits of agreement, -3.04/2.93 L/min/m(2) ). The mean CIPulseCO -CIPiCCOc bias was -0.04 ± 1.91 L/min/m(2) (limits of agreement, -1.95/1.87 L/min/m(2) ), which suggested good agreement. The CIPulseCO -CIPiCCOc trend score, calculated from 252 paired comparisons, was 93.3% positive after zone exclusion (∆CI < 15%). CONCLUSIONS Both LiDCO and PiCCOTD agreed well with PAC-TD for the measurement of CO under different hemodynamic conditions. Moreover, PiCCOc appears to be an accurate method for monitoring continuous CO in dogs as its performance for measurement was similar to that of PulseCO.
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Affiliation(s)
- Juan Morgaz
- Department of Animal Medicine and Surgery, University of Córdoba, Córdoba, Spain
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50
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Abstract
Advanced haemodynamic monitoring employing minimally invasive cardiac output measurement may lead to significant improvements in patient outcomes in major surgery. However, the precision (scatter) of measurement of available generic technologies has been shown to be unsatisfactory with percentage error of agreement with bolus thermodilution (% error) of 40% to 50%. Simultaneous measurement and averaging by two or more technologies may reduce random measurement scatter and improve precision. This concept, called the hybrid method, was tested by comparing accuracy and precision of measurement relative to bolus thermodilution using combinations of three component methods. Thirty patients scheduled for either elective cardiac surgery or liver transplantation were studied. Agreement with simultaneous bolus thermodilution of hybrid combinations of continuous thermodilution (QtCCO) or Vigeleo™/FloTrac™ pulse contour measurement (QtFT) with pulmonary Capnotracking (QtCO2) was assessed pre- and post-cardiopulmonary bypass or pre- and post-reperfusion of the donor liver and compared with that of the component methods alone. Hybridisation of QtCO2 (% error 42.2) and QtCCO (% error 51.3) achieved significantly better precision (% error 31.3) than the component methods (P=0.0004) and (P=0.0195). Due to poor inherent precision of QtFT (% error 82.8), hybrid combination of QtFT with QtCO2 did not result in better precision than QtCO2 alone. Hybrid measurement can approach a 30% error, which is recommended as the upper limit for acceptability. This is a practical option where at least one component method, such as Capnotracking, is automated and does not increase the cost or complexity of the measurement process.
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Affiliation(s)
- P Peyton
- Department of Anaesthesia, Austin Health, Melbourne, Victoria, Australia, and University Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
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