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Putko K, Erber J, Wagner F, Busch D, Schuster H, Schmid RM, Lahmer T, Rasch S. Accuracy of hemodynamic parameters derived by GE E-PiCCO in comparison with PiCCO® in patients admitted to the intensive care unit. Sci Rep 2023; 13:6861. [PMID: 37100865 PMCID: PMC10133386 DOI: 10.1038/s41598-023-34141-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 04/25/2023] [Indexed: 04/28/2023] Open
Abstract
To evaluate the agreement and accuracy of a novel advanced hemodynamic monitoring (AHM) device, the GE E-PiCCO module, with the well-established PiCCO® device in intensive care patients using pulse contour analysis (PCA) and transpulmonary thermodilution (TPTD). A total of 108 measurements were performed in 15 patients with AHM. Each of the 27 measurement sequences (one to four per patient) consisted of a femoral and a jugular indicator injection via central venous catheters (CVC) and measurement using both PiCCO (PiCCO® Jug and Fem) and GE E-PiCCO (GE E-PiCCO Jug and Fem) devices. For statistical analysis, Bland-Altman plots were used to compare the estimated values derived from both devices. The cardiac index measured via PCA (CIpc) and TPTD (CItd) was the only parameter that fulfilled all a priori-defined criteria based on bias and the limits of agreement (LoA) by the Bland-Altman method as well as the percentage error by Critchley and Critchley for all three comparison pairs (GE E-PiCCO Jug vs. PiCCO® Jug, GE E-PiCCO Fem vs. PiCCO® Fem, and GE E-PiCCO Fem vs. GE E-PiCCO Jug), while the GE E-PiCCO did not accurately estimate EVLWI, SVRI, SVV, and PPV values measured via the jugular and femoral CVC compared with values assessed by PiCCO®. Consequently, measurement discrepancy should be considered on evaluation and interpretation of the hemodynamic status of patients admitted to the ICU when using the GE E-PiCCO module instead of the PiCCO® device.
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Affiliation(s)
- Katarzyna Putko
- Department of Internal Medicine II, School of Medicine, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Johanna Erber
- Department of Internal Medicine II, School of Medicine, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Franziska Wagner
- Department of Internal Medicine II, School of Medicine, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Daniel Busch
- Department of Internal Medicine II, School of Medicine, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Hannah Schuster
- Department of Internal Medicine II, School of Medicine, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Roland M Schmid
- Department of Internal Medicine II, School of Medicine, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Tobias Lahmer
- Department of Internal Medicine II, School of Medicine, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Sebastian Rasch
- Department of Internal Medicine II, School of Medicine, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany.
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Ylikauma LA, Tuovila MJ, Ohtonen PP, Erkinaro TM, Vakkala MA, Takala HT, Liisanantti JH, Kaakinen TI. Reliability of bioreactance and pulse power analysis in measuring cardiac index during cytoreductive abdominal surgery with hyperthermic intraperitoneal chemotherapy (HIPEC). BMC Anesthesiol 2023; 23:38. [PMID: 36721097 PMCID: PMC9887811 DOI: 10.1186/s12871-023-01988-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 01/16/2023] [Indexed: 02/02/2023] Open
Abstract
PURPOSE Various malignancies with peritoneal carcinomatosis are treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC). The hemodynamic instability resulting from fluid balance alterations during the procedure necessitates reliable hemodynamic monitoring. The aim of the study was to compare the accuracy, precision and trending ability of two less invasive hemodynamic monitors, bioreactance-based Starling SV and pulse power device LiDCOrapid with bolus thermodilution technique with pulmonary artery catheter in the setting of cytoreductive surgery with HIPEC. METHODS Thirty-one patients scheduled for cytoreductive surgery were recruited. Twenty-three of them proceeded to HIPEC and were included to the study. Altogether 439 and 430 intraoperative bolus thermodilution injections were compared to simultaneous cardiac index readings obtained with Starling SV and LiDCOrapid, respectively. Bland-Altman method, four-quadrant plots and error grids were used to assess the agreement of the devices. RESULTS Comparing Starling SV with bolus thermodilution, the bias was acceptable (0.13 l min- 1 m- 2, 95% CI 0.05 to 0.20), but the limits of agreement were wide (- 1.55 to 1.71 l min- 1 m- 2) and the percentage error was high (60.0%). Comparing LiDCOrapid with bolus thermodilution, the bias was acceptable (- 0.26 l min- 1 m- 2, 95% CI - 0.34 to - 0.18), but the limits of agreement were wide (- 1.99 to 1.39 l min- 1 m- 2) and the percentage error was high (57.1%). Trending ability was inadequate with both devices. CONCLUSION Starling SV and LiDCOrapid were not interchangeable with bolus thermodilution technique limiting their usefulness in the setting of cytoreductive surgery with HIPEC.
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Affiliation(s)
- Laura Anneli Ylikauma
- grid.412326.00000 0004 4685 4917Research Group of Surgery, Intensive Care Unit, Anaesthesiology and Intensive Care Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, PL 21, 90029 OYS Oulu, Finland
| | - Mari Johanna Tuovila
- grid.412326.00000 0004 4685 4917Research Group of Surgery, Intensive Care Unit, Anaesthesiology and Intensive Care Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, PL 21, 90029 OYS Oulu, Finland
| | - Pasi Petteri Ohtonen
- grid.412326.00000 0004 4685 4917Research Group of Surgery, Intensive Care Unit, Anaesthesiology and Intensive Care Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, PL 21, 90029 OYS Oulu, Finland ,grid.412326.00000 0004 4685 4917Research Service Unit, Oulu University Hospital, Oulu, Finland
| | - Tiina Maria Erkinaro
- grid.412326.00000 0004 4685 4917Research Group of Surgery, Intensive Care Unit, Anaesthesiology and Intensive Care Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, PL 21, 90029 OYS Oulu, Finland
| | - Merja Annika Vakkala
- grid.412326.00000 0004 4685 4917Research Group of Surgery, Intensive Care Unit, Anaesthesiology and Intensive Care Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, PL 21, 90029 OYS Oulu, Finland
| | - Heikki Timo Takala
- grid.412326.00000 0004 4685 4917Department of Surgery, Oulu University Hospital, Oulu, Finland
| | - Janne Henrik Liisanantti
- grid.412326.00000 0004 4685 4917Research Group of Surgery, Intensive Care Unit, Anaesthesiology and Intensive Care Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, PL 21, 90029 OYS Oulu, Finland
| | - Timo Ilari Kaakinen
- grid.412326.00000 0004 4685 4917Research Group of Surgery, Intensive Care Unit, Anaesthesiology and Intensive Care Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, PL 21, 90029 OYS Oulu, Finland
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Ylikauma LA, Lanning KM, Erkinaro TM, Ohtonen PP, Vakkala MA, Liisanantti JH, Juvonen TS, Kaakinen TI. Reliability of Bioreactance and Pulse-Power Analysis in Measuring Cardiac Index in Patients Undergoing Cardiac Surgery With Cardiopulmonary Bypass. J Cardiothorac Vasc Anesth 2021; 36:2446-2453. [PMID: 35027295 DOI: 10.1053/j.jvca.2021.11.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/21/2021] [Accepted: 11/29/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Less-invasive and continuous cardiac output monitors recently have been developed to monitor patient hemodynamics. The aim of this study was to compare the accuracy, precision, and trending ability of noninvasive bioreactance-based Starling SV and miniinvasive pulse-power device LiDCOrapid to bolus thermodilution technique with a pulmonary artery catheter (TDCO) when measuring cardiac index in the setting of cardiac surgery with cardiopulmonary bypass (CPB). DESIGN A prospective method-comparison study. SETTING Oulu University Hospital, Finland. PARTICIPANTS Twenty patients undergoing cardiac surgery with CPB. INTERVENTIONS Cardiac index measurements were obtained simultaneously with TDCO intraoperatively and postoperatively, resulting in 498 measurements with Starling SV and 444 with LiDCOrapid. MEASUREMENTS AND MAIN RESULTS The authors used the Bland-Altman method to investigate the agreement between the devices and four-quadrant plots with error grids to assess the trending ability. The agreement between TDCO and Starling SV was qualified with a bias of 0.43 L/min/m2 (95% confidence interval [CI], 0.37-0.50), wide limits of agreement (LOA, -1.07 to 1.94 L/min/m2), and a percentage error (PE) of 66.3%. The agreement between TDCO and LiDCOrapid was qualified, with a bias of 0.22 L/min/m2 (95% CI 0.16-0.27), wide LOA (-0.93 to 1.43), and a PE of 53.2%. With both devices, trending ability was insufficient. CONCLUSION The reliability of bioreactance-based Starling SV and pulse-power analyzer LiDCOrapid was not interchangeable with TDCO, thus limiting their usefulness in cardiac surgery with CPB.
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Affiliation(s)
- Laura Anneli Ylikauma
- Research Group of Surgery, Anesthesiology and Intensive Care Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.
| | - Katriina Marjatta Lanning
- Research Group of Surgery, Anesthesiology and Intensive Care Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Tiina Maria Erkinaro
- Research Group of Surgery, Anesthesiology and Intensive Care Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Pasi Petteri Ohtonen
- Research Group of Surgery, Anesthesiology and Intensive Care Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; Division of Operative Care, Oulu University Hospital, Oulu, Finland
| | - Merja Annika Vakkala
- Research Group of Surgery, Anesthesiology and Intensive Care Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Janne Henrik Liisanantti
- Research Group of Surgery, Anesthesiology and Intensive Care Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Tatu Sakari Juvonen
- Research Group of Surgery, Anesthesiology and Intensive Care Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; Department of Cardiac Surgery, Heart and Lung Center, Helsinki University Central Hospital, Helsinki University Hospital, Helsinki, Finland
| | - Timo Ilari Kaakinen
- Research Group of Surgery, Anesthesiology and Intensive Care Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
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Effect of fluid strategy on stroke volume, cardiac output, and fluid responsiveness in adult patients undergoing major abdominal surgery: a sub-study of the Restrictive versus Liberal Fluid Therapy in Major Abdominal Surgery (RELIEF) trial. Br J Anaesth 2021; 126:818-825. [PMID: 33632521 DOI: 10.1016/j.bja.2021.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 12/18/2020] [Accepted: 01/09/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND We designed a prospective sub-study of the larger Restrictive versus Liberal Fluid Therapy in Major Abdominal Surgery (RELIEF) trial to measure differences in stroke volume and other haemodynamic parameters at the end of the intraoperative fluid protocols. The haemodynamic effects of the two fluid regimens may increase our understanding of the observed perioperative outcomes. METHODS Stroke volume and cardiac output were measured with both an oesophageal Doppler ultrasound monitor and arterial pressure waveform analysis. Stroke volume variation, pulse pressure variation, and plethysmographic variability index were also obtained. A passive leg raise manoeuvre was performed to identify fluid responsiveness. RESULTS Analysis of 105 patients showed that the primary outcome, Doppler monitor-derived stroke volume index, was higher in the liberal group: restrictive 38.5 (28.6-48.8) vs liberal 44.0 (34.9-61.9) ml m-2; P=0.043. Similarly, there was a higher cardiac index in the liberal group: 2.96 (2.32-4.05) vs 2.42 (1.94-3.26) L min-1 m-2; P=0.015. Arterial-pressure-based stroke volume and cardiac index did not differ, nor was there a significant difference in stroke volume variation, pulse pressure variation, or plethysmographic variability index. The passive leg raise manoeuvre showed fluid responsiveness in 40% of restrictive and 30% of liberal protocol patients (not significant). CONCLUSIONS The liberal fluid group from the RELIEF trial had significantly higher Doppler ultrasound monitor-derived stroke volume and cardiac output compared with the restrictive fluid group at the end of the intraoperative period. Measures of fluid responsiveness did not differ significantly between groups. CLINICAL TRIAL REGISTRATION ACTRN12615000125527.
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Sengupta SP, Mungulmare K, Okwose NC, MacGowan GA, Jakovljevic DG. Comparison of cardiac output estimates by echocardiography and bioreactance at rest and peak dobutamine stress test in heart failure patients with preserved ejection fraction. Echocardiography 2020; 37:1603-1609. [PMID: 32949037 DOI: 10.1111/echo.14836] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/25/2020] [Accepted: 08/02/2020] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To assess the agreement between cardiac output estimated by two-dimensional echocardiography and bioreactance methods at rest and during dobutamine stress test in heart failure patients with preserved left ventricular ejection fraction (HFpEF). METHODS Hemodynamic measurements were assessed in 20 stable HFpEF patients (12 females; aged 61 ± 7 years) using echocardiography and bioreactance methods during rest and dobutamine stress test at increment dosages of 5, 10, 15, and 20 μg/kg/min until maximal dose was achieved or symptoms and sign occurred, that is, chest pain, abnormal blood pressure elevation, breathlessness, ischemic changes, or arrhythmia. RESULTS Resting cardiac output and cardiac index estimated by bioreactance and echocardiography were not significantly different. At peak dobutamine stress test, cardiac output and cardiac index estimated by echocardiography and bioreactance were significantly different (7.06 ± 1.43 vs 5.71 ± 1.59 L/min, P < .01; and 4.27 ± 0.67 vs 3.43 ± 0.87 L/m2 /min; P < .01) due to the significant differences in stroke volume. There was a strong positive relationship between cardiac outputs obtained by the two methods at peak dobutamine stress (r = .79, P < .01). The mean difference (lower and upper limits of agreement) between bioreactance and echocardiography cardiac outputs at rest and peak dobutamine stress was -0.45 (1.71 to -2.62) L/min and -1.35 (0.60 to -3.31) L/min, respectively. CONCLUSION Bioreactance and echocardiography methods provide different cardiac output values at rest and during stress thus cannot be used interchangeably. Ability to continuously monitor key hemodynamic variables such as cardiac output, stroke volume, and heart rate is the major advantage of bioreactance method.
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Affiliation(s)
- Shantanu P Sengupta
- Cardiology, Sengupta Hospital and Research Institute, Ravinagar Nagpur, Maharashtra, India.,Faculty of Medical Sciences, Cardiovascular Research Translational and Clinical Research Institute, Newcastle upon Tyne, UK
| | - Kunda Mungulmare
- Cardiology, Sengupta Hospital and Research Institute, Ravinagar Nagpur, Maharashtra, India
| | - Nduka C Okwose
- Faculty of Medical Sciences, Cardiovascular Research Translational and Clinical Research Institute, Newcastle upon Tyne, UK
| | - Guy A MacGowan
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,Faculty of Medical Sciences, Biosciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Djordje G Jakovljevic
- Faculty of Medical Sciences, Cardiovascular Research Translational and Clinical Research Institute, Newcastle upon Tyne, UK.,Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,Faculty of Health and Life Sciences, Coventry University, Coventry, UK
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Milam AJ, Ghoddoussi F, Lucaj J, Narreddy S, Kumar N, Reddy V, Hakim J, Krishnan SH. Comparing the Mutual Interchangeability of ECOM, FloTrac/Vigileo, 3D-TEE, and ITD-PAC Cardiac Output Measuring Systems in Coronary Artery Bypass Grafting. J Cardiothorac Vasc Anesth 2020; 35:514-529. [PMID: 32622708 DOI: 10.1053/j.jvca.2020.03.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 03/18/2020] [Accepted: 03/24/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVE The aim of this study was to compare the mutual interchangeability of 4 cardiac output measuring devices by comparing their accuracy, precision, and trending ability. DESIGN A single-center prospective observational study. DESIGN Nonuniversity teaching hospital, single center. PARTICIPANTS Forty-four consecutive patients scheduled for elective, nonemergent coronary artery bypass grafting (CABG). INTERVENTIONS The cardiac output was measured for each participant using 4 methods: intermittent thermodilution via pulmonary artery catheter (ITD-PAC), Endotracheal Cardiac Output Monitor (ECOM), FloTrac/Vigileo System (FLOTRAC), and 3-dimensional transesophageal echocardiography (3D-TEE). MEASUREMENTS AND MAIN RESULTS Measurements were performed simultaneously at 5 time points: presternotomy, poststernotomy, before cardiopulmonary bypass, after cardiopulmonary bypass, and after sternal closure. A series of statistical and comparison analyses including ANOVA, Pearson correlation, Bland-Altman plots, quadrant plots, and polar plots were performed, and inherent precision for each method and percent errors for mutual interchangeability were calculated. For the 6 two-by-two comparisons of the methods, the Pearson correlation coefficients (r), the percentage errors (% error), and concordance ratios (CR) were as follows: ECOM_versus_ITD-PAC (r = 0.611, % error = 53%, CR = 75%); FLOTRAC_versus_ITD-PAC (r = 0.676, % error = 49%, CR = 77%); 3D-TEE versus ITD-PAC (r = 0.538, % error = 64%, CR = 67%); FLOTRAC_versus_ECOM (r = 0.627, % error = 51%, CR = 75%); 3D-TEE_versus ECOM (r = 0.423, % error = 70%, CR = 60%), and 3D-TEE_versus_FLOTRAC (r = 0.602, % error = 59%, CR = 61%). CONCLUSIONS Based on the recommended statistical measures of interchangeability, ECOM, FLOTRAC, and 3D-TEE are not interchangeable with each other or to the reference standard invasive ITD-PAC method in patients undergoing nonemergent cardiac bypass surgery. Despite the negative result in this study and the majority of previous studies, these less-invasive methods of CO have continued to be used in the hemodynamic management of patients. Each device has its own distinct technical features and inherent limitations; it is clear that no single device can be used universally for all patients. Therefore, different methods or devices should be chosen based on individual patient conditions, including the degree of invasiveness, measurement performance, and the ability to provide real-time, continuous CO readings.
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Affiliation(s)
- Adam J Milam
- Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Farhad Ghoddoussi
- Department of Anesthesiology, Wayne State University School of Medicine, Detroit, MI
| | - Jon Lucaj
- Department of Anesthesiology, Wayne State University School of Medicine, Detroit, MI; Department of Anesthesiology, St. Joseph Mercy Oakland Hospital, Pontiac, MI
| | - Spurthy Narreddy
- Department of Anesthesiology, Wayne State University School of Medicine, Detroit, MI; Department of Anesthesiology, St. Joseph Mercy Oakland Hospital, Pontiac, MI
| | - Nakul Kumar
- Department of Anesthesiology, Cleveland Clinic, Cleveland, OH
| | - Vennela Reddy
- Department of Anesthesiology, Wayne State University School of Medicine, Detroit, MI; Department of Anesthesiology, St. Joseph Mercy Oakland Hospital, Pontiac, MI
| | - Joffer Hakim
- Department of Anesthesiology, Wayne State University School of Medicine, Detroit, MI; Department of Anesthesiology, St. Joseph Mercy Oakland Hospital, Pontiac, MI
| | - Sandeep H Krishnan
- Department of Anesthesiology, Wayne State University School of Medicine, Detroit, MI; Department of Anesthesiology, St. Joseph Mercy Oakland Hospital, Pontiac, MI.
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Rüschen D, Rimke M, Gesenhues J, Leonhardt S, Walter M. Online cardiac output estimation during transvalvular left ventricular assistance. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2019; 171:87-97. [PMID: 27609634 DOI: 10.1016/j.cmpb.2016.08.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 08/09/2016] [Accepted: 08/25/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND AND OBJECTIVES Sufficient cardiac output is one of the main goals of ventricular assist device therapy. To date, there is no adequate method to estimate the combined amount of blood the native heart and a continuous-flow assist device pump through the circulatory system. This paper presents an approach to estimate total cardiac output based on the signals provided by optical pressure sensors mounted on the inlet and outlet of an Abiomed Impella CP pump. METHODS Two Kalman filters were used in parallel for joint estimation of the aortic flow rate and the hydraulic resistance of the aortic valve. The filters utilized a third order nonlinear state-space representation of the cardiovascular system with two nominal parameter sets, one for ovine and another for human subjects. The accuracy of the estimated cardiac output has been investigated in a hybrid mock circulatory loop and an animal study involving two sheep with experimentally induced acute ischaemic heart disease supported by a transvalvular left ventricular assist device. RESULTS The in vitro accuracy of the cardiac output estimation is ±3.64%. In an ovine model, the comparison of the estimated cardiac output with an ultrasonic flow measurement in the pulmonary artery showed 95% limits of agreement of -0.004 ± 0.897 L min-1. The estimation errors were comparable to the accuracy of the measurement (±10%), which is the gold standard in research for invasive blood flow diagnostics. CONCLUSIONS The online estimation of total cardiac output may give the treating physician a direct and physiologically meaningful feedback on the pump speed setting. One promising possible application of our method is physiological control, where the cardiac output can be used as the control variable for closed-loop ventricular assist device therapy.
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Affiliation(s)
- Daniel Rüschen
- Philips Chair for Medical Information Technology, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany.
| | - Miriam Rimke
- Philips Chair for Medical Information Technology, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany
| | - Jonas Gesenhues
- Institute of Automatic Control, RWTH Aachen University, Aachen, Germany
| | - Steffen Leonhardt
- Philips Chair for Medical Information Technology, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany
| | - Marian Walter
- Philips Chair for Medical Information Technology, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany
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Altamirano-Diaz L, Welisch E, Dempsey AA, Park TS, Grattan M, Norozi K. Non-invasive measurement of cardiac output in children with repaired coarctation of the aorta using electrical cardiometry compared to transthoracic Doppler echocardiography. Physiol Meas 2018; 39:055003. [PMID: 29695645 DOI: 10.1088/1361-6579/aac02b] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate the equivalence of the ICON® electrical cardiometry (EC) haemodynamic monitor to measure cardiac output (CO) relative to transthoracic Doppler echocardiography (TTE) in paediatric patients with repaired coarctation of the aorta (CoA). APPROACH A group of n = 28 CoA patients and n = 27 matched controls were enrolled. EC and TTE were performed synchronously on each participant and CO measurements compared using linear regression and Bland-Altman analysis. The CoA group was further subdivided into two groups, with n = 10 and without n = 18 increased left ventricular outflow tract velocity (iLVOTv) for comparison. MAIN RESULTS CO measurements from EC and TTE in controls showed a strong correlation (R = 0.80, p < 0.001) and an acceptable percentage error (PE) of 28.1%. However, combining CoA and control groups revealed a moderate correlation (R = 0.57, p < 0.001) and a poor PE (44.2%). We suspected that the CO in a subset of CoA participants with iLVOTv was overestimated by TTE. Excluding the iLVOTv CoA participants improved the correlation (R = 0.77, p < 0.001) and resulted in an acceptable PE of 31.2%. SIGNIFICANCE CO measurements in paediatric CoA patients in the absence of iLVOTv are clinically equivalent between EC and TTE. The presence of iLVOTv may impact the accuracy of CO measurement by TTE, but not EC.
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Affiliation(s)
- Luis Altamirano-Diaz
- Department of Paediatrics, Western University, London, Ontario, Canada. Children's Health Research Institute, London, Ontario, Canada. Paediatric Cardiopulmonary Research Laboratory, London Health Sciences Centre, London, Ontario, Canada
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Okwose NC, Chowdhury S, Houghton D, Trenell MI, Eggett C, Bates M, MacGowan GA, Jakovljevic DG. Comparison of cardiac output estimates by bioreactance and inert gas rebreathing methods during cardiopulmonary exercise testing. Clin Physiol Funct Imaging 2018; 38:483-490. [PMID: 28574213 DOI: 10.1111/cpf.12442] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 05/02/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE This study assessed the agreement between cardiac output estimated by inert gas rebreathing and bioreactance methods at rest and during exercise. METHODS Haemodynamic measurements were assessed in 20 healthy individuals (11 females, nine males; aged 32 ± 10 years) using inert gas rebreathing and bioreactance methods. Gas exchange and haemodynamic data were measured simultaneously under rest and different stages (i.e. 30, 60, 90, 120, 150 and 180 W) of progressive graded cardiopulmonary exercise stress testing using a bicycle ergometer. RESULTS At rest, bioreactance produced significantly higher cardiac output values than inert gas rebreathing (7·8 ± 1·4 versus 6·5 ± 1·7 l min-1 , P = 0·01). At low-to-moderate exercise intensities (i.e. 30-90 W), bioreactance produced significantly higher cardiac outputs compared with rebreathing method (P<0·05). At workloads of 120 W and above, there was no significant difference in cardiac outputs between the two methods (P = 0·10). There was a strong relationship between the two methods (r = 0·82, P = 0·01). Bland-Altman analysis including rest and exercise data showed that inert gas rebreathing reported 1·95 l min-1 lower cardiac output than bioreactance, with lower and upper limits of agreement of -3·1-7·07 l min-1 . Analysis of peak exercise data showed a mean difference of 0·4 l min-1 (lower and upper limits of agreement of -4·9-5·7 l min-1 ) between both devices. CONCLUSION Bioreactance and inert gas rebreathing methods show acceptable levels of agreement for estimating cardiac output at higher levels of metabolic demand. However, they cannot be used interchangeably due to strong disparity in results at rest and low-to-moderate exercise intensity.
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Affiliation(s)
- Nduka C Okwose
- Institute of Cellular Medicine, Medical School, Newcastle University, Newcastle Upon Tyne, UK
| | - Shakir Chowdhury
- Institute of Cellular Medicine, Medical School, Newcastle University, Newcastle Upon Tyne, UK
| | - David Houghton
- Institute of Cellular Medicine, Medical School, Newcastle University, Newcastle Upon Tyne, UK
| | - Michael I Trenell
- Institute of Cellular Medicine, Medical School, Newcastle University, Newcastle Upon Tyne, UK
- RCUK Centre for Ageing and Vitality, Newcastle University, Newcastle Upon Tyne, UK
| | - Christopher Eggett
- Institute of Cellular Medicine, Medical School, Newcastle University, Newcastle Upon Tyne, UK
| | - Matthew Bates
- Institute of Cellular Medicine, Medical School, Newcastle University, Newcastle Upon Tyne, UK
| | - Guy A MacGowan
- Cardiology Department, Freeman Hospital and Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Djordje G Jakovljevic
- Institute of Cellular Medicine, Medical School, Newcastle University, Newcastle Upon Tyne, UK
- RCUK Centre for Ageing and Vitality, Newcastle University, Newcastle Upon Tyne, UK
- Clinical Research Facility, Royal Victoria Infirmary, Newcastle Upon Tyne, UK
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Accuracy, Precision, and Trending Ability of Electrical Cardiometry Cardiac Index versus Continuous Pulmonary Artery Thermodilution Method: A Prospective, Observational Study. BIOMED RESEARCH INTERNATIONAL 2017; 2017:2635151. [PMID: 29130036 PMCID: PMC5654291 DOI: 10.1155/2017/2635151] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 07/21/2017] [Accepted: 08/20/2017] [Indexed: 11/17/2022]
Abstract
Introduction Evaluation of accuracy, precision, and trending ability of cardiac index (CI) measurements using the Aesculon™ bioimpedance electrical cardiometry (Aesc) compared to the continuous pulmonary artery thermodilution catheter (PAC) technique before, during, and after cardiac surgery. Methods A prospective observational study with fifty patients with ASA 3-4. At six time points (T), measurements of CI simultaneously by continuous cardiac output pulmonary thermodilution and thoracic bioimpedance and standard hemodynamics were performed. Analysis was performed using Bland-Altman, four-quadrant plot, and polar plot methodology. Results CI obtained with pulmonary artery thermodilution and thoracic bioimpedance ranged from 1.00 to 6.75 L min−1 and 0.93 to 7.25 L min−1, respectively. Bland-Altman analysis showed a bias between CIBIO and CIPAC of 0.52 liters min−1 m−2, with LOA of [−2.2; 1.1] liters min−1 m−2. Percentage error between the two techniques was above 30% at every time point. Polar plot methodology and 4-quadrant analysis showed poor trending ability. Skin incision had no effect on the results. Conclusion CI obtained by continuous PAC and CI obtained by Aesculon bioimpedance are not interchangeable in cardiac surgical patients. No effects of skin incision were found. International clinical trial registration number is ISRCTN26732484.
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11
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Persona P, Saraceni E, Facchin F, Petranzan E, Parotto M, Baratto F, Ori C, Rossi S. Pulse contour analysis of arterial waveform in a high fidelity human patient simulator. J Clin Monit Comput 2017; 32:677-681. [PMID: 28975529 DOI: 10.1007/s10877-017-0066-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Accepted: 09/20/2017] [Indexed: 11/27/2022]
Abstract
The measurement of cardiac output (CO) may be useful to improve the assessment of hemodynamics during simulated scenarios. The purpose of this study was to evaluate the feasibility of introducing an uncalibrated pulse contour device (MostCare, Vytech, Vygon, Padova, Italy) into the simulation environment. MostCare device was plugged to a clinical monitor and connected to the METI human patient simulator (HPS) to obtain a continuous arterial waveform analysis and CO calculation. In six different simulated clinical scenarios (baseline, ventricular failure, vasoplegic shock, hypertensive crisis, hypovolemic shock and aortic stenosis), the HPS-CO and the MostCare-CO were simultaneously recorded. The level of concordance between the two methods was assessed by the Bland and Altman analysis. 150-paired CO values were obtained. The HPS-CO values ranged from 2.3 to 6.6 L min-1 and the MostCare-CO values from 2.8 to 6.4 L min-1. The mean difference between HPS-CO and MostCare-CO was - 0.3 L min-1 and the limits of agreement were - 1.5 and 0.9 L min-1. The percentage of error was 23%. A good correlation between HPS-CO and MostCare-CO was observed in each scenario of the study (r = 0.88). Although MostCare-CO tended to underestimate the CO over the study period, good agreements were found between the two methods. Therefore, a pulse contour device can be integrated into the simulation environment, offering the opportunity to create new simulated clinical settings.
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Affiliation(s)
- Paolo Persona
- Emergency Department, Azienda Ospedaliera di Padova, Via V. Gallucci 13, 35121, Padova, Italy.
| | - Elisabetta Saraceni
- Emergency Department, Azienda Ospedaliera di Padova, Via V. Gallucci 13, 35121, Padova, Italy
| | | | - Enrico Petranzan
- Emergency Department, Azienda Ospedaliera di Padova, Via V. Gallucci 13, 35121, Padova, Italy
| | - Matteo Parotto
- Department of Anesthesia, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Fabio Baratto
- Emergency Department, Azienda Ospedaliera di Padova, Via V. Gallucci 13, 35121, Padova, Italy
| | - Carlo Ori
- Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Sandra Rossi
- Emergency Department, Azienda Ospedaliera di Padova, Via V. Gallucci 13, 35121, Padova, Italy
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Kim DH, Yoo JY, Lee SY, Kim YJ, Lee SR, Park SY. Effects of pulse pressure alterations on cardiac output measurements derived from analysis of arterial pressure waveform. Anesth Pain Med (Seoul) 2016. [DOI: 10.17085/apm.2016.11.3.280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Dae-hee Kim
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Ji Young Yoo
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Sook Young Lee
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Yeo Jin Kim
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Se Ryeon Lee
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Sung-Yong Park
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon, Korea
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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: 0.3] [Reference Citation Analysis] [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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Wagner JY, Langemann M, Schön G, Kluge S, Reuter DA, Saugel B. Autocalibrating pulse contour analysis based on radial artery applanation tonometry for continuous non-invasive cardiac output monitoring in intensive care unit patients after major gastrointestinal surgery--a prospective method comparison study. Anaesth Intensive Care 2016; 44:340-5. [PMID: 27246932 DOI: 10.1177/0310057x1604400307] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The T-Line(®) system (Tensys(®) Medical Inc., San Diego, CA, USA) non-invasively estimates cardiac output (CO) using autocalibrating pulse contour analysis of the radial artery applanation tonometry-derived arterial waveform. We compared T-Line CO measurements (TL-CO) with invasively obtained CO measurements using transpulmonary thermodilution (TDCO) and calibrated pulse contour analysis (PC-CO) in patients after major gastrointestinal surgery. We compared 1) TL-CO versus TD-CO and 2) TL-CO versus PC-CO in 27 patients treated in the intensive care unit (ICU) after major gastrointestinal surgery. For the assessment of TD-CO and PC-CO we used the PiCCO(®) system (Pulsion Medical Systems SE, Feldkirchen, Germany). Per patient, we compared two sets of TD-CO and 30 minutes of PC-CO measurements with the simultaneously recorded TL-CO values using Bland-Altman analysis. The mean of differences (± standard deviation; 95% limits of agreement) between TL-CO and TD-CO was -0.8 (±1.6; -4.0 to +2.3) l/minute with a percentage error of 45%. For TL-CO versus PC-CO, we observed a mean of differences of -0.4 (±1.5; -3.4 to +2.5) l/minute with a percentage error of 43%. In ICU patients after major gastrointestinal surgery, continuous non-invasive CO measurement based on autocalibrating pulse contour analysis of the radial artery applanation tonometry-derived arterial waveform (TL-CO) is feasible in a clinical study setting. However, the agreement of TL-CO with TD-CO and PC-CO observed in our study indicates that further improvements are needed before the technology can be recommended for clinical use in these patients.
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Affiliation(s)
- J Y Wagner
- Anaesthesiologist, Department of Anaesthesiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - M Langemann
- Research assistant, Department of Anaesthesiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - G Schön
- Statistician, Department of Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - S Kluge
- Professor and Head of the Department of Intensive Care Medicine, Centre of Anaesthesiology and Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - D A Reuter
- Professor and Co-Chairman of the Department of Anaesthesiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - B Saugel
- EDIC and Associate Professor, Department of Anaesthesiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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Fischer MO, Diouf M, de Wilde RB, Dupont H, Hanouz JL, Lorne E. Evaluation of cardiac output by 5 arterial pulse contour techniques using trend interchangeability method. Medicine (Baltimore) 2016; 95:e3530. [PMID: 27336861 PMCID: PMC4998299 DOI: 10.1097/md.0000000000003530] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Cardiac output measurement with pulse contour analysis is a continuous, mini-invasive, operator-independent, widely used, and cost-effective technique, which could be helpful to assess changes in cardiac output. The 4-quadrant plot and the polar plot have been described to compare the changes between 2 measurements performed under different conditions, and the direction of change by using different methods of measurements. However, the 4-quadrant plot and the polar plot present a number of limitations, with a risk of misinterpretation in routine clinical practice. We describe a new trend interchangeability method designed to objectively define the interchangeability of each change of a variable. Using the repeatability of the reference method, we classified each change as either uninterpretable or interpretable and then as either noninterchangeable, in the gray zone or interchangeable. An interchangeability rate can then be calculated by the number of interchangeable changes divided by the total number of interpretable changes. In this observational study, we used this objective method to assess cardiac output changes with 5 arterial pulse contour techniques (Wesseling's method, LiDCO, PiCCO, Hemac method, and Modelflow) in comparison with bolus thermodilution technique as reference method in 24 cardiac surgery patients. A total of 172 cardiac output variations were available from the 199 data points: 88 (51%) were uninterpretable, according to the first step of the method. The second step of the method, based on the 84 (49%) interpretable variations, showed that only 18 (21%) to 30 (36%) variations were interchangeable regardless of the technique used. None of pulse contour cardiac output technique could be interchangeable with bolus thermodilution to assess changes in cardiac output using the trend interchangeability method in cardiac surgery patients. Future studies may consider using this method to assess interchangeability of changes between different methods of measurements.
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Affiliation(s)
- Marc-Olivier Fischer
- Pôle Réanimations Anesthésie SAMU/SMUR, CHU de Caen
- EA 4650, Université de Caen Normandie, Esplanade de la Paix, Caen
| | - Momar Diouf
- Department of Biostatistics and Clinical Research, Amiens University Hospital, Place Victor Pauchet, Amiens, France
| | - Robert B.P. de Wilde
- Department of Intensive Care, Leiden University Medical Center, RC Leiden, The Netherlands
| | - Hervé Dupont
- Anesthesiology and Critical Care Department, Amiens University Hospital, Amiens
- INSERM U 1088, Jules Vernes University of Picardy, Centre Universitaire de Recherche en Santé (CURS). Chemin du Thil, Amiens Cedex, France
| | - Jean-Luc Hanouz
- Pôle Réanimations Anesthésie SAMU/SMUR, CHU de Caen
- EA 4650, Université de Caen Normandie, Esplanade de la Paix, Caen
| | - Emmanuel Lorne
- Anesthesiology and Critical Care Department, Amiens University Hospital, Amiens
- INSERM U 1088, Jules Vernes University of Picardy, Centre Universitaire de Recherche en Santé (CURS). Chemin du Thil, Amiens Cedex, France
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16
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Sangkum L, Liu GL, Yu L, Yan H, Kaye AD, Liu H. Minimally invasive or noninvasive cardiac output measurement: an update. J Anesth 2016; 30:461-80. [PMID: 26961819 DOI: 10.1007/s00540-016-2154-9] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 02/17/2016] [Indexed: 12/15/2022]
Abstract
Although cardiac output (CO) by pulmonary artery catheterization (PAC) has been an important guideline in clinical management for more than four decades, some studies have questioned the clinical efficacy of CO in certain patient populations. Further, the use of CO by PAC has been linked to numerous complications including dysrhythmia, infection, rupture of pulmonary artery, injury to adjacent arteries, embolization, pulmonary infarction, cardiac valvular damage, pericardial effusion, and intracardiac catheter knotting. The use of PAC has been steadily declining over the past two decades. Minimally invasive and noninvasive CO monitoring have been studied in the past two decades with some evidence of efficacy. Several different devices based on pulse contour analysis are available currently, including the uncalibrated FloTrac/Vigileo system and the calibrated PiCCO and LiDCO systems. The pressure-recording analytical method (PRAM) system requires only an arterial line and is commercially available as the MostCare system. Transesophageal echocardiography (TEE) can measure CO by non-Doppler- or Doppler-based methods. The partial CO2 rebreathing technique, another method to measure CO, is marketed by Novametrix Medical Systems as the NICO system. Thoracic electrical bioimpedance (TEB) and electric bioreactance (EB) are totally noninvasive CO monitoring. Nexfin HD and the newer ClearSight systems are examples of noninvasive CO monitoring devices currently being marketed by Edwards Lifesciences. The developing focus in CO monitoring devices appears to be shifting to tissue perfusion and microcirculatory flow and aimed more at markers that indicate the effectiveness of circulatory and microcirculatory resuscitations.
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Affiliation(s)
- Lisa Sangkum
- Department of Anesthesiology, Ramathibodi Hospital, Bangkok, 10400, Thailand
- Department of Anesthesiology and Perioperative Medicine, Hahnemann University Hospital, Drexel University College of Medicine, 245 North 15th Street, MS 310, Philadelphia, PA, 19102, USA
| | - Geoffrey L Liu
- Department of Anesthesiology and Perioperative Medicine, Hahnemann University Hospital, Drexel University College of Medicine, 245 North 15th Street, MS 310, Philadelphia, PA, 19102, USA
| | - Ling Yu
- Department of Anesthesiology and Perioperative Medicine, Hahnemann University Hospital, Drexel University College of Medicine, 245 North 15th Street, MS 310, Philadelphia, PA, 19102, USA
| | - Hong Yan
- Department of Anesthesiology and Perioperative Medicine, Hahnemann University Hospital, Drexel University College of Medicine, 245 North 15th Street, MS 310, Philadelphia, PA, 19102, USA
| | - Alan D Kaye
- Department of Anesthesiology, LSU-Health Science Center-New Orleans, New Orleans, LA, 70112, USA
| | - Henry Liu
- Department of Anesthesiology and Perioperative Medicine, Hahnemann University Hospital, Drexel University College of Medicine, 245 North 15th Street, MS 310, Philadelphia, PA, 19102, USA.
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Montenij L, Buhre W, Jansen J, Kruitwagen C, de Waal E. Methodology of method comparison studies evaluating the validity of cardiac output monitors: a stepwise approach and checklist † †This Article is accompanied by Editorial Aew110. Br J Anaesth 2016; 116:750-8. [DOI: 10.1093/bja/aew094] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Seguin M, Bourqui J, Fear E, Okoniewski M. Monitoring the heart with ultra-wideband microwave signals: evaluation with a semi-dynamic heart model. Biomed Phys Eng Express 2016. [DOI: 10.1088/2057-1976/2/3/035011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Assessment of changes in cardiac index with calibrated pulse contour analysis in cardiac surgery: A prospective observational study. Anaesth Crit Care Pain Med 2016; 35:261-7. [PMID: 27083307 DOI: 10.1016/j.accpm.2015.12.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 12/02/2015] [Accepted: 12/14/2015] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To assess the trending ability of calibrated pulse contour cardiac index (CIPC) monitoring during haemodynamic changes (passive leg raising [PLR] and fluid loading) compared with transpulmonary thermodilution CI (CITD). METHOD Seventy-eight mechanically-ventilated patients admitted to intensive care with calibrated pulse contour following cardiac surgery were prospectively included and investigated during PLR, and after fluid loading. Fluid responsiveness was defined as a≥15% CITD increase after a 500ml bolus. Areas under the empiric receiver operating characteristic curves (ROCAUC) for changes in CIPC (ΔCIPC) during PLR to predict fluid responsiveness and after fluid challenge to predict an increase at least 15% in CITD after fluid loading were calculated. RESULTS Fifty-five patients (71%) were classified as responders, 23 (29%) as non-responders. ROCAUC for ΔCIPC during PLR in predicting fluid responsiveness, its sensitivity, specificity, and percentage of patients within the inconclusive class of response were 0.67 (95% CI=0.55-0.77), 0.76 (95% CI=0.63-0.87), 0.57 (95% CI=0.34-0.77) and 68%, respectively. Bias, precision and limits of agreements and percentage error between CIPC and CITD after fluid challenge were 0.14 (95% CI: 0.08-0.20), 0.26, -0.37 to 0.64 l min(-1)m(-2), and 20%, respectively. The concordance rate was 97% and the polar concordance at 30° was 91%. ROCAUC for ΔCIPC in predicting an increase of at least 15% in CITD after fluid loading was 0.85 (95% CI: 0.76-0.92). CONCLUSION Although ΔCIPC after fluid loading could track the direction of changes of CITD and was interchangeable with bolus transpulmonary thermodilution, PLR could not predict fluid responsiveness in cardiac surgery patients.
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Beltramo F, Menteer J, Razavi A, Khemani RG, Szmuszkovicz J, Newth CJL, Ross PA. Validation of an Ultrasound Cardiac Output Monitor as a Bedside Tool for Pediatric Patients. Pediatr Cardiol 2016; 37:177-83. [PMID: 26364291 DOI: 10.1007/s00246-015-1261-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 08/27/2015] [Indexed: 12/13/2022]
Abstract
The aim of our study was to determine the validity of cardiac output (CO) measurements taken with the ultrasonic cardiac output monitor (USCOM) by comparing to CO measured by pulmonary arterial catheter (PAC) thermodilution during cardiac catheterization. We enrolled thirty-one children (<18 years) undergoing cardiac catheterization in this double-blinded, prospective, observational study. The median CO measured by USCOM was 4.37 L/min (IQR 3.73, 5.60 L/min) compared to 4.28 L/min (IQR 3.52, 5.26 L/min) by PAC thermodilution. The bias (mean difference) between the two methods was 0.2 L/min, and the 95% limits of agreement were -1.2 to 1.6 L/min. The mean percentage error of CO between USCOM and PAC thermodilution was 11%. When excluding a sole outlier, the bias between the two measures decreased to 0.1 L/min (95% limits of agreement -0.6 to 0.9 L/min), and the percentage error was reduced to 8%. The median SVRI measured by USCOM was 22.0 Wood Units (IQR 17.0, 26.8 Wood Units) compared to 22.1 Wood Units (IQR 17.6, 27.4 Wood Units) by PAC thermodilution. Bias (mean difference) between the two methods was -0.6 Wood Units, and the 95% limits of agreement were -8.2 to 6.9 Wood Units. We found that the estimation of CO and by extension SVRI with USCOM is reliable against pulmonary artery catheter thermodilution in children with normal cardiac anatomy. Given the noninvasive nature of USCOM, speed of measurement, and relative ease of use, it may be useful as a bedside tool for pediatric patients.
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Affiliation(s)
- Fernando Beltramo
- Children's Hospital Los Angeles, 4650 West Sunset Boulevard, Mailstop # 3, Los Angeles, CA, 90027, USA
| | - Jondavid Menteer
- Children's Hospital Los Angeles, 4650 West Sunset Boulevard, Mailstop # 3, Los Angeles, CA, 90027, USA.,University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Asma Razavi
- Children's Hospital Los Angeles, 4650 West Sunset Boulevard, Mailstop # 3, Los Angeles, CA, 90027, USA
| | - Robinder G Khemani
- Children's Hospital Los Angeles, 4650 West Sunset Boulevard, Mailstop # 3, Los Angeles, CA, 90027, USA.,University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Jacqueline Szmuszkovicz
- Children's Hospital Los Angeles, 4650 West Sunset Boulevard, Mailstop # 3, Los Angeles, CA, 90027, USA.,University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Christopher J L Newth
- Children's Hospital Los Angeles, 4650 West Sunset Boulevard, Mailstop # 3, Los Angeles, CA, 90027, USA.,University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Patrick A Ross
- Children's Hospital Los Angeles, 4650 West Sunset Boulevard, Mailstop # 3, Los Angeles, CA, 90027, USA. .,University of Southern California Keck School of Medicine, Los Angeles, CA, USA.
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Montenij LJ, Sonneveld JP, Nierich AP, Buhre WF, De Waal EE. Accuracy, Precision, and Trending Ability of Uncalibrated Arterial Pressure Waveform Analysis of Cardiac Output in Patients With Impaired Left Ventricular Function: A Prospective, Observational Study. J Cardiothorac Vasc Anesth 2016; 30:115-21. [DOI: 10.1053/j.jvca.2015.07.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Indexed: 11/11/2022]
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Cho YJ, Koo CH, Kim TK, Hong DM, Jeon Y. Comparison of cardiac output measures by transpulmonary thermodilution, pulse contour analysis, and pulmonary artery thermodilution during off-pump coronary artery bypass surgery: a subgroup analysis of the cardiovascular anaesthesia registry at a single tertiary centre. J Clin Monit Comput 2015; 30:771-782. [DOI: 10.1007/s10877-015-9784-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 09/23/2015] [Indexed: 01/24/2023]
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Vrancken SL, van Heijst AF, Hopman JC, Liem KD, van der Hoeven JG, de Boode WP. Hemodynamic volumetry using transpulmonary ultrasound dilution (TPUD) technology in a neonatal animal model. J Clin Monit Comput 2015; 29:643-52. [PMID: 25500953 DOI: 10.1007/s10877-014-9647-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 12/08/2014] [Indexed: 10/24/2022]
Abstract
To analyze changes in cardiac output and hemodynamic volumes using transpulmonary ultrasound dilution (TPUD) in a neonatal animal model under different hemodynamic conditions. 7 lambs (3.5-8.3 kg) under general anesthesia received arterial and central venous catheters. A Gore-Tex(®) shunt was surgically inserted between the descending aorta and the left pulmonary artery to mimic a patent ductus arteriosus. After shunt opening and closure, induced hemorrhagic hypotension (by repetitive blood withdrawals) and repetitive volume challenges, the following parameters were assessed using TPUD: cardiac output, active circulating volume index (ACVI), central blood volume index (CBVI) and total end-diastolic volume index (TEDVI). 27 measurement sessions were analyzed. After shunt opening, there was a significant increase in TEDVI and a significant decrease in cardiac output with minimal change in CBVI and ACVI. With shunt closure, these results reversed. After progressive hemorrhage, cardiac output and all volumes decreased significantly, except for ACVI. Following repetitive volume resuscitation, cardiac output increased and all hemodynamic volumes increased significantly. Correlations between changes in COufp and changes in hemodynamic volumes (ACVI 0.83; CBVI 0.84 and TEDVI 0.78 respectively) were (slightly) better than between changes in COufp and changes in heart rate (0.44) and central venous pressure (0.7). Changes in hemodynamic volumes using TPUD were as expected under different conditions. Hemodynamic volumetry using TPUD might be a promising technique that has the potential to improve the assessment and interpretation of the hemodynamic status in critically ill newborns and children.
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Affiliation(s)
- Sabine L Vrancken
- Division of Neonatology, Department of Pediatrics, Radboud University Nijmegen Medical Center, Internal Postal Code 804, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Arno F van Heijst
- Division of Neonatology, Department of Pediatrics, Radboud University Nijmegen Medical Center, Internal Postal Code 804, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Jeroen C Hopman
- Department of Radiology, Medical Ultrasound Imaging Centre, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Kian D Liem
- Division of Neonatology, Department of Pediatrics, Radboud University Nijmegen Medical Center, Internal Postal Code 804, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Johannes G van der Hoeven
- Department of Pediatric Intensive Care, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Willem P de Boode
- Division of Neonatology, Department of Pediatrics, Radboud University Nijmegen Medical Center, Internal Postal Code 804, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
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Radial Artery Applanation Tonometry for Continuous Noninvasive Cardiac Output Measurement. Crit Care Med 2015; 43:1423-8. [DOI: 10.1097/ccm.0000000000000979] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Arterial pressure waveform analysis versus thermodilution cardiac output measurement during open abdominal aortic aneurysm repair. Eur J Anaesthesiol 2015; 32:13-9. [DOI: 10.1097/eja.0000000000000160] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rüschen D, Rimke M, Gesenhues J, Leonhardt S, Walter M. Continuous Cardiac Output Estimation Under Left Ventricular Assistance. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.ifacol.2015.10.202] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Jakovljevic DG, Trenell MI, MacGowan GA. Bioimpedance and bioreactance methods for monitoring cardiac output. Best Pract Res Clin Anaesthesiol 2014; 28:381-94. [DOI: 10.1016/j.bpa.2014.09.003] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 09/09/2014] [Accepted: 09/16/2014] [Indexed: 12/18/2022]
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Mechanical ventilation-induced intrathoracic pressure distribution and heart-lung interactions*. Crit Care Med 2014; 42:1983-90. [PMID: 24743042 DOI: 10.1097/ccm.0000000000000345] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Mechanical ventilation causes cyclic changes in the heart's preload and afterload, thereby influencing the circulation. However, our understanding of the exact physiology of this cardiopulmonary interaction is limited. We aimed to thoroughly determine airway pressure distribution, how this is influenced by tidal volume and chest compliance, and its interaction with the circulation in humans during mechanical ventilation. DESIGN Intervention study. SETTING ICU of a university hospital. PATIENTS Twenty mechanically ventilated patients following coronary artery bypass grafting surgery. INTERVENTION Patients were monitored during controlled mechanical ventilation at tidal volumes of 4, 6, 8, and 10 mL/kg with normal and decreased chest compliance (by elastic binding of the thorax). MEASUREMENTS AND MAIN RESULTS Central venous pressure, airway pressure, pericardial pressure, and pleural pressure; pulse pressure variations, systolic pressure variations, and stroke volume variations; and cardiac output were obtained during controlled mechanical ventilation at tidal volume of 4, 6, 8, and 10 mL/kg with normal and decreased chest compliance. With increasing tidal volume (4, 6, 8, and 10 mL/kg), the change in intrathoracic pressures increased linearly with 0.9 ± 0.2, 0.5 ± 0.3, 0.3 ± 0.1, and 0.3 ± 0.1 mm Hg/mL/kg for airway pressure, pleural pressure, pericardial pressure, and central venous pressure, respectively. At 8 mL/kg, a decrease in chest compliance (from 0.12 ± 0.07 to 0.09 ± 0.03 L/cm H2O) resulted in an increase in change in airway pressure, change in pleural pressure, change in pericardial pressure, and change in central venous pressure of 1.1 ± 0.7, 1.1 ± 0.8, 0.7 ± 0.4, and 0.8 ± 0.4 mm Hg, respectively. Furthermore, increased tidal volume and decreased chest compliance decreased stroke volume and increased arterial pressure variations. Transmural pressure of the superior vena cava decreased during inspiration, whereas the transmural pressure of the right atrium did not change. CONCLUSIONS Increased tidal volume and decreased chest wall compliance both increase the change in intrathoracic pressures and the value of the dynamic indices during mechanical ventilation. Additionally, the transmural pressure of the vena cava is decreased, whereas the transmural pressure of the right atrium is not changed.
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Mehta Y, Arora D. Newer methods of cardiac output monitoring. World J Cardiol 2014; 6:1022-1029. [PMID: 25276302 PMCID: PMC4176793 DOI: 10.4330/wjc.v6.i9.1022] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 02/11/2014] [Accepted: 07/15/2014] [Indexed: 02/07/2023] Open
Abstract
Cardiac output (CO) is the volume of blood ejected by each ventricle per minute and is the product of stroke volume and heart rate. CO can thus be manipulated by alteration in heart rate or rhythm, preload, contractility and afterload. Moreover it gives important information about tissue perfusion and oxygen delivery. CO can be measured by various methods and thermodilution method using pulmonary artery catheter (PAC) is till date considered as gold standard method. Complications associated with PAC led to development of newer methods which are minimally or non-invasive. Newer methods fulfil other properties like continuous and reproducible reading, cost effective, reliable during various physiological states and have fast response time. These methods are validated against the gold standard with good level agreement. In this review we have discussed various newer methods of CO monitoring and their effectiveness in clinical use.
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Montenij L, de Waal E, Frank M, van Beest P, de Wit A, Kruitwagen C, Buhre W, Scheeren T. Influence of early goal-directed therapy using arterial waveform analysis on major complications after high-risk abdominal surgery: study protocol for a multicenter randomized controlled superiority trial. Trials 2014; 15:360. [PMID: 25227114 PMCID: PMC4175278 DOI: 10.1186/1745-6215-15-360] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 08/28/2014] [Indexed: 01/20/2023] Open
Abstract
Background Early goal-directed therapy refers to the use of predefined hemodynamic goals to optimize tissue oxygen delivery in critically ill patients. Its application in high-risk abdominal surgery is, however, hindered by safety concerns and practical limitations of perioperative hemodynamic monitoring. Arterial waveform analysis provides an easy, minimally invasive alternative to conventional monitoring techniques, and could be valuable in early goal-directed strategies. We therefore investigate the effects of early goal-directed therapy using arterial waveform analysis on complications, quality of life and healthcare costs after high-risk abdominal surgery. Methods/Design In this multicenter, randomized, controlled superiority trial, 542 patients scheduled for elective, high-risk abdominal surgery will be included. Patients are allocated to standard care (control group) or early goal-directed therapy (intervention group) using a randomization procedure stratified by center and type of surgery. In the control group, standard perioperative hemodynamic monitoring is applied. In the intervention group, early goal-directed therapy is added to standard care, based on continuous monitoring of cardiac output with arterial waveform analysis. A treatment algorithm is used as guidance for fluid and inotropic therapy to maintain cardiac output above a preset, age-dependent target value. The primary outcome measure is a combined endpoint of major complications in the first 30 days after the operation, including mortality. Secondary endpoints are length of stay in the hospital, length of stay in the intensive care or post-anesthesia care unit, the number of minor complications, quality of life, cost-effectiveness and one-year mortality and morbidity. Discussion Before the start of the study, hemodynamic optimization by early goal-directed therapy with arterial waveform analysis had only been investigated in small, single-center studies, including minor complications as primary endpoint. Moreover, these studies did not include quality of life, healthcare costs, and long-term outcome in their analysis. As a result, the definitive role of arterial waveform analysis in the perioperative hemodynamic assessment and care for high-risk surgical patients is unknown, which gave rise to the present trial. Patient inclusion started in May 2012 and is expected to end in 2016. Trial registration This trial was registered in the Dutch Trial Register (registration number NTR3380) on 3 April 2012. Electronic supplementary material The online version of this article (doi:10.1186/1745-6215-15-360) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Eric de Waal
- University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
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Mabote T, Wong K, Cleland JGF. The utility of novel non-invasive technologies for remote hemodynamic monitoring in chronic heart failure. Expert Rev Cardiovasc Ther 2014; 12:923-8. [PMID: 25026973 DOI: 10.1586/14779072.2014.935339] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Monitoring a patient's hemodynamic status may be a revolutionary way to aid a 'health maintenance' strategy in which the physician strives to therapeutically keep the patient in an ideal hemodynamic range. Currently, home telemonitoring employs a 'crisis-prevention' approach. This strategy is still based on easily acquired measures such as heart rate, weight and blood pressure--measurements that are useful to help implement guideline-directed therapy but provide little information about impending decompensation or the risk of hospitalisation. Current systems provide limited information to personalize and adapt medication therapy for heart failure. Several innovative technologies that can remotely monitor estimates of cardiovascular hemodynamics, such as cardiac index, systemic vascular resistance, augmentation index and added heart sounds may enable earlier detection of heart failure decompensation. This editorial presents an overview of the innovative technologies that are available for non-invasive hemodynamic monitoring and maybe adapted for home telemonitoring for chronic heart failure.
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Affiliation(s)
- Thato Mabote
- Department of Academic Cardiology, Hull York Medical School, Castle Hill Hospital, Cottingham, Kingston upon Hull, HU16 5JQ, UK
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Maass SW, Roekaerts PM, Lancé MD. Cardiac Output Measurement by Bioimpedance and Noninvasive Pulse Contour Analysis Compared With the Continuous Pulmonary Artery Thermodilution Technique. J Cardiothorac Vasc Anesth 2014; 28:534-9. [DOI: 10.1053/j.jvca.2014.01.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Indexed: 01/12/2023]
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Yee S, Scalzetti EM. Measurement of cardiac output from dynamic pulmonary circulation time CT. Med Phys 2014; 41:061904. [DOI: 10.1118/1.4875676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Nusmeier A, van der Hoeven JG, Lemson J. Cardiac output monitoring in pediatric patients. Expert Rev Med Devices 2014; 7:503-17. [DOI: 10.1586/erd.10.19] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Barile L, Landoni G, Pieri M, Ruggeri L, Maj G, Nigro Neto C, Pasin L, Cabrini L, Zangrillo A. Cardiac Index Assessment by the Pressure Recording Analytic Method in Critically Ill Unstable Patients After Cardiac Surgery. J Cardiothorac Vasc Anesth 2013; 27:1108-13. [DOI: 10.1053/j.jvca.2013.02.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Indexed: 11/11/2022]
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Fischer MO, Balaire X, Le Mauff de Kergal C, Boisselier C, Gérard JL, Hanouz JL, Fellahi JL. The diagnostic accuracy of estimated continuous cardiac output compared with transthoracic echocardiography. Can J Anaesth 2013; 61:19-26. [DOI: 10.1007/s12630-013-0055-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 10/09/2013] [Indexed: 11/28/2022] Open
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Kirton OC, Calabrese RC, Staff I. Increasing use of less-invasive hemodynamic monitoring in 3 specialty surgical intensive care units: a 5-year experience at a tertiary medical center. J Intensive Care Med 2013; 30:30-6. [PMID: 23940109 DOI: 10.1177/0885066613498055] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Less-invasive hemodynamic monitoring (eg, esophageal doppler monitoring [EDM] and arterial pressure contour analysis, FloTrac) is increasingly used as an alternative to pulmonary artery catheters (PACs) in critically ill intensive care unit (ICU). HYPOTHESIS The decrease in use of PACs is not associated with increased mortality. METHODS Five-year retrospective review of 1894 hemodynamically monitored patients admitted to 3 surgical ICUs in a university-affiliate, tertiary care urban hospital. Data included the number of admissions, diagnosis-related group discharge case mix, length of stay, insertion of monitoring devices (PAC, EDM, and FloTrac probes), administered intravenous vasoactive agents (β-predominant agonists--dobutamine, epinephrine, and dopamine; vasopressors--norepinephrine and phenylephrine), and mortality. Data from hospital administrative databases were compiled to create patient characteristic and monitoring variables across a 5-year time period, 2005 to 2009 inclusive. Chi-square for independent proportions, 1-way analysis of variance, and Kruskal-Wallis tests were used; tests for trend were conducted. An α level of .05 was considered significant. Statistical Package for the Social Sciences v14 was used for all statistical testing. RESULTS There was a significant change in the type of hemodynamic monitors inserted in 2 of the 3 surgical ICUs (in the general surgery and neurointensive care but not in the cardiac ICU) from PACs to less-invasive devices (FloTrac or EDM) during the 5-year study period (P < .001). There was no change in mortality rate over the time period (P = .492). There was an overall increase in the proportion of monitored patients who received intravenous vasoactive agents (P < .001) with a progressive shift from β-agonists to vasopressors (P < .002). Multivariate analyses indicated that age, case mix, and use of vasoactive agents were all independent predictors of inhospital mortality (P = .001) but that type of monitoring was not (P = .638). CONCLUSIONS In a 5-year period, the decreased insertions of PACs were replaced by increased utilization of less-invasive hemodynamic monitoring devices. This change in practice did not adversely impact mortality.
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Affiliation(s)
| | | | - Ilene Staff
- Research Administration, Hartford Hospital, Hartford, CT, USA
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Kim JY, Kim BR, Lee KH, Kim KW, Kim JH, Lee SI, Kim KT, Choe WJ, Park JS, Kim JW. Comparison of cardiac output derived from FloTrac™/Vigileo™ and impedance cardiography during major abdominal surgery. J Int Med Res 2013; 41:1342-9. [DOI: 10.1177/0300060513487649] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objectives Impedance cardiography (ICG) is a noninvasive technique that provides reasonably accurate measurements of cardiac output, but the usefulness of ICG in patients undergoing open abdominal surgery has not been validated. Methods Cardiac output was measured while patients underwent open gastrectomy using an ICG monitor ( niccomo™; ICG-CO); the results were compared with those measured using a FloTrac™/Vigileo™ monitor (Flo-CO), which measures cardiac output by analysing the arterial waveform. Data collection commenced at the beginning of anaesthetic induction and continued until the patient was awake. Data were compared using the Bland–Altman analysis, and the clinical significance of the difference between the two methods was evaluated by calculating the percentage error (%). Results Eleven patients were monitored during surgery. The bias of the Flo-CO and ICG-CO values was −0.45 l/min. The upper and lower limits of agreement were 0.96 l/min and −1.85 l/min, respectively. The percentage error was 28.5%. Electrocautery induced interference that transiently impaired the performance of the ICG monitor. Conclusions ICG provided useful information in evaluating the cardiac output of patients during abdominal surgery.
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Affiliation(s)
- Ji-Yeon Kim
- Department of Anaesthesiology and Pain Medicine, Ilsan Paik Hospital, Inje University, Goyang, Republic of Korea
| | - Bo-Ram Kim
- Department of Anaesthesiology and Pain Medicine, Ilsan Paik Hospital, Inje University, Goyang, Republic of Korea
| | - Kang-Hun Lee
- Department of Anaesthesiology and Pain Medicine, Ilsan Paik Hospital, Inje University, Goyang, Republic of Korea
| | - Kyung-Woo Kim
- Department of Anaesthesiology and Pain Medicine, Ilsan Paik Hospital, Inje University, Goyang, Republic of Korea
| | - Jun-Hyun Kim
- Department of Anaesthesiology and Pain Medicine, Ilsan Paik Hospital, Inje University, Goyang, Republic of Korea
| | - Sang-Il Lee
- Department of Anaesthesiology and Pain Medicine, Ilsan Paik Hospital, Inje University, Goyang, Republic of Korea
| | - Kyung-Tae Kim
- Department of Anaesthesiology and Pain Medicine, Ilsan Paik Hospital, Inje University, Goyang, Republic of Korea
| | - Won-Joo Choe
- Department of Anaesthesiology and Pain Medicine, Ilsan Paik Hospital, Inje University, Goyang, Republic of Korea
| | - Jang-Su Park
- Department of Anaesthesiology and Pain Medicine, Ilsan Paik Hospital, Inje University, Goyang, Republic of Korea
| | - Jung-Won Kim
- Department of Anaesthesiology and Pain Medicine, Ilsan Paik Hospital, Inje University, Goyang, Republic of Korea
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Nielsen K, Dahl B, Johansson PI, Henneberg SW, Rasmussen LS. Intraoperative transfusion threshold and tissue oxygenation: a randomised trial. Transfus Med 2012; 22:418-25. [PMID: 23121563 DOI: 10.1111/j.1365-3148.2012.01196.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Revised: 09/16/2012] [Accepted: 09/16/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES Transfusion with allogeneic red blood cells (RBCs) may be needed to maintain oxygen delivery during major surgery, but the appropriate haemoglobin (Hb) concentration threshold has not been well established. We hypothesised that a higher level of Hb would be associated with improved subcutaneous oxygen tension during major spinal surgery. MATERIALS AND METHODS Fifty patients aged 18 years or older scheduled for spinal fusion with instrumentation were included and randomised to receive RBCs at either a Hb concentration of 7·3 g dL(-1) (restrictive group) or a Hb concentration of 8·9 g dL(-1) (liberal group) (Registration no.: H-C-2009-072). Oxygen tension was measured with a polarographic electrode placed subcutaneously over the left deltoid muscle. The primary endpoint was subcutaneous oxygen tension at the time most patients were still undergoing surgery. RESULTS Forty-eight patients were included in the intention-to-treat analysis; 25 patients in the restrictive group and 23 patients in the liberal group. The median change in subcutaneous oxygen tension 60 min after surgical incision was -0·79 and -0·75 kPa in the restrictive and the liberal groups, respectively (P = 0·78). No significant difference was found in the lowest subcutaneous oxygen tension; -2·07 vs. -1·95 kPa in the restrictive and the liberal groups, respectively (P = 0·85). CONCLUSION A Hb concentration transfusion threshold of 8·9 g dL(-1) was not associated with a higher subcutaneous oxygen tension during major spinal surgery than a threshold of 7·3 g dL(-1), but the trial was compromised by methodological difficulties.
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Affiliation(s)
- K Nielsen
- Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
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Abstract
Hemodynamic monitoring is used to identify deviations from hemodynamic goals and to assess responses to therapy. To accomplish these goals one must understand how the circulation is regulated. In this review I begin with an historical review of the work of Arthur Guyton and his conceptual understanding of the circulation and then present an approach by which Guyton's concepts can be applied at the bedside. Guyton argued that cardiac output and central venous pressure are determined by the interaction of two functions: cardiac function, which is determined by cardiac performance; and a return function, which is determined by the return of blood to the heart. This means that changes in cardiac output are dependent upon changes of one of these two functions or of both. I start with an approach based on the approximation that blood pressure is determined by the product of cardiac output and systemic vascular resistance and that cardiac output is determined by cardiac function and venous return. A fall in blood pressure with no change in or a rise in cardiac output indicates that a decrease in vascular resistance is the dominant factor. If the fall in blood pressure is due to a fall in cardiac output then the role of a change in the return function and cardiac function can be separated by the patterns of changes in central venous pressure and cardiac output. Measurement of cardiac output is a central component to this approach but until recently it was not easy to obtain and was estimated from surrogates. However, there are now a number of non-invasive devices that can give measures of cardiac output and permit the use of physiological principles to more rapidly appreciate the primary pathophysiology behind hemodynamic abnormalities and to provide directed therapy.
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Affiliation(s)
- Sheldon Magder
- McGill University Health Centre, Royal Victoria Hospital, 687 Pine Avenue West, Montreal, Quebec, Canada H3A 1A1
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Emergency department noninvasive (NICOM) cardiac outputs are associated with trauma activation, patient injury severity and host conditions and mortality. J Trauma Acute Care Surg 2012; 73:479-85. [PMID: 23019674 DOI: 10.1097/ta.0b013e31825eeaad] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Anoninvasive cardiac output (CO) monitor (NICOM), using Bioreactance technology, has been validated in several nontrauma patient studies. We hypothesized that NICOM CO would have more significant associations with clinical conditions than would systolic blood pressure (sBP). METHODS This is a prospective observational study of consecutive trauma activation patients during the first 10 to 60 minutes after emergency department arrival. RESULTS Analysis includes 270 consecutive trauma activation patients with 1,568 observations. CO was decreased (p ≤ 0.002) with major blood loss, hypotension, red blood cell transfusion, Injury Severity Score (ISS) higher than 20, low PetCO₂, abnormal pupils, elderly, preexisting conditions, low body surface area level, females, hypothermia, and death. CO was increased (p < 0.0001) with base deficit, ethanol positivity, and illicit drug positivity. The sBP was decreased (p ≤ 0.0005) with major blood loss, red blood cell transfusion, low PetCO₂, low body surface area level, and illicit drug positivity. The sBP was increased (p e 0.01) with ISS higher than 20, elderly, and preexisting conditions. Total significant condition associations were CO 83% (15 of 18 patients) and sBP 47% (8 of 17 patients; p = 0.03). In hypotensive patients, CO was lower with major blood loss (3.3 ± 2.1 L/ min) than without (6.0 ± 2.2 L/min; p < 0.0001). Of survivors with ISS 15 or higher, NICOM patients experienced a shorter hospital length of stay (10.5 days) when compared with 2009 and 2010 patients (14.0 days; p = 0.03). CONCLUSION The multiple associations of CO with patient conditions imply that NICOM provides an objective and clinically valid, relevant, and discriminate measure of cardiac function in acutely injured trauma activation patients. NICOM use may be associated with a shorter length of stay in surviving patients with complex injuries.
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Cardiac parameters in children recovered from acute illness as measured by electrical cardiometry and comparisons to the literature. J Clin Monit Comput 2012; 27:81-91. [PMID: 23054385 DOI: 10.1007/s10877-012-9401-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Accepted: 09/26/2012] [Indexed: 12/30/2022]
Abstract
Electrical cardiometry (EC) is a non-invasive cardiac output method that can assess cardiac index (CI) and stroke index (SI) but there are no reference values for children per se. The primary aim of this study was to develop reference values for clinical application. The secondary aim was to compare the EC measurements to published values. We performed a prospective observational study in patients (<21 years of age) without structural heart disease who had recovered from an acute illness. EC recordings in children that had normal heart rate and mean arterial blood pressure at discharge were eligible for analysis. The relationship of CI or SI and age in children was performed by regression analysis. Similar analysis was performed comparing measurements by EC to cardiac parameters values compiled from reference sources to assess bias in EC. Eighty-three children (2 weeks-21 years of age) were studied. There was a significant curvilinear relationship between CI or SI and age by EC (F-test, p < 0.05). Regression curves of cardiac parameters reported in the literature using 6 Fick's method, thermodilution, echocardiography and cardiac MRI were the same or higher than (0-19.6 %) values obtained with EC, with higher values being statistically significant (p < 0.05 all). There is a curvilinear relationship of CI or SI and age by EC in normal children. Cardiac parameters reported in the literature using alternative methods are different from those obtained with EC but are within acceptable ranges, with EC biased to underestimate CI. Adjustment of target value is required for EC goal-directed therapies.
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van der Spoel AGE, Voogel AJ, Folkers A, Boer C, Bouwman RA. Comparison of noninvasive continuous arterial waveform analysis (Nexfin) with transthoracic Doppler echocardiography for monitoring of cardiac output. J Clin Anesth 2012; 24:304-9. [PMID: 22608585 DOI: 10.1016/j.jclinane.2011.09.008] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Revised: 09/13/2011] [Accepted: 09/21/2011] [Indexed: 10/28/2022]
Abstract
STUDY OBJECTIVES To compare the Nexfin cardiac output (CO) with the CO obtained from transthoracic Doppler echocardiography (TTE) during routine cardiac function screening. DESIGN Observational clinical study. SETTING Echocardiography laboratory. PATIENTS 40 ASA physical status 1 and 2 patients scheduled for routine TTE examination. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS In 40 patients scheduled for routine TTE examination, we obtained simultaneous CO measurements with Doppler ultrasound and derived from Nexfin blood pressure measurements. Correlation and level of agreement between Nexfin and TTE were analyzed using Pearson correlation coefficient and Bland-Altman plots. The Pearson correlation coefficient for Nexfin versus TTE was 0.68 (CI: 0.46 - 0.82, P < 0.0001). Bland-Altman analysis showed a bias of 0.51 ± 1.1 L/min and limits of agreement of -1.6 to 2.6 L/min, with a percentage error of 39%. CONCLUSIONS Considering limits of precision of CO measurements with Doppler echocardiography (± 30%), the agreement between noninvasive CO measurement with the Nexfin and TTE is reasonable.
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Affiliation(s)
- Anna G E van der Spoel
- Department of Anesthesiology, Institute for Cardiovascular Research, VU University Medical Center, 1081 HV, Amsterdam, The Netherlands
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Bouwman R, Boer C. I. Minimal invasive cardiac output monitoring: get the dose of fluid right. Br J Anaesth 2012; 109:299-302. [DOI: 10.1093/bja/aes277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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Bektas RN, Kutter APN, Hartnack S, Jud RS, Schnyder M, Matos JM, Bettschart-Wolfensberger R. Evaluation of a minimally invasive non–calibrated pulse contour cardiac output monitor (FloTrac/Vigileo) in anaesthetized dogs. Vet Anaesth Analg 2012; 39:464-71. [DOI: 10.1111/j.1467-2995.2012.00741.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Konings MK, Goovaerts HG, Roosendaal MR, Rienks R, Koevoets FM, Bleys RL, Buhre WF, Dorresteijn PM, Hesselink T, Officier AE, Hollenkamp CL, Rademakers FE. A new electric method for non-invasive continuous monitoring of stroke volume and ventricular volume-time curves. Biomed Eng Online 2012; 11:51. [PMID: 22900831 PMCID: PMC3541084 DOI: 10.1186/1475-925x-11-51] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Accepted: 07/25/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In this paper a new non-invasive, operator-free, continuous ventricular stroke volume monitoring device (Hemodynamic Cardiac Profiler, HCP) is presented, that measures the average stroke volume (SV) for each period of 20 seconds, as well as ventricular volume-time curves for each cardiac cycle, using a new electric method (Ventricular Field Recognition) with six independent electrode pairs distributed over the frontal thoracic skin. In contrast to existing non-invasive electric methods, our method does not use the algorithms of impedance or bioreactance cardiography. Instead, our method is based on specific 2D spatial patterns on the thoracic skin, representing the distribution, over the thorax, of changes in the applied current field caused by cardiac volume changes during the cardiac cycle. Since total heart volume variation during the cardiac cycle is a poor indicator for ventricular stroke volume, our HCP separates atrial filling effects from ventricular filling effects, and retrieves the volume changes of only the ventricles. METHODS ex-vivo experiments on a post-mortem human heart have been performed to measure the effects of increasing the blood volume inside the ventricles in isolation, leaving the atrial volume invariant (which can not be done in-vivo). These effects have been measured as a specific 2D pattern of voltage changes on the thoracic skin. Furthermore, a working prototype of the HCP has been developed that uses these ex-vivo results in an algorithm to decompose voltage changes, that were measured in-vivo by the HCP on the thoracic skin of a human volunteer, into an atrial component and a ventricular component, in almost real-time (with a delay of maximally 39 seconds). The HCP prototype has been tested in-vivo on 7 human volunteers, using G-suit inflation and deflation to provoke stroke volume changes, and LVot Doppler as a reference technique. RESULTS The ex-vivo measurements showed that ventricular filling caused a pattern over the thorax quite distinct from that of atrial filling. The in-vivo tests of the HCP with LVot Doppler resulted in a Pearson's correlation of R = 0.892, and Bland-Altman plotting of SV yielded a mean bias of -1.6 ml and 2SD =14.8 ml. CONCLUSIONS The results indicate that the HCP was able to track the changes in ventricular stroke volume reliably. Furthermore, the HCP produced ventricular volume-time curves that were consistent with the literature, and may be a diagnostic tool as well.
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Affiliation(s)
- Maurits K Konings
- Dept, of Medical Technology, University Medical Center Utrecht, Utrecht, The Netherlands.
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Truijen J, van Lieshout JJ, Wesselink WA, Westerhof BE. Noninvasive continuous hemodynamic monitoring. J Clin Monit Comput 2012; 26:267-78. [PMID: 22695821 PMCID: PMC3391359 DOI: 10.1007/s10877-012-9375-8] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2011] [Accepted: 05/30/2012] [Indexed: 11/25/2022]
Abstract
Monitoring of continuous blood pressure and cardiac output is important to prevent hypoperfusion and to guide fluid administration, but only few patients receive such monitoring due to the invasive nature of most of the methods presently available. Noninvasive blood pressure can be determined continuously using finger cuff technology and cardiac output is easily obtained using a pulse contour method. In this way completely noninvasive continuous blood pressure and cardiac output are available for clinical use in all patients that would otherwise not be monitored. Developments and state of art in hemodynamic monitoring are reviewed here, with a focus on noninvasive continuous hemodynamic monitoring form the finger.
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Affiliation(s)
- Jasper Truijen
- Laboratory for Clinical Cardiovascular Physiology, AMC Heart Failure Research Center, Amsterdam, The Netherlands
| | - Johannes J. van Lieshout
- Laboratory for Clinical Cardiovascular Physiology, AMC Heart Failure Research Center, Amsterdam, The Netherlands
- Acute Admissions Unit, Department of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- School of Biomedical Sciences, University of Nottingham Medical School, Queen’s Medical Centre, Nottingham, UK
| | - Wilbert A. Wesselink
- Clinical Team, BMEYE BV, Centerpoint 1, 4th floor, Hoogoorddreef 60, 1101 BE Amsterdam, The Netherlands
| | - Berend E. Westerhof
- Laboratory for Clinical Cardiovascular Physiology, AMC Heart Failure Research Center, Amsterdam, The Netherlands
- Clinical Team, BMEYE BV, Centerpoint 1, 4th floor, Hoogoorddreef 60, 1101 BE Amsterdam, The Netherlands
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Park SY, Kim DH, Joe HB, Yoo JY, Kim JS, Kang M, Hong YW. Accuracy of cardiac output measurements during off-pump coronary artery bypass grafting: according to the vessel anastomosis sites. Korean J Anesthesiol 2012; 62:423-8. [PMID: 22679538 PMCID: PMC3366308 DOI: 10.4097/kjae.2012.62.5.423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Revised: 09/28/2011] [Accepted: 09/28/2011] [Indexed: 11/24/2022] Open
Abstract
Background During beating heart surgery, the accuracy of cardiac output (CO) measurement techniques may be influenced by several factors. This study was conducted to analyze the clinical agreement among stat CO mode (SCO), continuous CO mode (CCO), arterial pressure waveform-based CO estimation (APCO), and transesophageal Doppler ultrasound technique (UCCO) according to the vessel anastomosis sites. Methods This study was prospectively performed in 25 patients who would be undergoing elective OPCAB. Hemodynamic variables were recorded at the following time points: during left anterior descending (LAD) anastomosis at 1 min and 5 min; during obtuse marginal (OM) anastomosis at 1 min and 5 min: and during right coronary artery (RCA) anastomosis at 1 min and 5 min. The variables measured including the SCO, CCO, APCO, and UCCO. Results CO measurement techniques showed different correlations according to vessel anastomosis site. However, the percent error observed was higher than the value of 30% postulated by the criteria of Critchley and Critchley during all study periods for all CO measurement techniques. Conclusions In the beating heart procedure, SCO, CCO and APCO showed different correlations according to the vessel anastomosis sites and did not agree with UCCO. CO values from the various measurement techniques should be interpreted with caution during OPCAB.
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Affiliation(s)
- Sung Yong Park
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon, Korea
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Caplow J, McBride SC, Steil GM, Wong J. Changes in cardiac output and stroke volume as measured by non-invasive CO monitoring in infants with RSV bronchiolitis. J Clin Monit Comput 2012; 26:197-205. [PMID: 22526738 DOI: 10.1007/s10877-012-9361-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Accepted: 04/10/2012] [Indexed: 12/26/2022]
Abstract
OBJECTIVES The primary aim of the study was to determine the changes, if any, in cardiac output (CO) and stroke volume (SV) in normal infants with RSV bronchiolitis. The secondary aim was to determine whether changes in CO (ΔCO) and SV (ΔSV) are associated with changes in respiratory rate (ΔRR). METHODS Non-invasive CO recordings were obtained within 24 h of admission and discharge. Changes in CO, SV, and HR measurements were compared using paired t-tests. The effect of fluid boluses during the first 24 h (<60 or ≥60 cc/kg) on CO was assessed by 2 way ANOVA with time and group as main effect. The relationship between ΔRR and ΔCO or ΔSV was assessed by linear regression. Data is presented as Mean ± SEM and mean differences with 95 % confidence interval (p < 0.05 considered significant). RESULTS 15 infants with RSV bronchiolitis were studied. CO (1.31 ± 0.13 to 1.11 ± 0.11 l/min (0.21 [0.04-0.37]) and SV (9.42 ± 1.10 to 7.75 ± 0.83 ml/beat (1.67 [0.21-3.12]) decreased significantly while HR (142.1 ± 4.0 to 145.2 ± 3.1 beats/min 3.0 [-5.3 to 11.3]) was unchanged. SV (p = 0.02) and CO (p = 0.04) significantly decreased only in the 7 infants that received ≥60 cc/kg. ΔRR correlated significantly with ΔCO (r (2) = 0.28, p = 0.04); but not with ΔSV (r (2) = 0.20, p = 0.09). CONCLUSIONS ∆CO was related to ΔSV and not Δ HR. The ∆CO and ΔSV were affected by fluid boluses. ΔRR correlated with ΔCO. Non-invasive CO monitoring can trend CO and SV in infants with bronchiolitis during hospitalization.
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Affiliation(s)
- Julie Caplow
- Department of Medicine Children Hospital Boston, Harvard Medical School, Boston, MA 02115, USA
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Bernstein DP, Henry IC, Banet MJ, Dittrich T. Stroke volume obtained by electrical interrogation of the brachial artery: transbrachial electrical bioimpedance velocimetry. Physiol Meas 2012; 33:629-49. [DOI: 10.1088/0967-3334/33/4/629] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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