Hostname: page-component-586b7cd67f-2brh9 Total loading time: 0 Render date: 2024-11-28T00:33:58.293Z Has data issue: false hasContentIssue false
  • English
  • Français

Comparison of invasive and less-invasive techniques of cardiac output measurement under different haemodynamic conditions in a pig model

Published online by Cambridge University Press:  23 December 2005

J. Bajorat ,
R. Hofmockel ,
D. A. Vagts ,
M. Janda ,
B. Pohl ,
C. Beck  and
G. Noeldge-Schomburg
J. Bajorat
Affiliation:
University of Rostock, School of Medicine, Department of Anaesthesiology and Intensive Care Medicine, Rostock, Germany
R. Hofmockel
Affiliation:
University of Rostock, School of Medicine, Department of Anaesthesiology and Intensive Care Medicine, Rostock, Germany
D. A. Vagts
Affiliation:
University of Rostock, School of Medicine, Department of Anaesthesiology and Intensive Care Medicine, Rostock, Germany
M. Janda
Affiliation:
University of Rostock, School of Medicine, Department of Anaesthesiology and Intensive Care Medicine, Rostock, Germany
B. Pohl
Affiliation:
University of Rostock, School of Medicine, Department of Anaesthesiology and Intensive Care Medicine, Rostock, Germany
C. Beck
Affiliation:
University of Rostock, School of Medicine, Department of Anaesthesiology and Intensive Care Medicine, Rostock, Germany
G. Noeldge-Schomburg
Affiliation:
University of Rostock, School of Medicine, Department of Anaesthesiology and Intensive Care Medicine, Rostock, Germany
Get access

Extract

Summary

Background and objective: Despite the introduction of various less-invasive concepts of cardiac output measurement, pulmonary arterial thermodilution is still the most common measurement technique. Methods: This prospective controlled study was designed to compare different methods of cardiac output measurement simultaneously. Pulmonary arterial thermodilution, transpulmonary thermodilution (PiCCO™), trans-oesophageal echo-Doppler probe (HemoSonic™) and partial carbon dioxide rebreathing technique (NICO™ monitor) were evaluated against a peri-aortic transit-time flow-probe as reference method in a clinically relevant animal model. After approval from the Local Ethics Committee on Animal Research, the investigations were conducted in nine anesthetized domestic pigs. Systemic haemodynamics were modulated systematically by the application of catecholamines, caval occlusion and exsanguination. Statistical analysis was performed with Bland–Altman and linear regression. Results: A total of 366 paired cardiac output measurements were carried out at a reference cardiac output between 0.5 and 7 L min−1. The correlation coefficients for pulmonary arterial and transpulmonary thermodilution against reference were 0.93 and 0.95, for trans-oesophageal Doppler and partial rebreathing technique 0.84 and 0.77. Pulmonary arterial thermodilution and transpulmonary thermodilution showed comparable bias and limits of agreement. Where HemoSonic™ showed an overestimation of cardiac output at a higher precision, NICO™ overestimated low and underestimated higher cardiac output values. Conclusions: Our data suggest that pulmonary arterial thermodilution and PiCCO™ may be interchangeably used for cardiac output measurement even under acute haemodynamic changes. The method described by Bland and Altman demonstrated an overestimation of cardiac output for both thermodilution methods. HemoSonic™ and NICO™ offer non-invasive alternatives and complementary monitoring tools in numerous clinical situations. Trend monitoring and haemodynamic optimizing can be applied sufficiently, when absolute measures are judged critically in a clinical context. The use of the NICO™ system seems to be limited during acute circulatory changes.

Keywords

CARDIAC OUTPUT, measurement, comparisonsFICK PRINCIPLEOESOPHAGEAL DOPPLERPARTIAL CARBON DIOXIDE REBREATHINGMONITORING PHYSIOLOGICCATHETERIZATION SWAN GANZ
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 23 , Issue 1 , January 2006 , pp. 23 - 30
Copyright
© 2006 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Connors Jr AF, Speroff T, Dawson NV et al. The effectiveness of right heart catheterization in the initial care of critically ill patients. JAMA 1996; 276: 889–897.Google Scholar
Dalen JE, Bone RC. Is it time to pull the pulmonary artery catheter? JAMA 1996; 276: 916–918.Google Scholar
Gödje O, Hoeke K, LichtwarcK-Aschoff M et al. Continuous cardiac output by femoral arterial thermodilution calibrated pulse contour analysis: comparison with pulmonary arterial thermodilution. Crit Care Med 1999; 27: 2407–2412.Google Scholar
Valtier B, Cholley BP, Belot JP et al. Noninvasive monitoring of cardiac output in critically ill patients using transoesophageal Doppler. Am J Respir Crit Care Med 1998; 158: 77–83.Google Scholar
Heerden van PV, Baker S, Lim SI et al. Clinical evaluation of the non-invasive cardiac output (NICO) monitor in the intensive care unit. Anaesth Intens Care 2000; 28: 427–430.Google Scholar
Cariou A, Monchi M, Joly LM. Non invasive cardiac output monitoring by aortic blood flow determination: evaluation of the sometec Dynemo 3000. Crit Care Med 1998; 26: 2066–2072.Google Scholar
Simanski O, Kaehler R, Pohl B, Hofmockel R. Control in general anaesthesia – a contribution. In: Adlassnig KP. Intelligent Systems in Patient Care. European Network on Intelligent Technology for Smart Adaptive Systems and the Austrian Society of Artificial Intelligence. Vienna: Austrian Computer Society, 2001: 169–176.
Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986; 1: 307–310.Google Scholar
Ganz W, Swan HJ. Measurement of blood flow by thermodilution. Am J Cardiol 1970; 29: 241–246.Google Scholar
Hartman J, Olszanski DA, Hullinger TG, Brunden MN. In vivo validation of a transit-time flow meter. J Pharm Tox Meth 1994; 31: 153–160.Google Scholar
Lundell A, Bergquist D, Maattson E, Nilsson B. Volume flow measurements with a transit-time flowmeter – an in vivo and in vitro variability and validation study. Clin Physiol 1993; 13: 547–550.Google Scholar
Aadahl P, Aakhus S, Saether OD, Stomholm T, Myhre HO. Cardiac output measurement during cross-clamping of the descending thoracic aorta in pigs. Acta Anaesthesiol Scand 2000; 44: 180–185.Google Scholar
Renner LE, Morton MJ, Sakuma GY. Indicator amount, temperature, and intrinsic cardiac output affect thermodilution cardiac output accuracy and reproducibility. Crit Care Med 1993; 21: 586–597.Google Scholar
Rödig G, Prasser C, Keyl et al. Continuous cardiac output measurement: pulse contour analysis vs thermodilution technique in cardiac surgical patients. Br J Anaesth 1999; 82: 525–530.Google Scholar
Gueugniaud PY, Muchada R, Moussa M et al. Continuous oesophageal aortic blood flow echo-Doppler measurement during general anaesthesia in infants. Can J Anaesth 1997; 44: 745–750.Google Scholar
Yem YS, Tang Y, Turner MJ, Baker AB. Sources of error in noninvasive pulmonary blood flow measurements by partial rebreathing: a computer model study. Anesthesiology 2003; 98: 881–887.Google Scholar
Nilsson LB, Eldrup N, Berthelsen PG. Lack of agreement between thermodilution and carbon dioxide-rebreathing cardiac output. Acta Anaesthesiol Scand 2001; 45: 680–685.Google Scholar
Neuhäuser C, Müller M, Bräu M et al. Partial CO2 rebreathing technique versus thermodilution: measurement of cardiac output before and after operations with extracorporal circulation. Anesthetist 2002; 51: 625–633.Google Scholar
Gan TJ, Soppitt A, Maroof M et al. Goal directed intraoperative fluid administration reduces length of hospital stay after major surgery. Anesthesiology 2002; 97: 820–826.Google Scholar