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Transoesophageal echo-Doppler vs. thermodilution cardiac output measurement during hepatic vascular exclusion in liver transplantation

Published online by Cambridge University Press:  01 June 2008

C. Boucaud ,
Y. Bouffard ,
J. Dumortier ,
N. Gaillac ,
P. Sagnard ,
M. C. Graber ,
M. Adham  and
O. Boillot
C. Boucaud*
Affiliation:
Hôpital Edouard Herriot, Hospices Civils de Lyon, Anesthesiology and Intensive Care Department, Lyon, France Hôpital Edouard Herriot, Hospices Civils de Lyon, Liver Transplant Unit, Lyon, France
Y. Bouffard
Affiliation:
Hôpital Edouard Herriot, Hospices Civils de Lyon, Anesthesiology and Intensive Care Department, Lyon, France Hôpital Edouard Herriot, Hospices Civils de Lyon, Liver Transplant Unit, Lyon, France
J. Dumortier
Affiliation:
Hôpital Edouard Herriot, Hospices Civils de Lyon, Liver Transplant Unit, Lyon, France
N. Gaillac
Affiliation:
Hôpital Edouard Herriot, Hospices Civils de Lyon, Anesthesiology and Intensive Care Department, Lyon, France
P. Sagnard
Affiliation:
Hôpital Edouard Herriot, Hospices Civils de Lyon, Anesthesiology and Intensive Care Department, Lyon, France Hôpital Edouard Herriot, Hospices Civils de Lyon, Liver Transplant Unit, Lyon, France
M. C. Graber
Affiliation:
Hôpital Edouard Herriot, Hospices Civils de Lyon, Anesthesiology and Intensive Care Department, Lyon, France Hôpital Edouard Herriot, Hospices Civils de Lyon, Liver Transplant Unit, Lyon, France
M. Adham
Affiliation:
Hôpital Edouard Herriot, Hospices Civils de Lyon, Liver Transplant Unit, Lyon, France
O. Boillot
Affiliation:
Hôpital Edouard Herriot, Hospices Civils de Lyon, Liver Transplant Unit, Lyon, France
*
Correspondence to: Catherine Boucaud, Hôpital Edouard Herriot, 3 Place d’Arsonval, 69437 Lyon, Cedex 3, France. E-mail: [email protected]; Tel: +33 472116269; Fax: +33 472116783
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Summary

Background and objective

Continuous monitoring of cardiac output during liver transplantation is essential to evaluate the patient’s haemodynamic tolerance to acute volume variations. The aim of this study was to compare the cardiac output values obtained with a transoesophageal echo-Doppler and those obtained with a continuous thermodilution cardiac output pulmonary artery catheter.

Methods

Twenty adult patients were prospectively studied during a 5 min hepatic vascular exclusion test performed at the end of the dissection phase. Echo-Doppler and continuous thermodilution cardiac output, mean arterial pressure and end-tidal CO2 were measured before and at the end of the test.

Results

Before the test, echo-Doppler cardiac output was 7.0 ± 2.7 L min−1 and thermodilution was 9.4 ± 3.1 L min−1, (R = 0.85, P < 0.001). The end test values were, respectively, 3.5 ± 2.7 and 7.8 ± 3.5 L min−1 (R = 0.23, P = 0.34). Bland and Altman analysis showed a bias of −2.2 before the test, which increased to −4.4 at the end of the test. Mean arterial pressure decreased from 85.5 ± 15 to 66.8 ± 16 mmHg, end-tidal CO2 from 31.4 ± 2.3 to 23.8 ± 2.7 mmHg.

Conclusion

Echo-Doppler cardiac output values are different from those measured by thermodilution cardiac output in these patients. Echo-Doppler cardiac output monitoring seems to detect the output changes, which can occur during acute haemodynamic changes more rapidly than thermodilution cardiac output in the course of liver transplantation.

Keywords

CARDIAC OUTPUTTHERMODILUTIONECHOCARDIOGRAPHY DOPPLERLIVER TRANSPLANTATION
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 25 , Issue 6 , June 2008 , pp. 485 - 489
Copyright
Copyright © European Society of Anaesthesiology 2008

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References

1.Schwarz, B, Pomaroli, A, Hoermann, C, Margreiter, R, Mair, P. Liver transplantation without venovenous bypass: morbidity and mortality in patients with greater than 50% reduction in cardiac output after vena cava clamping. J Cardiothorac Vasc Anesth 2001; 15: 460–462.CrossRefGoogle ScholarPubMed
2.Nemec, P, Cerny, J, Hokl, J et al. Hemodynamic measurement in liver transplantation. Piggyback versus conventional techniques. Ann Transplant 2000; 5: 35–37.Google ScholarPubMed
3.Chaib, E, Saad, WA, Fujimura, I, JrSaad, WA, Rodrigues, J. The main indications and techniques for vascular exclusion of the liver. Arq gastroenterol 2003; 40: 131–136.CrossRefGoogle ScholarPubMed
4.Moise, SF, Sinclair, CJ, Scott, DHT. Pulmonary artery blood temperature and the measurement of cardiac output by thermodilution. Anaesthesia 2002; 57: 562–566.CrossRefGoogle ScholarPubMed
5.Greim, CA, Roewer, N, Thiel, H, Laux, G, Esch, JS. Continuous cardiac output monitoring during adult liver transplantation: thermal filament technique versus bolus thermodilution. Anesth Analg 1997; 85: 483–488.CrossRefGoogle ScholarPubMed
6.Salmenpera, M, Aittomaki, J. Cardiac output monitoring: need for improvement? Acta Anaesthesiol Scand 2003; 47: 375–377.CrossRefGoogle ScholarPubMed
7.Aranada, M, Mihm, FG, Garrett, S, Mihm, MN, Pearl, RG. Continuous cardiac output catheters: delay in in vitro response time after controlled flow changes. Anesthesiology 1998; 89: 1592–1595.CrossRefGoogle Scholar
8.Böttiger, BW, Sinner, B, Motsch, J, Bach, A, Bauer, H, Martin, E. Continuous versus intermittent thermodilution cardiac output measurement during orthotopic liver transplantation. Anaesthesia 1997; 52: 207–214.CrossRefGoogle ScholarPubMed
9.Bajorat, J, Hofmockel, R, Vagts, DA et al. Comparison of invasive and less-invasive techniques of cardiac output measurement under different haemodynamic conditions in a pig model. Eur J Anaesthesiol 2006; 23: 23–30.CrossRefGoogle Scholar
10.Odenstedt, H, Aneman, A, Oi, Y, Svensson, M, Stenqvist, O, Lundin, S. Descending aortic blood flow and cardiac output: a clinical and experimental study of continuous oesophageal echo-Doppler flowmeter. Acta Anaesthesiol Scand 2001; 45: 180–187.CrossRefGoogle Scholar
11.Sinclair, S, James, S, Singer, M. Intraoperative intravascular volume optimisation and length of hospital stay after repair of proximal femoral fracture: randomised controlled study. Br Med J 1997; 315: 909–912.CrossRefGoogle Scholar
12.Venn, R, Steele, A, Richardson, P, Poloniecki, J, Grounds, M, Newman, P. Randomized controlled trial to investigate influence of the fluid challenge on duration of hospital stay and perioperative morbidity in patients with hip fractures. Br J Anaesth 2002; 88: 65–71.CrossRefGoogle ScholarPubMed
13.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.CrossRefGoogle ScholarPubMed
14.Bland, JM, Altman, DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986; 327: 307–310.CrossRefGoogle Scholar
15.Dark, PM, Singer, M. The validity of trans-esophageal Doppler ultrasonography as a measure of cardiac output in critically ill adults. Intensive Care Med 2004; 30: 2060–2066.CrossRefGoogle ScholarPubMed
16.Valtier, B, Cholley, BP, Belot, JP, de la Coussaye, JE, Mateo, J, Payen, DM. Noninvasive monitoring of cardiac output in critically ill patients using transesophageal Doppler. Am J Respir Crit Care Med 1998; 158: 77–83.CrossRefGoogle ScholarPubMed
17.Keyl, C, Rödig, G, Lemberger, P, Hobbhahn, J. A comparison of the use of transoesophageal Doppler and thermodilution techniques for cardiac output determination. Eur J Anaesthesiol 1996; 13: 136–142.CrossRefGoogle ScholarPubMed
18.Colbert, S, O’Hanlon, DM, Duranteau, J, Ecoffey, C. Cardiac output during liver transplantation. Can J Anesth 1998; 45: 133–138.CrossRefGoogle ScholarPubMed
19.Collins, S, Girard, F, Boudreault, D et al. Esophageal Doppler and thermodilution are not interchangeable for determination of cardiac output. Can J Anesth 2005; 52: 978–985.CrossRefGoogle Scholar
20.Laupland, KB, Bands, CJ. Utility of esophageal Doppler as a minimally invasive hemodynamic monitor: a review. Can J Anesth 2002; 49: 393–401.CrossRefGoogle ScholarPubMed
21.Lafanechère, A, Albaladejo, P, Raux, M et al. Cardiac output measurement during infrarenal aortic surgery: echo-esophageal Doppler versus thermodilution catheter. J Cardiothorac Vasc Anesth 2006; 20: 26–30.CrossRefGoogle ScholarPubMed
22.Monnet, X, Chemla, D, Osman, D et al. Measuring aortic diameter improves accuracy of Doppler in assessing fluid responsiveness. Crit Care Med 2007; 35: 477–482.CrossRefGoogle ScholarPubMed
23.Griffin, K, Benjamin, E, DelGiudice, R, Schechter, C, Iberti, TJ. Thermodilution cardiac output measurement during simultaneous volume infusion through the venous port of the pulmonary artery catheter. J Cardiothorac Vasc Anesth 1997; 11: 437–439.CrossRefGoogle ScholarPubMed
24.Goldstein, LJ. Response time of the opti-Q continuous cardiac output pulmonary catheter in the urgent mode to a step change in cardiac output. J Clin Monit Comput 1999; 15: 435–439.CrossRefGoogle ScholarPubMed