Semi-invasive monitoring of cardiac output by a new device using arterial pressure waveform analysis: a comparison with intermittent pulmonary artery thermodilution in patients undergoing cardiac surgery |
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Authors: | Mayer J Boldt J Schöllhorn T Röhm K D Mengistu A M Suttner S |
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Institution: | Department of Anaesthesiology and Intensive Care Medicine, Klinikum Ludwigshafen, Bremserstr. 79, 67063 Ludwigshafen, Germany |
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Abstract: | BACKGROUND: Thermodilution technique using a pulmonary artery catheter (PAC)is a widely used method to determine cardiac output (CO). Itis increasingly criticized because of its invasiveness and itsunclear riskbenefit ratio. Thus, less invasive techniquesfor measuring CO are highly desirable. We compared a new, semi-invasivedevice (FloTrac/VigileoTM) using arterial pressure waveformanalysis for CO measurement in patients undergoing cardiac surgerywith bolus thermodilution measurements. METHODS: Forty patients undergoing coronary artery bypass grafting orvalve repair were enrolled. A PAC was inserted and routine radialarterial access was used for semi-invasive determination ofCO with the Vigileo. CO was measured simultaneously by bolusthermodilution and the Vigileo technique after induction ofanaesthesia (T1), before cardiopulmonary bypass (CPB) (T2),after CPB (T3), after sternal closure (T4), on arrival in theintensive care unit (ICU) (T5), and 4 h (T6), 8 h(T7), and 24 h after surgery (T8). CO was indexed to thebody surface area (cardiac index, CI). RESULTS: A total of 244 pairs of CI measurements were analysed. Biasand precision (1.96 SD of the bias) were 0.46 litre min1m2 and ± 1.15 litre min1 m2 (r =0.53) resulting in an overall percentage error of 46%. Subgroupanalysis revealed a percentage error of 51% for data pairs obtainedintraoperatively (T1T4), 42% in ICU (T5T8), and56% for values obtained during low CI (T1T8). CONCLUSIONS: In cardiac surgery patients, CO measured by a new semi-invasivearterial pressure waveform analysis device showed only moderateagreement with intermittent pulmonary artery thermodilutionmeasurement. |
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Keywords: | measurement techniques thermodilution monitoring cardiopulmonary surgery cardiovascular |
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