Measurement of cardiac output: a comparison between transpulmonary thermodilution and uncalibrated pulse contour analysis†‡
TLDR
Pulse contour analysis-derived CO (Vigileo system) underestimates CO(TPID) and is not as reliable as transpulmonary thermodilution in septic patients.Abstract:
Background Recently, continuous monitoring of cardiac output (CO) based on pulse contour analysis (Vigileo®) has been introduced into practice. In this clinical study, we evaluated the accuracy of this system by comparing it with the transpulmonary thermodilution technique (TPID) in septic patients. Methods We studied 24 mechanically ventilated patients with septic shock (16 male, 8 female, age 26–77 yr) receiving treatment with norepinephrine who for clinical indication underwent haemodynamic monitoring by the transpulmonary thermodilution technique using a PiCCO®plus system (Pulsion Medical Systems, Munich, Germany). In parallel, arterial pulse contour was applied using the femoral arterial pressure curve (FloTrac® pressure sensor, Vigileo® monitor, Edwards Lifesciences, Irvine, USA). After baseline measurement, mean arterial pressure was elevated by increasing norepinephrine dosage, and CO was measured again before mean arterial pressure was reduced back to baseline levels. Fluid status and ventilator settings remained unchanged throughout. At each time point, CO by transpulmonary thermodilution was calculated from three central venous bolus injections of 15 ml of saline ( Results Overall, CO was 6.7 (sd 1.8) (3.2–10.1) litre min−1 for CO(TPID) and 6.2 (2.4) (3.0–17.6) litre min−1 for CO(Vigileo®). Linear regression revealed: CO(Vigileo®) = 1.54 + 0.72 × CO(TPID) litre min−1, r2 = 0.26 (P Conclusions Pulse contour analysis-derived CO (Vigileo® system) underestimates CO(TPID) and is not as reliable as transpulmonary thermodilution in septic patients.read more
Citations
More filters
Journal ArticleDOI
Minimally invasive measurement of cardiac output during surgery and critical care: a meta-analysis of accuracy and precision.
Philip J Peyton,Simon W Chong +1 more
TL;DR: None of the four minimally invasive methods adapted for use during surgery and critical care has achieved agreement with bolus thermodilution which meets the expected 30% limits.
Journal ArticleDOI
Noninvasive cardiac output monitors: a state-of the-art review.
TL;DR: The resuscitation of hemodynamically unstable patients requires an accurate assessment of the patients' intravascular volume status (cardiac preload) and the ability to predict the hemodynamic response after a fluid challenge (volume responsiveness) to minimize the risks of over- or under-resuscitation.
Journal ArticleDOI
Assessment of trending ability of cardiac output monitors by polar plot methodology.
TL;DR: Polar plots can be used to show the trending ability of CO monitors in comparative validation studies and overcome the deficiencies of concordance analysis, which uses the direction of change as a statistic and ignores the magnitude of change in CO.
Journal ArticleDOI
Will This Hemodynamically Unstable Patient Respond to a Bolus of Intravenous Fluids
Peter Bentzer,Donald E. G. Griesdale,John H. Boyd,Kelly A. MacLean,Demetrios Sirounis,Najib T. Ayas +5 more
TL;DR: Passive leg raising followed by measurement of cardiac output or related parameters following passive leg raising may be the most useful test for predicting fluid responsiveness in hemodynamically unstable adults.
Journal ArticleDOI
Cardiac output measurement in patients undergoing liver transplantation: pulmonary artery catheter versus uncalibrated arterial pressure waveform analysis.
Biais Matthieu,Nouette-Gaulain Karine,Cottenceau Vincent,Vallet Alain,Cochard Jean Francois,Revel Philippe,Sztark Francois +6 more
TL;DR: The results suggest that Vigileo/FloTrac CO monitoring data do not agree well with those of automatic thermodilution in patients undergoing liver transplantation, especially in Child-Pugh grade B and C patients with low systemic vascular resistance.
References
More filters
Journal ArticleDOI
Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock
R. Phillip Dellinger,Jean Carlet,Henry Masur,Herwig Gerlach,Thierry Calandra,Jonathan Cohen,Juan Gea-Banacloche,Didier Keh,John C. Marshall,Margaret M. Parker,Graham Ramsay,Janice L. Zimmerman,Jean Louis Vincent,Mitchell M. Levy +13 more
TL;DR: Evidence-based recommendations can be made regarding many aspects of the acute management of sepsis and septic shock that will hopefully translate into improved outcomes for the critically ill patient.
Journal ArticleDOI
Catheterization of the Heart in Man with Use of a Flow-Directed Balloon-Tipped Catheter
H.J.C. Swan,William Ganz,James S. Forrester,Harold S. Marcus,George A. Diamond,David W. Chonette +5 more
TL;DR: Pressures in the right side of the heart and pulmonary capillary wedge can be obtained by cardiac catheterization without the aid of fluoroscopy.
Journal ArticleDOI
Pulmonary-artery versus central venous catheter to guide treatment of acute lung injury.
TL;DR: The relationship of benefits and risks of PACs in 1000 patients with established acute lung injury in a randomized trial comparing hemodynamic management guided by a PAC with hemodynamic managed by a central venous catheter (CVC) using an explicit management protocol was evaluated.
Journal ArticleDOI
Assessment of cardiac preload and extravascular lung water by single transpulmonary thermodilution.
Samir G. Sakka,C C Rühl,U. J. Pfeiffer,Richard Beale,A McLuckie,Konrad Reinhart,Andreas Meier-Hellmann +6 more
TL;DR: Determinations of ITBV and EVLW by single thermodilution agreed closely with the corresponding values from the double-indicator technique, making it a promising technique for the bedside.
Pulmonary-Artery versus Central Venous Catheter to Guide Treatment of Acute Lung Injury The National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network*
TL;DR: PAC-guided therapy did not improve survival or organ function but was associated with more complications than CVC-guided Therapy, suggesting that the PAC should not be routinely used for the management of acute lung injury.