scholarly journals Estimation of cardiac output variations induced by hemodynamic interventions using multi-beat analysis of arterial waveform: a comparative off-line study with transesophageal Doppler method during non-cardiac surgery

2021 ◽  
Author(s):  
Arthur Le Gall ◽  
Fabrice Vallée ◽  
Jona Joachim ◽  
Alex Hong ◽  
Joaquim Matéo ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Cardiac Surgery ◽  
Fluid Challenge ◽  
Percentage Error ◽  
Exclusion Zone ◽  
Upper Limits ◽  
Before And After ◽  
Transesophageal Doppler ◽  
Trending Ability ◽  
Arterial Wave Reflection

AbstractMulti-beat analysis (MBA) of the radial arterial pressure (AP) waveform is a new method that may improve cardiac output (CO) estimation via modelling of the confounding arterial wave reflection. We evaluated the precision and accuracy using the trending ability of the MBA method to estimate absolute CO and variations (ΔCO) during hemodynamic challenges. We reviewed the hemodynamic challenges (fluid challenge or vasopressors) performed when intra-operative hypotension occurred during non-cardiac surgery. The CO was calculated offline using transesophageal Doppler (TED) waveform (COTED) or via application of the MBA algorithm onto the AP waveform (COMBA) before and after hemodynamic challenges. We evaluated the precision and the accuracy according to the Bland & Altman method. We also assessed the trending ability of the MBA by evaluating the percentage of concordance with 15% exclusion zone between ΔCOMBA and ΔCOTED. A non-inferiority margin was set at 87.5%. Among the 58 patients included, 23 (40%) received at least 1 fluid challenge, and 46 (81%) received at least 1 bolus of vasopressors. Before treatment, the COTED was 5.3 (IQR [4.1–8.1]) l min−1, and the COMBA was 4.1 (IQR [3–5.4]) l min−1. The agreement between COTED and COMBA was poor with a 70% percentage error. The bias and lower and upper limits of agreement between COTED and COMBA were 0.9 (CI95 = 0.82 to 1.07) l min−1, −2.8 (CI95 = −2.71 to−2.96) l min−1 and 4.7 (CI95 = 4.61 to 4.86) l min−1, respectively. After hemodynamic challenge, the percentage of concordance (PC) with 15% exclusion zone for ΔCO was 93 (CI97.5 = 90 to 97)%. In this retrospective offline analysis, the accuracy, limits of agreements and percentage error between TED and MBA for the absolute estimation of CO were poor, but the MBA could adequately track induced CO variations measured by TED. The MBA needs further evaluation in prospective studies to confirm those results in clinical practice conditions.

scholarly journals Accuracy of Cardiac Output by Nine Different Pulse Contour Algorithms in Cardiac Surgery Patients: A Comparison with Transpulmonary Thermodilution

2016 ◽  
Vol 2016 ◽  
pp. 1-13 ◽  
Author(s):  
Ole Broch ◽  
Berthold Bein ◽  
Matthias Gruenewald ◽  
Sarah Masing ◽  
Katharina Huenges ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Transpulmonary Thermodilution ◽  
Pulse Contour ◽  
Passive Leg Raising ◽  
Percentage Error ◽  
Poor Correlation ◽  
Hemodynamic Changes ◽  
Before And After ◽  
Four Quadrant ◽  
Trending Ability

Objective. Today, there exist several different pulse contour algorithms for calculation of cardiac output (CO). The aim of the present study was to compare the accuracy of nine different pulse contour algorithms with transpulmonary thermodilution before and after cardiopulmonary bypass (CPB). Methods. Thirty patients scheduled for elective coronary surgery were studied before and after CPB. A passive leg raising maneuver was also performed. Measurements included CO obtained by transpulmonary thermodilution (COTPTD) and by nine pulse contour algorithms (COX1–9). Calibration of pulse contour algorithms was performed by esophageal Doppler ultrasound after induction of anesthesia and 15 min after CPB. Correlations, Bland-Altman analysis, four-quadrant, and polar analysis were also calculated. Results. There was only a poor correlation between COTPTD and COX1–9 during passive leg raising and in the period before and after CPB. Percentage error exceeded the required 30% limit. Four-quadrant and polar analysis revealed poor trending ability for most algorithms before and after CPB. The Liljestrand-Zander algorithm revealed the best reliability. Conclusions. Estimation of CO by nine different pulse contour algorithms revealed poor accuracy compared with transpulmonary thermodilution. Furthermore, the less-invasive algorithms showed an insufficient capability for trending hemodynamic changes before and after CPB. The Liljestrand-Zander algorithm demonstrated the highest reliability. This trial is registered with NCT02438228 (ClinicalTrials.gov).

scholarly journals Performance of a capnodynamic method estimating cardiac output during respiratory failure - before and after lung recruitment

2019 ◽  
Vol 34 (6) ◽  
pp. 1199-1207
Author(s):  
Thorir Svavar Sigmundsson ◽  
Tomas Öhman ◽  
Magnus Hallbäck ◽  
Eider Redondo ◽  
Fernando Suarez Sipmann ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Respiratory Failure ◽  
Reference Method ◽  
Hemodynamic Instability ◽  
Lung Lavage ◽  
Lung Recruitment ◽  
Recruitment Manoeuvre ◽  
Percentage Error ◽  
Before And After ◽  
The Right

AbstractRespiratory failure may cause hemodynamic instability with strain on the right ventricle. The capnodynamic method continuously calculates cardiac output (CO) based on effective pulmonary blood flow (COEPBF) and could provide CO monitoring complementary to mechanical ventilation during surgery and intensive care. The aim of the current study was to evaluate the ability of a revised capnodynamic method, based on short expiratory holds (COEPBFexp), to estimate CO during acute respiratory failure (LI) with high shunt fractions before and after compliance-based lung recruitment. Ten pigs were submitted to lung lavage and subsequent ventilator-induced lung injury. COEPBFexp, without any shunt correction, was compared to a reference method for CO, an ultrasonic flow probe placed around the pulmonary artery trunk (COTS) at (1) baseline in healthy lungs with PEEP 5 cmH2O (HLP5), (2) LI with PEEP 5 cmH2O (LIP5) and (3) LI after lung recruitment and PEEP adjustment (LIPadj). CO changes were enforced during LIP5 and LIPadj to estimate trending. LI resulted in changes in shunt fraction from 0.1 (0.03) to 0.36 (0.1) and restored to 0.09 (0.04) after recruitment manoeuvre. Bias (levels of agreement) and percentage error between COEPBFexp and COTS changed from 0.5 (− 0.5 to 1.5) L/min and 30% at HLP5 to − 0.6 (− 2.3 to 1.1) L/min and 39% during LIP5 and finally 1.1 (− 0.3 to 2.5) L/min and 38% at LIPadj. Concordance during CO changes improved from 87 to 100% after lung recruitment and PEEP adjustment. COEPBFexp could possibly be used for continuous CO monitoring and trending in hemodynamically unstable patients with increased shunt and after recruitment manoeuvre.

scholarly journals Increased FIO2 Influences SvO2 Interpretation and Accuracy of Fick-based Cardiac Output Assessment in Cardiac Surgery Patients

2020 ◽  
Author(s):  
Sheng-Yi Lin ◽  
Feng-Cheng Chang ◽  
Jr-Rung Lin ◽  
An-Hsun Chou ◽  
Yung-Fong Tsai ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Cardiac Surgery ◽  
Percentage Error ◽  
Surgical Incision ◽  
Elective Cardiac Surgery ◽  
Venous Oxygen Saturation ◽  
Fraction Of Inspired Oxygen ◽  
Pearson Correlations ◽  
Fick Equation ◽  
Inspired Oxygen

Abstract Background: The study aimed to reveal how the fraction of inspired oxygen (FIO2) affected the value of mixed venous oxygen saturation (SvO2) and the accuracy of Fick-equation-based cardiac output (Fick-CO). Methods: Forty-two adult patients who underwent elective cardiac surgery were enrolled and randomly divided into two groups: FIO2 <0.7 or >0.85. Under stable general anesthesia, thermodilution-derived cardiac output (TD-CO), SvO2, PvO2, hemoglobin, SaO2, PaO2, and blood pH levels were recorded before surgical incision. Results: Significant differences in FIO2 values were observed between the two groups (0.56 ±0.08 in the <70% group and 0.92 ±0.03 in the >0.85 group; p <0.0001). The increasing FIO2 values lead to increases in SvO2, PvO2, and PaO2, with little effects on cardiac output and hemoglobin levels. When comparing to TD-CO, the calculated Fick-CO in both groups had moderate Pearson correlations and similar linear regression results. Although the FIO2 <0.7 group presented a less mean bias and a smaller limits of agreement, neither group met the percentage error criteria of <30% in Bland-Altman analysis.Conclusions: Increased FIO2 may influence the interpretation of SvO2 and the exacerbation of Fick-CO estimation, which could affect clinical management. Trial Registration: ClinicalTrials.gov ID number: NCT04265924. Retrospectively registered (Date of registration: February 12, 2020).

scholarly journals Cardiac Output Evaluation on Septic Shock Patients: Comparison between Calibrated and Uncalibrated Devices during Vasopressor Therapy

2021 ◽  
Vol 10 (2) ◽  
pp. 213
Author(s):  
Paolo Persona ◽  
Ilaria Valeri ◽  
Elisabetta Saraceni ◽  
Alessandro De Cassai ◽  
Fabrizia Calabrese ◽  
...  
Keyword(s):  
Septic Shock ◽  
Cardiac Output ◽  
Volume Expansion ◽  
Transpulmonary Thermodilution ◽  
Percentage Error ◽  
Arterial Waveform ◽  
Polar Plot ◽  
Norepinephrine Infusion ◽  
The Mean ◽  
Trending Ability

There are no reliable, non-invasive methods to accurately measure cardiac output (CO) in septic patients. MostCare (Vytech Health™, Vygon, Padova, Italy), is a beat-to-beat, self calibrated method for CO measurement based on continuous analysis of reflected arterial pressure waveforms. We enrolled 40 patients that were suffering from septic shock and requiring norepinephrine infusion to target blood pressure in order to to evaluate the level of agreement between a calibrated transpulmonary thermodilution device (PiCCO System, Pulsion Medical Systems, Feldkirchen, Germany) and the MostCare system in detecting and tracking changes in CO measurements related to norepinephrine reduction in septic shock patients,. PiCCO was connected to a 5 Fr femoral artery catheter and to a central venous catheter. System calibration was performed with 15 mL of cold saline injection over about 3 s. The MostCare device was connected to the artery catheter to analyze the arterial waveform. Before reducing norepinephrine infusion, the PiCCO system was calibrated, the MostCare waveform was optimized, and the values of the complete hemodynamic profile were recorded (T1). Norepinephrine infusion was then reduced by 0.03 mcg/Kg/min. After 30 min, a new calibration of PiCCO system and a new record on both monitors were performed (T2). Static measurements agreements were assessed using the Bland-Altman test, while trending ability was investigated using polar plot analysis. If volume expansion occurred, then related data were separately analyzed. At T1 mean the CO was 5.38 (SD 0.60) L/min, the mean difference was 0.176 L/min, the limits of agreement (LoA) was +1.39 and −1.04 L/min, and the percentage error (PE) was 22.6%; at T2 the mean CO was 5.44 (SD 0.73) L/min, the mean difference was 0.053 L/min, the LoA was +1.51 and −1.40, and the PE was 27%. After considering the volume expansion between T1 and T2, the mean CO at T1 was 5.39 L/min (SD 0.47), the LoA was +1.09 and −0.78 L/min, and the percentage error (PE) was 17%; at T2 the mean CO was 5.35 L/min (SD 0.81), the LoA was +1.73 and −1.52 L/min, and the PE was 30%. The polar plot diagram seems to confirm the trending ability of MostCare system versus the reference method. In septic patients, when the arterial waveform is accurate, MostCare and PiCCO transpulmonary thermodilution exhibit good agreement even after the reduction of norepinephrine and changes in vascular tone or volume expansion. MostCare could be a rapid to set, reliable, and useful tool to monitor hemodynamic variations in septic patients in emergency contexts where thermodilution methods or other advanced systems are not easily available.

Changes in Radial Artery Pulse Pressure During a Fluid Challenge Cannot Assess Fluid Responsiveness in Patients With Septic Shock

2017 ◽  
Vol 35 (2) ◽  
pp. 149-153
Author(s):  
Victor De la Puente-Diaz de Leon ◽  
Valente de Jesus Jaramillo-Rocha ◽  
Jean-Louis Teboul ◽  
Sofia Garcia-Miranda ◽  
Bernardo A. Martinez-Guerra ◽  
...  
Keyword(s):  
Septic Shock ◽  
Cardiac Output ◽  
Radial Artery ◽  
Pulse Pressure ◽  
Pearson Correlation ◽  
Characteristic Curve ◽  
Fluid Challenge ◽  
Arterial Blood ◽  
Paired Student ◽  
Before And After

Background: Arterial blood pressure is the most common variable used to assess the response to a fluid challenge in routine clinical practice. The aim of this study was to evaluate the accuracy of the change in the radial artery pulse pressure (rPP) to detect the change in cardiac output after a fluid challenge in patients with septic shock. Methods: Prospective observational study including 35 patients with septic shock in which rPP and cardiac output were measured before and after a fluid challenge with 400 mL of crystalloid solution. Cardiac output was measured with intermittent thermodilution technique using a pulmonary artery catheter. Patients were divided between responders (increase >15% of cardiac output after fluid challenge) and nonresponders. The area under the receiver operating characteristic curve (AUROC), Pearson correlation coefficient and paired Student t test were used in statistical analysis. Results: Forty-three percent of the patients were fluid responders. The change in rPP could not neither discriminate between responders and nonresponders (AUROC = 0.52; [95% confidence interval: 0.31-0.72] P = .8) nor correlate ( r = .21, P = .1) with the change in cardiac output after the fluid challenge. Conclusions: The change in rPP neither discriminated between fluid responders and nonresponders nor correlated with the change in cardiac output after a fluid challenge. The change in rPP cannot serve as a surrogate of the change in cardiac output to assess the response to a fluid challenge in patients with septic shock.

Measurement of Cardiac Output by Pulse Dye Densitometry Using Indocyanine Green 

1997 ◽  
Vol 87 (4) ◽  
pp. 816-822 ◽  
Author(s):  
Takasuke Imai ◽  
Kenichirou Takahashi ◽  
Haruhiko Fukura ◽  
Yasuo Morishita
Keyword(s):  
Cardiac Output ◽  
Indocyanine Green ◽  
Major Surgery ◽  
Percentage Error ◽  
Paired Data ◽  
Thermodilution Method ◽  
Accuracy And Precision ◽  
Before And After ◽  
Pulmonary Arterial Catheter ◽  
A Prospective Study

Background A new method for determining cardiac output (CO, l/min) using dye dilution combined with pulse dye densitometry (PDD), based on the principle of pulse oximetry, has been developed. The aim of the study was to determine the accuracy and precision of PDD by comparing it with the thermodilution method. Methods A prospective study was performed in 22 patients having surgery who were monitored using a pulmonary arterial catheter. In addition to the catheter, a specially designed photodetector was placed on the nasal wing. Ten milliliters of ice-cold indocyanine green dissolved in a 5% glucose solution (0.5 mg/ml) was injected. The dye and thermal dilution curves were simultaneously measured to calculate CO. Three to six injections were performed before and after surgery. Paired data were assessed in absolute terms, and the percentage errors were calculated by the degree of agreement and compared at three levels of CO (low &lt; or = 3.5 &lt; medium &lt; or = 6 &lt; high) by analysis of variance. Results The mean and SDs of the differences between dye and thermodilution CO were 0.16 +/- 0.80 l/min or 4.5 +/- 19.6% for 191 paired data. Measurement after surgery failed in one patient. The percentage error with low CO (9.3 +/- 19.3%) was greater (P &lt; 0.05) than those obtained with other CO. Conclusions Pulse dye densitometry could measure CO repeatedly in patients having major surgery with the same degree of accuracy as the thermodilution method; however, a considerable degree of error was observed in some patients.

A mini-fluid challenge of 150 mL predicts fluid responsiveness using Modelflow R pulse contour cardiac output directly after cardiac surgery

2018 ◽  
Vol 46 ◽  
pp. 17-22 ◽  
Author(s):  
Annemieke Smorenberg ◽  
Thomas G.V. Cherpanath ◽  
Bart F. Geerts ◽  
Robert B.P. de Wilde ◽  
Jos R.C. Jansen ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Cardiac Surgery ◽  
Fluid Responsiveness ◽  
Fluid Challenge ◽  
Pulse Contour ◽  
Pulse Contour Cardiac Output

Are Noninvasive Continuous Cardiac Output Monitoring Interchangeable with Esophageal Doppler?

2020 ◽  
Vol 103 (6) ◽  
pp. 541-547
Keyword(s):  
Cardiac Output ◽  
Stroke Volume ◽  
Correlation Coefficient ◽  
Percentage Error ◽  
Cardiac Output Monitoring ◽  
Esophageal Doppler ◽  
Limits Of Agreement ◽  
Pulse Wave Transit Time ◽  
Output Monitoring ◽  
Trending Ability

Objective: To compare the trending ability, accuracy, and precision of non-invasive stroke volume (SV) measurement based on a bioreactance technique and measurement of the pulse wave transit time (PWTT) versus the esophageal Doppler monitoring (EDM). Materials and Methods: Two hundred twenty-seven paired measurements from 10 patients who underwent abdominal surgery under general anesthesia were included for SV measurements. Pearson’s correlation coefficient was calculated, and Bland-Altman analysis was performed to evaluate the agreement between EDM and bioreactance (EDM-bioreactance) and between EDM and PWTT (EDM-PWTT). Results: EDM-bioreactance had a correlation coefficient of 0.75 (95% confidence interval [CI] 0.62 to 0.78; p<0.001), bias of 0.28 ml (limits of agreement –30.92 to 31.38 ml), and percentage error of 46.82%. EDM-PWTT had a correlation coefficient of 0.48 (95% CI 0.44 to 0.72; p<0.001), bias of –0.18 ml (limits of agreement –40.28 to 39.92 ml), and percentage error of 60.17%. A subgroup analysis of data from patients who underwent crystalloid loading was performed to detect the trending ability. The four-quadrant plot analysis between EDM-bioreactance and EDM-PWTT demonstrated concordance rates of 70.00% and 73.68%, respectively. Conclusion: SV measurement based on bioreactance technique and measurement of PWTT are not interchangeable with EDM. Trial registration: Thai Clinical Trials Registry, TCTR 20181217003 Keywords: Stroke volume, Cardiac output, Doppler, Perioperative care, Pulse, Time

Bioreactance Cardiac Output Trending Ability in Preterm Infants: A Single Centre, Longitudinal Study

Neonatology ◽  
2021 ◽  
pp. 1-9
Author(s):  
Lizelle Van Wyk ◽  
Johan Smith ◽  
John Lawrenson ◽  
Carl J. Lombard ◽  
Willem-Pieter de Boode
Keyword(s):  
Cardiac Output ◽  
Longitudinal Study ◽  
Preterm Infants ◽  
Ductus Arteriosus ◽  
Concordance Rate ◽  
Preterm Neonates ◽  
Exclusion Zone ◽  
The Mean ◽  
Trending Ability ◽  
Angular Bias

<b><i>Introduction:</i></b> It is unknown whether bioreactance (BR) can accurately track cardiac output (CO) changes in preterm neonates. <b><i>Methods:</i></b> A prospective observational longitudinal study was performed in stable preterm infants (&#x3c;37 weeks) during the first 72 h of life. Stroke volume (SV) and CO, as measured by BR and transthoracic echocardiography, were compared. <b><i>Results:</i></b> The mean gestational age (GA) was 31.3 weeks and mean birth weight (BW) was 1,563 g. Overall, 690 measurements were analysed for trending ability by 4-quadrant and polar plots. For non-weight-indexed measurements, 377 (54.6%) lay outside the 5% exclusion zone, the concordance rate was poor (77.2%) with a high mean angular bias (28.6°), wide limits of agreement and a poor angular concordance rate (17.4%). Neither GA, BW nor respiratory support mode affected trending data. Patent ductus arteriosus, postnatal age, and CO level had variable effects on trending data. Trending data for 5 and 10% exclusion zones were also compared. <b><i>Conclusion:</i></b> The ability of BR to track changes in CO is not interchangeable with CO changes as measured by echocardiography. BR, as a trend monitor for changes in CO or SV to determine clinical decisions around interventions in neonatology, should be used with caution.

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