Consistency between Impedance Technique and Echocardiogram Hemodynamic Measurements in Neonates

2020 ◽  
Author(s):  
Wenshen Wu ◽  
Sulian Lin ◽  
Caixuan Xie ◽  
Jianbo Li ◽  
Jingen Lie ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Prospective Observational Study ◽  
Limits Of Agreement ◽  
Output Measurement ◽  
Accuracy And Precision ◽  
Impedance Technique ◽  
Precision And Accuracy ◽  
Larger Sample ◽  
Hemodynamic Measurements ◽  
Cardiac Output Measurements

Abstract Objective The aim of this study was to validate impedance technique (IT) by investigating the agreement in cardiac output measurements performed by IT and echocardiography (ECHO). Study design This is a prospective observational study, including a total of 30 neonates who underwent hemodynamic measurements by IT and ECHO. To determine the agreement between both methods, we performed IT to measure stroke volume (SV-IT) and cardiac output (CO-IT) immediately before or after ECHO to measure SV (SV-ECHO) and CO (CO-ECHO). The precision and accuracy of the IT relative to ECHO were assessed. Results SV-ECHO and SV-IT were (4.45 ± 0.78) and (4.54 ± 0.81) mL, respectively. The bias and limits of agreement of SV-IT were 0.09 mL and ( –1.92 to 1.73) mL, respectively. The true precision of SV-IT was 27.3%. Furthermore, CO-ECHO and CO-IT were (0.62 ± 0.12) and (0.61 ± 0.12) L/min, respectively. The bias and LoA of CO-IT were 0.01L/min and (–0.33 to 0.31) L/min, respectively. The true precision of CO-IT was 28.3%. Conclusion Agreement between the IT and ECHO in the cardiac output measurement appeared acceptable. However, the accuracy and precision of the IT approach should be further investigated using a larger sample.

Cardiac Output Determination

1993 ◽  
Vol 4 (1) ◽  
pp. 81-97 ◽  
Author(s):  
Susan L. Woods ◽  
Susan Osguthorpe
Keyword(s):  
Cardiac Output ◽  
Critical Care Nurses ◽  
Cardiac Output Measurement ◽  
Nursing Management ◽  
Output Measurement ◽  
Thermodilution Cardiac Output ◽  
Cardiac Output Determination ◽  
Output System ◽  
Cardiac Output Measurements ◽  
Management Issues

Critical care nurses frequently are involved in obtaining cardiac output measurements and in using these data to assess and to plan therapy. This article reviews the physiologic determinants of cardiac output and the clinical factors that influence these determinants. Principles and techniques of common methods of cardiac output measurement are discussed. A thorough presentation of guidelines for troubleshooting problems with thermodilution cardiac output measurement is provided in a table. Nursing management issues are discussed using relevant nursing research. Future considerations in cardiac output measurement are discussed, and suggestions of an ideal cardiac output system are provided

scholarly journals Noninvasive Assessment of Cardiac Output: Accuracy and Precision of the Closed‐Circuit Acetylene Rebreathing Technique for Cardiac Output Measurement

2020 ◽  
Vol 9 (17) ◽  
Author(s):  
E. Ashley Hardin ◽  
Douglas Stoller ◽  
Justin Lawley ◽  
Erin J. Howden ◽  
Michinari Hieda ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Coefficient Of Variation ◽  
Clinical Disease ◽  
Closed Circuit ◽  
Stress Tests ◽  
Healthy Individuals ◽  
Output Measurement ◽  
Disease States ◽  
Accuracy And Precision ◽  
Rebreathing Method

Background Accurate assessment of cardiac output is critical to the diagnosis and management of various cardiac disease states; however, clinical standards of direct Fick and thermodilution are invasive. Noninvasive alternatives, such as closed‐circuit acetylene (C 2 H 2 ) rebreathing, warrant validation. Methods and Results We analyzed 10 clinical studies and all available cardiopulmonary stress tests performed in our laboratory that included a rebreathing method and direct Fick or thermodilution. Studies included healthy individuals and patients with clinical disease. Simultaneous cardiac output measurements were obtained under normovolemic, hypovolemic, and hypervolemic conditions, along with submaximal and maximal exercise. A total of 3198 measurements in 519 patients were analyzed (mean age, 59 years; 48% women). The C 2 H 2 method was more precise than thermodilution in healthy individuals with half the typical error (TE; 0.34 L/min [ r =0.92] and coefficient of variation, 7.2%) versus thermodilution (TE=0.67 [ r =0.70] and coefficient of variation, 13.2%). In healthy individuals during supine rest and upright exercise, C 2 H 2 correlated well with thermodilution (supine: r =0.84, TE=1.02; exercise: r =0.82, TE=2.36). In patients with clinical disease during supine rest, C 2 H 2 correlated with thermodilution ( r =0.85, TE=1.43). C 2 H 2 was similar to thermodilution and nitrous oxide (N 2 O) rebreathing technique compared with Fick in healthy adults (C 2 H 2 rest: r =0.85, TE=0.84; C 2 H 2 exercise: r =0.87, TE=2.39; thermodilution rest: r =0.72, TE=1.11; thermodilution exercise: r =0.73, TE=2.87; N 2 O rest: r =0.82, TE=0.94; N 2 O exercise: r =0.84, TE=2.18). The accuracy of the C 2 H 2 and N 2 O methods was excellent ( r =0.99, TE=0.58). Conclusions The C 2 H 2 rebreathing method is more precise than, and as accurate as, the thermodilution method in a variety of patients, with accuracy similar to an N 2 O rebreathing method approved by the US Food and Drug Administration.

scholarly journals Cardiac Output Measurements in Septic Patients: Comparing the Accuracy of USCOM to PiCCO

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Sophia Horster ◽  
Hans-Joachim Stemmler ◽  
Nina Strecker ◽  
Florian Brettner ◽  
Andreas Hausmann ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Prospective Observational Study ◽  
University Hospital ◽  
Percentage Error ◽  
Cardiac Output Monitoring ◽  
Saps Ii Score ◽  
The Mean ◽  
Output Monitoring ◽  
Clinical Conditions ◽  
Cardiac Output Measurements

USCOM is an ultrasound-based method which has been accepted for noninvasive hemodynamic monitoring in various clinical conditions (USCOM, Ultrasonic cardiac output monitoring). The present study aimed at comparing the accuracy of the USCOM device with that of the thermodilution technique in patients with septicemia. We conducted a prospective observational study in a medical but noncardiological ICU of a university hospital. Septic adult patients (median age 55 years, median SAPS-II-Score 43 points) on mechanical ventilation and catecholamine support were monitored with USCOM and PiCCO (). Seventy paired left-sided CO measurements (transaortic access = COUS-A) were obtained. The mean COUS-Awere 6.55 l/min (±2.19) versus COPiCCO6.5 l/min (±2.18). The correlation coefficient was . Comparison by Bland-Altman analysis revealed a bias of −0.36 l/min (±0.99 l/min) leading to a mean percentage error of 29%. USCOM is a feasible and rapid method to evaluate CO in septic patients. USCOM does reliably represent CO values as compared to the reference technique based on thermodilution (PiCCO). It seems to be appropriate in situations where CO measurements are most pertinent to patient management.

scholarly journals Comparing doppler-echocardiography and thermodilution for cardiac output measurements in resuscitated out-of-hospital cardiac arrest patients undergoing targeted temperature management

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
J Grand ◽  
C Hassager ◽  
J Kjaergaard ◽  
JE Moller ◽  
J Bro-Jeppesen
Keyword(s):  
Cardiac Arrest ◽  
Cardiac Output ◽  
Doppler Echocardiography ◽  
Targeted Temperature Management ◽  
Temperature Management ◽  
Limits Of Agreement ◽  
Funding Sources ◽  
The Individual ◽  
Hospital Cardiac Arrest ◽  
Cardiac Output Measurements

Abstract Funding Acknowledgements Type of funding sources: None. Background Cardiovascular dysfunction is common after out-of-hospital cardiac arrest (OHCA). Cardiac output measurements can be used to guide treatment during post-resuscitation care and echocardiography allows noninvasive cardiac output estimation. Purpose The aim of the present study was to compare Doppler echocardiography (doppler_CO) with thermodilution using pulmonary artery catheters (PAC_CO) for cardiac output estimation in a large and consecutively included cohort of comatose OHCA-patients undergoing targeted temperature management (TTM). Methods Single-center substudy of 171 patients included in the TTM-trial randomly assigned to 33 or 36 degrees C for 24 hours after OHCA. We measured PAC_CO and doppler_CO simultaneously shortly after admission and again after 24 hours. Measurements and Main Results We excluded 19 (11%) patients without PAC-measurement and 31 (18%) without doppler-measurements resulting in 120 paired measurements at admission. Patients were 61 (±11) years old, 86% were men and 91% had a witnessed OHCA. At ICU-admission, PAC_CO was 4.81 (±1.81) L/min. and doppler_CO was 3.74 (±1.38) L/min., with a mean bias of 1.07 (±1.65) L/min (with 95% limits of agreement of –2.16 to 4.04) L/min. Examining the Bland-Altman plot, precision fell with higher cardiac output  (figure). A statistically significant, but moderate correlation was found between doppler_CO and PAC_CO at admission (r = 0.49), p < 0.0001). After 24 hours, PAC_CO was 4.63 (±1.38) L/min. and doppler_CO was 3.61 (±1.14) L/min, with a mean bias of 0.96 L/min. Assessing the change from admission to 24 hours, PAC_CO decreased averagely -0.12 (±2.22) L/min. and doppler_CO decreased -0.19 (±1.91) L/min. The changes from admission to 24 hours correlated between doppler_CO and PAC_CO (r = 0.55), p < 0.0001) with a mean bias of the changes of 0.07 L/min, with 95% limits of agreement of –3.76 to 3.91 L/min. Conclusions Changes in cardiac output during TTM may be evaluated with Doppler echocardiography with little mean bias compared to changes in CO measured with thermodilution, but relatively large changes are needed in the individual patient before it can be considered as real. Abstract Figure. Comparing Doppler vs. thermodilution

scholarly journals The Influence of Limited Dynamic Response of the Indicator Detector in a Swan-Ganz Catheter on the Overestimation of Cardiac Output Measurement By Means of Thermodilution

2012 ◽  
Vol 19 (4) ◽  
pp. 751-758
Author(s):  
Maciej Gawlikowski ◽  
Tadeusz Pustelny
Keyword(s):  
Cardiac Output ◽  
Pulmonary Artery ◽  
Dynamic Response ◽  
Cardiac Output Measurement ◽  
Slew Rate ◽  
Pulmonary Artery Catheterization ◽  
Output Measurement ◽  
The Relationship ◽  
Cardiac Output Measurements

Abstract Nowadays the “gold clinical standard” of hemodynamics diagnostic and cardiac output measurements is pulmonary artery catheterization by means of the Swan-Ganz catheter and thermodilution. The method itself is sensitive to numerous disturbances which cause inaccurate results. One of the well-known disadvantages of thermodilution is the overestimation of results at low values of cardiac output. This effect may concern the limited slew rate of the thermoelement mounted at the tip of the catheter. In this paper the relationship between the dynamic response of the thermoelement and the uncertainty of cardiac output measurements by means of thermodilution has been investigated theoretically and experimentally.

scholarly journals Accuracy and trending abilities of finger plethysmographic blood pressure and cardiac output compared with invasive measurements during caesarean delivery in healthy women. An observational study.

2020 ◽  
Author(s):  
Ivar Nagelgaard Omenås ◽  
Christian Tronstad ◽  
Leiv Arne Rosseland
Keyword(s):  
Blood Pressure ◽  
Cardiac Output ◽  
Caesarean Section ◽  
Spinal Anaesthesia ◽  
Caesarean Delivery ◽  
Limits Of Agreement ◽  
Polar Plot ◽  
Non Invasive ◽  
Healthy Women ◽  
Cardiac Output Measurements

Abstract Background: In women presenting for caesarean section under spinal anaesthesia, continuous measurement of circulatory aspects, such as blood pressure and cardiac output, is often needed. At present, invasive techniques are used almost exclusively. Reliable non-invasive monitors would be welcome, as they could be safer and less uncomfortable, while easy and quick to apply. We aimed to evaluate whether a non-invasive, finger plethysmographic device, the ccNexFin monitor, can replace invasively measured blood pressure in the radial artery, and whether cardiac output measurements from this device can be used interchangeably with measurements from the mini-invasive LiDCO monitor, currently in use at our institution. Methods: Simultaneous invasive measurements were compared with ccNexFin in 23 healthy women during elective caesarean section under spinal anaesthesia. We used Bland Altman statistics for assessing agreement, and polar plot methodology for judging trending abilities with pre-defined limits. Results: Mean arterial and systolic pressures showed biases (invasive – ccNexFin) of -4.3 and 12.2 mmHg, with limits of agreement of -15.9 – 7.4 and -11.1 – 35.6, respectively. The ccNexFin trending abilities were within suggested limits for mean pressure, but insufficient for systolic pressure compared with invasive measurements. Cardiac output had a small bias of 0.2 L/min, but wide limits of agreement of -2.6 – 3.0. The ccNexFin trending abilities compared with the invasive estimated values (LiDCO) were unsatisfactory. Conclusions: We consider the ccNexFin monitor to have sufficient accuracy in measuring mean arterial pressures. The limits of agreement for systolic measurements were wider, and the trending ability, compared with invasive measurements, was outside the recommended limit. The ccNexFin is not reliable for cardiac output measurements or trend in pregnant women for caesarean delivery under spinal anaesthesia.

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