Transoesophageal echocardiography accurately detects cardiac output variation: a prospective comparison with thermodilution in cardiac surgery

2006 ◽  
Vol 23 (Supplement 38) ◽  
pp. 39
Author(s):  
V. Parra ◽  
G. Fita ◽  
I. Rovira ◽  
E. Arcos ◽  
I. Bel ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Cardiac Surgery ◽  
Transoesophageal Echocardiography ◽  
Prospective Comparison

Cardiac output monitoring in paediatric cardiac surgery: a review

2021 ◽  
pp. 1-8
Author(s):  
Hannah M. Woodman ◽  
Corlyn Lee ◽  
Ayesha N. Ahmed ◽  
Bassit A. Malik ◽  
Sophie Mellor ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Cardiac Surgery ◽  
Transoesophageal Echocardiography ◽  
Pulse Contour Analysis ◽  
Pulse Contour ◽  
Cardiac Output Monitoring ◽  
Contour Analysis ◽  
Advantages And Disadvantages ◽  
Output Monitoring ◽  
Effectiveness Assessment

Abstract The aim of this review is to present the current options for cardiac output (CO) monitoring in children undergoing cardiac surgery. Current technologies for monitoring identified were a range of invasive, minimally invasive, and non-invasive technologies. These include pulmonary artery catheter, transoesophageal echocardiography, pulse contour analysis, electrical cardiography, and thoracic bioreactance. A literature search was conducted using evidence databases which identified two current guidelines; the NHS Greater Glasgow and Clyde guideline and Royal College of Anaesthetics Guideline. These were appraised using the AGREE II tool and the evidence identified was used to create an overview summary of each technological option for CO monitoring. There is limited evidence regarding the accuracy of modalities available for CO monitoring in paediatric patients during cardiac surgery. Each technology has advantages and disadvantages; however, none could be championed as the most beneficial. Furthermore, a gold standard for CO monitoring has not yet been identified for paediatric populations, nor is it apparent whether one modality is preferable based on the available evidence. Additional evidence using a standardised method for comparing CO measurements should be conducted in order to determine the best option for CO monitoring in paediatrics. Furthermore, cost-effectiveness assessment of each modality should be conducted. Only then will it be possible for clear, evidence-based guidance to be written.

Transoesophageal echocardiography is unreliable for cardiac output assessment after cardiac surgery compared with thermodilution*

Anaesthesia ◽  
2004 ◽  
Vol 59 (12) ◽  
pp. 1184-1192 ◽  
Author(s):  
D. A. Bettex ◽  
V. Hinselmann ◽  
J. P. Hellermann ◽  
R. Jenni ◽  
E. R. Schmid
Keyword(s):  
Cardiac Output ◽  
Cardiac Surgery ◽  
Transoesophageal Echocardiography

Risk factors for poor outcome after ECMO treatment of low cardiac output after cardiac surgery

2007 ◽  
Vol 55 (S 1) ◽  
Author(s):  
S Deiters ◽  
H Welp ◽  
J Graf ◽  
A Löher ◽  
S Schneider ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiac Output ◽  
Cardiac Surgery ◽  
Low Cardiac Output ◽  
Poor Outcome ◽  
Ecmo Treatment

Blood gas analysis in newborns with low cardiac output syndrome after cardiac surgery.

2018 ◽  
Vol 19 (5) ◽  
pp. 676-687
Author(s):  
G.G. Khubulava ◽  
A.B. Naumov ◽  
S.P. Marchenko ◽  
O.Yu. Chupaeva ◽  
A.A. Seliverstova ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Cardiac Surgery ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Blood Gas ◽  
Low Cardiac Output Syndrome ◽  
Low Cardiac Output

scholarly journals Dobutamine-sparing versus dobutamine-to-all strategy in cardiac surgery: a randomized noninferiority trial

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Rafael Alves Franco ◽  
Juliano Pinheiro de Almeida ◽  
Giovanni Landoni ◽  
Thomas W. L. Scheeren ◽  
Filomena Regina Barbosa Gomes Galas ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Cardiac Surgery ◽  
Prolonged Mechanical Ventilation ◽  
Kidney Injury ◽  
Composite Endpoint ◽  
Tissue Perfusion ◽  
Hospital Length Of Stay ◽  
Low Cardiac Output Syndrome ◽  
Low Cardiac Output ◽  
Noninferiority Trial

Abstract Background The detrimental effects of inotropes are well-known, and in many fields they are only used within a goal-directed therapy approach. Nevertheless, standard management in many centers includes administering inotropes to all patients undergoing cardiac surgery to prevent low cardiac output syndrome and its implications. Randomized evidence in favor of a patient-tailored, inotrope-sparing approach is still lacking. We designed a randomized controlled noninferiority trial in patients undergoing cardiac surgery with normal ejection fraction to assess whether an dobutamine-sparing strategy (in which the use of dobutamine was guided by hemodynamic evidence of low cardiac output associated with signs of inadequate tissue perfusion) was noninferior to an inotrope-to-all strategy (in which all patients received dobutamine). Results A total of 160 patients were randomized to the dobutamine-sparing strategy (80 patients) or to the dobutamine-to-all approach (80 patients). The primary composite endpoint of 30-day mortality or occurrence of major cardiovascular complications (arrhythmias, acute myocardial infarction, low cardiac output syndrome and stroke or transient ischemic attack) occurred in 25/80 (31%) patients of the dobutamine-sparing group (p = 0.74) and 27/80 (34%) of the dobutamine-to-all group. There were no significant differences between groups regarding the incidence of acute kidney injury, prolonged mechanical ventilation, intensive care unit or hospital length of stay. Discussion Although it is common practice in many centers to administer inotropes to all patients undergoing cardiac surgery, a dobutamine-sparing strategy did not result in an increase of mortality or occurrence of major cardiovascular events when compared to a dobutamine-to-all strategy. Further research is needed to assess if reducing the administration of inotropes can improve outcomes in cardiac surgery. Trial registration ClinicalTrials.gov, NCT02361801. Registered Feb 2nd, 2015. https://clinicaltrials.gov/ct2/show/NCT02361801

HEMODYNAMIC EFFECTS OF HYDROCORTISONE IN NEONATES WITH LOW CARDIAC OUTPUT SYNDROME AFTER CARDIAC SURGERY

2004 ◽  
Vol 32 (Supplement) ◽  
pp. A49
Author(s):  
Heather Dickerson ◽  
Antonio R Mott ◽  
Jack F Price ◽  
Anthony C Chang ◽  
Pertti K Suominen ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Cardiac Surgery ◽  
Hemodynamic Effects ◽  
Low Cardiac Output Syndrome ◽  
Low Cardiac Output

Pharmacokinetics of Propofol in Adult Patients Undergoing Coronary Revascularization

1996 ◽  
Vol 84 (6) ◽  
pp. 1288-1297 ◽  
Author(s):  
James M. Bailey ◽  
Christina T. Mora ◽  
Stephen L. Shafer ◽  
Keyword(s):  
Cardiac Surgery ◽  
Cross Validation ◽  
Predictive Accuracy ◽  
Coronary Revascularization ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Adult Patients ◽  
Pharmacokinetic Parameters ◽  
Surgery Patient ◽  
Prospective Comparison

Background Propofol is increasingly used for cardiac anesthesia and for perioperative sedation. Because pharmacokinetic parameters vary among distinct patient populations, rational drug dosing in the cardiac surgery patient is dependent on characterization of the drug's pharmacokinetic parameters in patients actually undergoing cardiac procedures and cardiopulmonary bypass (CPB). In this study, the pharmacokinetics of propofol was characterized in adult patients undergoing coronary revascularization. Methods Anesthesia was induced and maintained by computer-controlled infusions of propofol and alfentanil, or sufentanil, in 41 adult patients undergoing coronary artery bypass graft surgery. Blood samples for determination of plasma propofol concentrations were collected during the predefined study periods and assayed by high-pressure liquid chromatography. Three-compartment model pharmacokinetic parameters were determined by nonlinear extended least-squares regression of pooled data from patients receiving propofol throughout the perioperative period. The effect of CPB on propofol pharmacokinetics was modeled by allowing the parameters to change with the institution and completion of extracorporeal circulation and selecting the optimal model on the basis of the logarithm of the likelihood. Predicted propofol concentrations were calculated by convolving the infusion rates with unit disposition functions using the estimated parameters. The predictive accuracy of the parameters was evaluated by cross-validation and by a prospective comparison of predicted and measured levels in a subset of patients. Results Optimal pharmacokinetic parameters were: central compartment volume = 6.0 l; second compartment volume = 49.5 l; third compartment volume = 429.3 l; Cl1 (elimination clearance) = 0.68 l/min; Cl2 (distribution clearance) = 1.97 l/min1; and Cl3 (distribution clearance) = 0.70 l/min. The effects of CPB were optimally modeled by step changes in V1 and Cl1 to values of 15.9 and 1.95, respectively, with the institution of CPB. Median absolute prediction error was 18% in the cross-validation assessment and 19% in the prospective evaluation. There was no evidence for nonlinear kinetics. Previously published propofol pharmacokinetic parameter sets poorly predicted the observed concentrations in cardiac surgical patients. Conclusions The pharmacokinetics of propofol in adult patients undergoing cardiac surgery with CPB are dissimilar from those reported for other adult patient populations. The effect of CPB was best modeled by an increase in V1 and Cl1. Predictive accuracy of the derived pharmacokinetic parameters was excellent as measured by cross-validation and a prospective test.

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