Comparison of the ability of two continuous cardiac output monitors to detect stroke volume index: Estimated continuous cardiac output estimated by modified pulse wave transit time and measured by an arterial pulse contour-based cardiac output device

BACKGROUND: Estimated continuous cardiac output (esCCO), a non-invasive technique for continuously measuring cardiac output (CO), is based on modified pulse wave transit time, which is determined by pulse oximetry and electrocardiography. OBJECTIVE: We examined the ability of esCCO to detect stroke volume index (SVI) and changes in SVI compared with currently available arterial waveform analysis methods. METHODS: We retrospectively reanalysed 15 of the cases from our previous study on esCCO measurement. SVI was calculated using an esCCO system, measured using the arterial pressure-based CO (APCO) method, and compared with a corresponding intermittent bolus thermodilution CO (ICO) method. Percentage error measurement and statistical methods, including concordance analysis and polar plot analysis, were performed. RESULTS: The difference in the SVI values between esCCO and ICO was -3.0 ± 8.8 ml (percentage error, 33.5%). The mean angular bias was 0.8 and the radial limits of agreement were ± 27.3. The difference in the SVI values between APCO and ICO was 0.9 ± 11.2 ml (percentage error, 42.6%). The mean angular bias was -6.8 and the radial limits of agreement were ± 44.1. CONCLUSION: This study demonstrated that the accuracy, precision, and dynamic trend of esCCO are better than those of APCO.

Comparing Clinical Efficacy of Artificial Intelligence-powered Ultrasound with Pulse Index Continuous Cardiac Output for Monitoring Critically ill Patients

Background: To compare safety and clinical efficacy of artificial intelligence (AI)-powered ultrasound with pulse index continuous cardiac output (PiCCO) for monitoring critically ill patients.Methods: Patients who were admitted to our hospital from April to June 2020 were recruited. PiCCO was employed to monitor cardiac output (CO) and extravascular lung water index (ELWI). Simultaneously, an AI-powered ultrasound was used to automatically monitor CO and the left ventricular outflow tract velocity time integral (LVOT-VTI), and Lung ultrasound B line.Results: A total of 41 patients were enrolled, the male/female ratio was 26:15, and the patients’ median age was 73.6±8.85 years old. There was no significant difference between PiCCO and AI-powered ultrasound in monitoring of CO (t = 1.01, P = 0.316), and the correlation between these two techniques was significant (r=0.911; 95% confidence interval (CI): [0.82; 0.96]; P < 0.001). Similarly, the correlation between lung ultrasound and ELWI was significant r=0.770 (95%CI: [0.58; 0.88]; P < 0.001). Conclusions: Clinical management of critically ill patients can be achieved via monitoring techniques, such as PICCO and AI-powered ultrasound.

Clinical significance of pulse index contour continuous cardiac output monitoring in patients with constrictive pericarditis undergoing pericardiectomy

OBJECTIVES The efficacy of pulse index contour continuous cardiac output (PiCCO) monitoring in patients with constrictive pericarditis undergoing pericardiectomy remains unclear. The goal of this study was to explore whether PiCCO monitoring could improve clinical outcomes in these patients. METHODS We retrospectively studied 74 patients with constrictive pericarditis undergoing pericardiectomy and assigned them to a PiCCO group and a control group. Postoperative and survival outcomes were compared between the 2 groups. RESULTS There were 33 (44.6%) cases in the PiCCO group and 41 (55.4%) cases in the control group. The baseline characteristics were comparable between the 2 groups. In comparison to the control group, the PiCCO group showed more intraoperative fluid infusion (P = 0.003), higher postoperative central venous pressure (P = 0.007) and lower levels of postoperative brain natriuretic peptide (P = 0.021). The incidence of postoperative complications (P = 0.004) including cardiac complications (P = 0.033) was also lower in the PiCCO group. Despite no difference in survival outcomes, duration of chest drainage (P = 0.032), length of stay in the intensive care unit (P &lt; 0.001) and the postoperative hospital stay (P = 0.044) were significantly shorter in the PiCCO group. CONCLUSIONS This study confirmed the clinical significance of PiCCO monitoring in the enhanced recovery of patients with constrictive pericarditis undergoing pericardiectomy and provided new evidence for applying PiCCO monitoring in these patients.