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.

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).

Acute Middle Cerebral Artery Occlusion: Experience with Volume Expansion Therapy

Neurosurgery ◽  
1986 ◽  
Vol 18 (4) ◽  
pp. 397-401 ◽  
Author(s):  
Bruce I. Tranmer ◽  
Cordell E. Gross ◽  
Ted S. Keller ◽  
Glenn W. Kindt
Keyword(s):  
Cardiac Output ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Volume Expansion ◽  
Artery Occlusion ◽  
Neurological Deficits ◽  
Life Styles ◽  
Arterial Blood ◽  
Mca Occlusion ◽  
The Mean

Abstract Five consecutive patients with acute neurological deficits after middle cerebral artery (MCA) occlusion were given emergency treatment with colloidal volume expansion. In each case, the diagnosis was confirmed promptly by computed tomography and cerebral angiography. Aggressive volume expansion therapy was started 2 to 18 hours (mean, 11 hr) after the onset of the neurological deficit. The mean colloidal volume used was 920 ml/day for an average of 4 days. During volume expansion, the mean cardiac output increased 57% from 4.6 + 0.6 to 7.2 + 1.9 litres/min (P < 0.05). The mean hematocrit decreased 19% from 46 + 3% to 37 + 4% (P < 0.01). The mean arterial blood pressure remained stable, and the pulmonary artery wedge pressure was maintained at < 15 mm Hg. Three patients improved dramatically with volume expansion therapy and have returned to their previous life-styles. Two patients made partial recoveries and manage at home with nursing care. The three patients who improved dramatically were young (aged <34) and, when compared to the older patients, they had greater increases in cardiac output (67% vs. 19%). No major complications or deaths were attributed to the volume expansion therapy. We propose that intravascular volume expansion and its concomitant augmentation of the cardiovascular dynamics may be effective in the treatment of acute neurological deficits after acute MCA occlusion.

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 Accuracy, Precision, and Trending Ability of Electrical Cardiometry Cardiac Index versus Continuous Pulmonary Artery Thermodilution Method: A Prospective, Observational Study

2017 ◽  
Vol 2017 ◽  
pp. 1-8 ◽  
Author(s):  
P. B. W. Cox ◽  
A. M. den Ouden ◽  
M. Theunissen ◽  
L. J. Montenij ◽  
A. G. H. Kessels ◽  
...  
Keyword(s):  
Cardiac Index ◽  
Observational Study ◽  
Pulmonary Artery ◽  
Prospective Observational Study ◽  
Skin Incision ◽  
Percentage Error ◽  
Quadrant Analysis ◽  
Polar Plot ◽  
Electrical Cardiometry ◽  
Trending Ability

Introduction. Evaluation of accuracy, precision, and trending ability of cardiac index (CI) measurements using the Aesculon™ bioimpedance electrical cardiometry (Aesc) compared to the continuous pulmonary artery thermodilution catheter (PAC) technique before, during, and after cardiac surgery. Methods. A prospective observational study with fifty patients with ASA 3-4. At six time points (T), measurements of CI simultaneously by continuous cardiac output pulmonary thermodilution and thoracic bioimpedance and standard hemodynamics were performed. Analysis was performed using Bland-Altman, four-quadrant plot, and polar plot methodology. Results. CI obtained with pulmonary artery thermodilution and thoracic bioimpedance ranged from 1.00 to 6.75 L min−1 and 0.93 to 7.25 L min−1, respectively. Bland-Altman analysis showed a bias between CIBIO and CIPAC of 0.52 liters min−1 m−2, with LOA of [−2.2; 1.1] liters min−1 m−2. Percentage error between the two techniques was above 30% at every time point. Polar plot methodology and 4-quadrant analysis showed poor trending ability. Skin incision had no effect on the results. Conclusion. CI obtained by continuous PAC and CI obtained by Aesculon bioimpedance are not interchangeable in cardiac surgical patients. No effects of skin incision were found. International clinical trial registration number is ISRCTN26732484.

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.

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

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

2020 ◽  
pp. 1-6
Author(s):  
Takashi Terada ◽  
Ryoichi Ochiai
Keyword(s):  
Cardiac Output ◽  
Pulse Wave ◽  
Stroke Volume Index ◽  
Continuous Cardiac Output ◽  
Volume Index ◽  
Percentage Error ◽  
Radial Limits ◽  
Pulse Wave Transit Time ◽  
The Mean ◽  
The Difference

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.

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