Cardiac output estimation using pulse wave analysis—physiology, algorithms, and technologies: a narrative review

Saugel, Bernd; Kouz, Karim; Scheeren, Thomas; Greiwe, Gillis; Hoppe, Phillip; Romagnoli, Stefano; Backer, Daniel De

doi:10.1016/j.bja.2020.09.049

Cited by 96 publications

(91 citation statements)

References 70 publications

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“…Cardiac output monitoring methods can be categorised according to invasiveness (invasive, minimally invasive, and non-invasive) and according to calibration (external calibration vs. uncalibrated methods) [ 49 ]. The summary conclusion from the three comparative studies is that there is limited agreement between derived measures of cardiac output and that values were not interchangeable.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative Monitoring of the Obese Patient Undergoing Surgery: A Narrative Review

et al. 2021

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With the increasing prevalence of obesity in the population, anaesthetists must confidently manage both the pathophysiological and technical challenges presented in bariatric and non-bariatric surgery. The intraoperative period represents an important opportunity to optimise and mitigate risk. However, there is little formal guidance on what intraoperative monitoring techniques should be used in this population. This narrative review collates the existing evidence for intraoperative monitoring devices in the obese patients. Although a number of non-invasive blood pressure monitors have been tested, an invasive arterial line remains the most reliable monitor if accurate, continuous monitoring is required. Goal-directed fluid therapy is recommended by clinical practice guidelines, but the methods tested to assess this had guarded applicability to the obese population. Transcutaneous carbon dioxide (CO 2 ) monitoring may offer additional benefit to standard capnography in this population. Individually titrated positive end expiratory pressure (PEEP) and recruitment manoeuvres improved intraoperative mechanics but yielded no benefit in the immediate postoperative period. Depth of anaesthesia monitoring appears to be beneficial in the perioperative period regarding recovery times and complications. Objective confirmation of reversal of neuromuscular blockade continues to be a central tenet of anaesthesia practice, particularly relevant to this group who have been characterised as an “at risk” extubation group. Where deep neuromuscular blockade is used, continuous neuromuscular blockade is suggested. Both obesity and the intraoperative context represent somewhat unstable search terms, as the clinical implications of the obesity phenotype are not uniform, and the type and urgency of surgery have significant impact on the intraoperative setting. This renders the generation of summary conclusions around what intraoperative monitoring techniques are suitable in this population highly challenging.

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Section: Discussionmentioning

confidence: 99%

Intraoperative Monitoring of the Obese Patient Undergoing Surgery: A Narrative Review

et al. 2021

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“…Acknowledging that direct comparison with other non-invasive CO determination methods based only on published literature has its limitations due to different reference methods used and different study populations, our data ranged within the margins of published evidence. However, a very recent review on currently available technologies for CO determination using pulse wave analysis does not mention oscillometry as a potential method ( Saugel et al, 2021 ), even though it has some very practical advantages like easiness, and rapidity of measurements as well as no requirement for any specific operator training.…”

Section: Discussionmentioning

confidence: 99%

“…Cardiac output (CO) is a key determinant of oxygen delivery and thus an important parameter to assess the hemodynamic situation of critically ill patients, guide perioperative goal-directed therapy, and monitor response to therapeutic interventions ( Cecconi et al, 2014 ). CO can be measured or estimated using invasive, minimally invasive, and non-invasive techniques as well ( Sakka et al, 1999 ; Saugel et al, 2021 ). While invasive indicator dilution techniques such as pulmonary arterial or transpulmonary thermodilution remain the clinical gold standard and reference methods for CO measurement, and minimally invasive CO determination methods are also available for use in the intensive care unit (ICU), there is a currently unmet need for non-invasive techniques to further simplify CO estimation, reduce complications related to invasive techniques such as pulmonary artery catheterization, and to facilitate use in non-intensive care settings, e.g., for rapid hemodynamic assessment in the emergency room or even in outpatient settings.…”

Section: Introductionmentioning

confidence: 99%

Non-invasive Oscillometry-Based Estimation of Cardiac Output – Can We Use It in Clinical Practice?

et al. 2021

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While invasive thermodilution techniques remain the reference methods for cardiac output (CO) measurement, there is a currently unmet need for non-invasive techniques to simplify CO determination, reduce complications related to invasive procedures required for indicator dilution CO measurement, and expand the application field toward emergency room, non-intensive care, or outpatient settings. We evaluated the performance of a non-invasive oscillometry-based CO estimation method compared to transpulmonary thermodilution. To assess agreement between the devices, we used Bland–Altman analysis. Four-quadrant plot analysis was used to visualize the ability of Mobil-O-Graph (MG) to track CO changes after a fluid challenge. Trending analysis of CO trajectories was used to compare MG and PiCCO® calibrated pulse wave analysis over time (6 h). We included 40 patients from the medical intensive care unit at the Charité – Universitätsmedizin Berlin, Campus Benjamin Franklin between November 2019 and June 2020. The median age was 73 years. Forty percent of the study population was male; 98% was ventilator-dependent and 75% vasopressor-dependent at study entry. The mean of the observed differences for the cardiac output index (COI) was 0.7 l∗min–1*m–2 and the lower, and upper 95% limits of agreement (LOA) were -1.9 and 3.3 l∗min–1*m–2, respectively. The 95% confidence interval for the LOA was ± 0.26 l∗min–1*m–2, the percentage error 83.6%. We observed concordant changes in CO with MG and PiCCO® in 50% of the measurements after a fluid challenge and over the course of 6 h. Cardiac output calculation with a novel oscillometry-based pulse wave analysis method is feasible and replicable in critically ill patients. However, we did not find clinically applicable agreement between MG and thermodilution or calibrated pulse wave analysis, respectively, assessed with established evaluation routine using the Bland–Altman approach and with trending analysis methods. In summary, we do not recommend the use of this method in critically ill patients at this time. As the basic approach is promising and the CO determination with MG very simple to perform, further studies should be undertaken both in hemodynamically stable patients, and in the critical care setting to allow additional adjustments of the underlying algorithm for CO estimation with MG.

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“…Since the endothelial dysfunction is characterized by reduced endothelial NO production, resulting in increased peripheral arterial resistance [66], pulse wave velocity (PWV) is a further vessels stiffness marker. Carotid-femoral PWV (cfPWV) indicates the velocity of propagation of the arterial blood pressure wave along the vascular wall [67] and represents the gold standard for arterial stiffness assessment [68]. This parameter has been demonstrated to predict organ damage [69] and CVD mortality [70], although it is still poorly applied in clinical practice.…”

Section: How To Measure Endothelial Dysfunction: Direct and Indirect mentioning

confidence: 99%

The “Hitchhiker’s Guide to the Galaxy” of Endothelial Dysfunction Markers in Human Fertility

Santi

Spaggiari

Greco

et al. 2021

IJMS

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Endothelial dysfunction is an early event in the pathogenesis of atherosclerosis and represents the first step in the pathogenesis of cardiovascular diseases. The evaluation of endothelial health is fundamental in clinical practice and several direct and indirect markers have been suggested so far to identify any alterations in endothelial homeostasis. Alongside the known endothelial role on vascular health, several pieces of evidence have demonstrated that proper endothelial functioning plays a key role in human fertility and reproduction. Therefore, this state-of-the-art review updates the endothelial health markers discriminating between those available for clinical practice or for research purposes and their application in human fertility. Moreover, new molecules potentially helpful to clarify the link between endothelial and reproductive health are evaluated herein.

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Cardiac output estimation using pulse wave analysis—physiology, algorithms, and technologies: a narrative review

Cited by 96 publications

References 70 publications

Intraoperative Monitoring of the Obese Patient Undergoing Surgery: A Narrative Review

Intraoperative Monitoring of the Obese Patient Undergoing Surgery: A Narrative Review

Non-invasive Oscillometry-Based Estimation of Cardiac Output – Can We Use It in Clinical Practice?

The “Hitchhiker’s Guide to the Galaxy” of Endothelial Dysfunction Markers in Human Fertility

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