Cardiac output monitoring: less invasiveness, less accuracy?

Saugel, Bernd; Wagner, Julia Y.; Scheeren, Thomas

doi:10.1007/s10877-016-9900-2

Cited by 12 publications

(6 citation statements)

References 22 publications

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“…thermodilution [ 19 ]. Consequently, to minimize measurement bias, we used relative (∆) values instead of absolute values for the comparisons [ 33 , 34 ].…”

Section: Discussionmentioning

confidence: 99%

Improved haemodynamic stability and cerebral tissue oxygenation after induction of anaesthesia with sufentanil compared to remifentanil: a randomised controlled trial

et al. 2020

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Background Balanced anaesthesia with propofol and remifentanil, compared to sufentanil, often decreases mean arterial pressure (MAP), heart rate (HR) and cardiac index (CI), raising concerns on tissue-oxygenation. This distinct haemodynamic suppression might be attenuated by atropine. This double blinded RCT, investigates if induction with propofol-sufentanil results in higher CI and tissue-oxygenation than with propofol-remifentanil and if atropine has more pronounced beneficial effects on CI and tissue-oxygenation in a remifentanil-based anaesthesia. Methods In seventy patients scheduled for coronary bypass grafting (CABG), anaesthesia was induced and maintained with propofol target controlled infusion (TCI) with a target effect-site concentration (Cet) of 2.0 μg ml− 1 and either sufentanil (TCI Cet 0.48 ng ml− 1) or remifentanil (TCI Cet 8 ng ml− 1). If HR dropped below 60 bpm, methylatropine (1 mg) was administered intravenously. Relative changes (∆) in MAP, HR, stroke volume (SV), CI and cerebral (SctO2) and peripheral (SptO2) tissue-oxygenation during induction of anaesthesia and after atropine administration were analysed. Results The sufentanil group compared to the remifentanil group showed significantly less decrease in MAP (∆ = − 23 ± 13 vs. -36 ± 13 mmHg), HR (∆ = − 5 ± 7 vs. -10 ± 10 bpm), SV (∆ = − 23 ± 18 vs. -35 ± 19 ml) and CI (∆ = − 0.8 (− 1.5 to − 0.5) vs. -1.5 (− 2.0 to − 1.1) l min− 1 m− 2), while SctO2 (∆ = 9 ± 5 vs. 6 ± 4%) showed more increase with no difference in ∆SptO2 (∆ = 8 ± 7 vs. 8 ± 8%). Atropine caused higher ∆HR (13 (9 to 19) vs. 10 ± 6 bpm) and ∆CI (0.4 ± 0.4 vs. 0.2 ± 0.3 l min− 1 m− 2) in sufentanil vs. remifentanil-based anaesthesia, with no difference in ∆MAP, ∆SV and ∆SctO2 and ∆SptO2. Conclusion Induction of anaesthesia with propofol and sufentanil results in improved haemodynamic stability and higher SctO2 compared to propofol and remifentanil in patients having CABG. Administration of atropine might be useful to counteract or prevent the haemodynamic suppression associated with these opioids. Trial registration Clinicaltrials.gov on June 7, 2013 (trial ID: NCT01871935).

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“…thermodilution [ 19 ]. Consequently, to minimize measurement bias, we used relative (∆) values instead of absolute values for the comparisons [ 33 , 34 ].…”

Section: Discussionmentioning

confidence: 99%

Improved haemodynamic stability and cerebral tissue oxygenation after induction of anaesthesia with sufentanil compared to remifentanil: a randomised controlled trial

et al. 2020

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“…These include patient-centered factors; the invasiveness, measurement performance, clinical applicability, and signal stability of the pulse wave analysis system; institutional factors such as the availability and the costs; and personal experience with monitoring systems of the caregiver. 41 A profound understanding of pulse wave analysis measurement principles and strengths and limitations of pulse wave analysis systems is important for clinicians to choose the appropriate pulse wave analysis system for the individual patient.…”

Section: Clinical Application Of Pulse Wave Analysismentioning

confidence: 99%

Pulse Wave Analysis to Estimate Cardiac Output

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“…This trend became possible through the technical development of innovative devices that have penetrated the market with variable success. The core question to be asked is whether less invasiveness also is accompanied by less accuracy, 18 which would limit the use of these devices markedly.…”

Section: Transition To Minimally Invasive and Noninvasive Hemodynamicmentioning

confidence: 99%

New Developments in Hemodynamic Monitoring

Scheeren

Ramsay

2019

Journal of Cardiothoracic and Vascular Anesthesia

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Hemodynamic monitoring is an essential part of the perioperative management of the cardiovascular patient. It helps to detect hemodynamic alterations, diagnose their underlying causes, and optimize oxygen delivery to the tissues. Furthermore, hemodynamic monitoring is necessary to evaluate the adequacy of therapeutic interventions such as volume expansion or vasoactive medications. Recent developments include the move from static to dynamic variables to assess conditions such as cardiac preload and fluid responsiveness and the transition to less-invasive or even noninvasive monitoring techniques, at least in the perioperative setting. This review describes the available techniques that currently are being used in the care of the cardiovascular patient and discusses their strengths and limitations. Even though the thermodilution method remains the gold standard for measuring cardiac output (CO), the use of the pulmonary artery catheter has declined over the last decades, even in the setting of cardiovascular anesthesia. The transpulmonary thermodilution method, in addition to accurately measuring CO, provides the user with some additional helpful variables, of which extravascular lung water is probably the most interesting. Less-invasive monitoring techniques use, for example, pulse contour analysis to originate flow-derived variables such as stroke volume and CO from the arterial pressure signal, or they may measure the velocity-time integral in the descending aorta to estimate the stroke volume, using, for example, the esophageal Doppler. Completely noninvasive methods such as the volume clamp method use finger cuffs to reconstruct the arterial pressure waveform, from which stroke volume and CO are calculated. All of these less-invasive CO monitoring devices have percentage errors around 40% compared with reference methods (thermodilution), meaning that the values are not interchangeable.

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Cardiac output monitoring: less invasiveness, less accuracy?

Cited by 12 publications

References 22 publications

Improved haemodynamic stability and cerebral tissue oxygenation after induction of anaesthesia with sufentanil compared to remifentanil: a randomised controlled trial

Improved haemodynamic stability and cerebral tissue oxygenation after induction of anaesthesia with sufentanil compared to remifentanil: a randomised controlled trial

Pulse Wave Analysis to Estimate Cardiac Output

New Developments in Hemodynamic Monitoring

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