Errors in Thermodilution Cardiac Output Measurements Caused by Rapid Pulmonary Artery Temperature Decreases after Cardiopulmonary Bypass

Bazaral, Michael G.; Petre, John; Novoa, Roberto

doi:10.1097/00000542-199207000-00006

Cited by 80 publications

(40 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Timing of intermittent cardiac output determinations may then unpredictably influence the zero reference level of pulmonary artery temperature with a subsequent impact on the area under the thermodilution curve [23,24,26]. Preliminary data obtained with randomly allocated intermittent cardiac output determinations, however, suggest that this effect does not explain the low levels of accuracy and precision of intermittent vs. continuous cardiac output measurement during these phases (data not shown).…”

Section: Discussionmentioning

confidence: 99%

“…The impact of thermal equilibration phenomena on the congruence between intermittent and continuous cardiac output measurement is underlined by preliminary data that showed a significant difference between intermittent and continuous cardiac output measurement when an upper body warming blanket was applied in patients undergoing aortic reconstruction surgery [13]. In general, rapid changes in pulmonary artery temperature that are not caused by the thermodilution signal are well-known sources of error in intermittent cardiac output determination [23,24]. Almost all available intermittent cardiac output algorithms including the one used in this study are based on the assumption that pulmonary artery temperature remains stable during the measurement phase.…”

Section: Discussionmentioning

confidence: 99%

“…Almost all available intermittent cardiac output algorithms including the one used in this study are based on the assumption that pulmonary artery temperature remains stable during the measurement phase. The pulmonary artery temperature recorded immediately before an intermittent cardiac output measurement is extrapolated and functions as the reference level for calculations [23,24]. A rapid decrease in baseline pulmonary artery temperature therefore leads to a systematic and substantial underestimation in intermittent cardiac output [23].…”

Section: Discussionmentioning

confidence: 99%

“…The pulmonary artery temperature recorded immediately before an intermittent cardiac output measurement is extrapolated and functions as the reference level for calculations [23,24]. A rapid decrease in baseline pulmonary artery temperature therefore leads to a systematic and substantial underestimation in intermittent cardiac output [23]. This may explain, in part, the observed discrepancy between intermittent and continuous cardiac output data.…”

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Continuous versus intermittent thermodilution cardiac output measurement during orthotopic liver transplantation

et al. 1997

View full text Add to dashboard Cite

SummaryWe evaluated intermittent and continuous thermodilution cardiac output data in 12 patients undergoing orthotopic liver transplantation. Measurements were performed at 16 predefined time points between induction of anaesthesia and 3 h after reperfusion of the liver graft. Cardiac output measurements yielded 192 data pairs (intermittent cardiac output range: 1.8-18.9 l.min ¹1 , continuous cardiac output range: 3.3-20.0 l.min ¹1 ). During most of the procedure the correlation between intermittent and continuous cardiac output measurements was significant (r = 0.87, p < 0.0001), accompanied with a bias of ¹0.240 l.min ¹1 and a degree of precision of 1.789 l.min ¹1 (< 10.0 l.min ¹1 : 1.137 l.min ¹1 , Ն10.0 l.min ¹1 : 2.220 l.min ¹1 ). However, in the early phases after caval clamping and after reperfusion, accuracy was not acceptable. Only during these phases did the difference between the mean values of pulmonary artery blood temperature and rectal temperature increase (after caval clamping) or decrease (after reperfusion). In conclusion, despite acceptable levels of accuracy and precision between intermittent and continuous cardiac output measurement under stable conditions, both methods showed markedly decreased accuracy and precision in the early phases after caval clamping and after reperfusion, possibly owing to increased thermal noise.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Continuous versus intermittent thermodilution cardiac output measurement during orthotopic liver transplantation

et al. 1997

View full text Add to dashboard Cite

show abstract

“…A number of variables have been shown to affect the accuracy of such measurements [2], including the rewarming of injectate from handling prior to injection [3], hypothermia [4] and concurrent peripheral intravenous fluid administration (51. CVVH is now increasingly used for renal support in the intensive care setting offering advantages of cardiovascular stability in those patients with multiorgan failure or shock [6].…”

Section: Cardiac Output Measurement and Continuous Venovenous Haemofimentioning

confidence: 99%

Cardiac output measurement and continuous venovenous haemofiltration

Thompson

Barker

1993

Anaesthesia

View full text Add to dashboard Cite

Comparison of calibrated and uncalibrated arterial pressure-based cardiac output monitors during orthotopic liver transplantation

et al. 2010

View full text Add to dashboard Cite

Arterial pressure-based cardiac output monitors (APCOs) are increasingly used as alternatives to thermodilution. Validation of these evolving technologies in high-risk surgery is still ongoing. In liver transplantation, FloTrac-Vigileo (Edwards Lifesciences) has limited correlation with thermodilution, whereas LiDCO Plus (LiDCO Ltd.) has not been tested intraoperatively. Our goal was to directly compare the 2 proprietary APCO algorithms as alternatives to pulmonary artery catheter thermodilution in orthotopic liver transplantation (OLT). The cardiac index (CI) was measured simultaneously in 20 OLT patients at prospectively defined surgical landmarks with the LiDCO Plus monitor (CI L ) and the FloTrac-Vigileo monitor (CI V ). LiDCO Plus was calibrated according to the manufacturer's instructions. FloTrac-Vigileo did not require calibration. The reference CI was derived from pulmonary artery catheter intermittent thermodilution (CI TD ). CI V -CI TD bias ranged from À1.38 (95% confidence interval ¼ À2.02 to À0.75 L/minute/m 2 , P ¼ 0.02) to À2.51 L/minute/m 2 (95% confidence interval ¼ À3.36 to À1.65 L/minute/m 2 , P < 0.001), and CI L -CI TD bias ranged from À0.65 (95% confidence interval ¼ À1.29 to À0.01 L/minute/ m 2 , P ¼ 0.047) to À1.48 L/minute/m 2 (95% confidence interval ¼ À2.37 to À0.60 L/minute/m 2 , P < 0.01). For both APCOs, bias to CI TD was correlated with the systemic vascular resistance index, with a stronger dependence for FloTrac-Vigileo. The capability of the APCOs for tracking changes in CI TD was assessed with a 4-quadrant plot for directional changes and with receiver operating characteristic curves for specificity and sensitivity. The performance of both APCOs was poor in detecting increases and fair in detecting decreases in CI TD . In conclusion, the calibrated and uncalibrated APCOs perform differently during OLT. Although the calibrated APCO is less influenced by changes in the systemic vascular resistance, neither device can be used interchangeably with thermodilution to monitor cardiac output during liver transplantation. Liver Transpl 16:773-782,

show abstract

Errors in Thermodilution Cardiac Output Measurements Caused by Rapid Pulmonary Artery Temperature Decreases after Cardiopulmonary Bypass

Cited by 80 publications

References 0 publications

Continuous versus intermittent thermodilution cardiac output measurement during orthotopic liver transplantation

Continuous versus intermittent thermodilution cardiac output measurement during orthotopic liver transplantation

Cardiac output measurement and continuous venovenous haemofiltration

Comparison of calibrated and uncalibrated arterial pressure-based cardiac output monitors during orthotopic liver transplantation

Contact Info

Product

Resources

About