Limitations of thermodilution ejection fraction

Maruschak, Gary F.; Schauble, James F.

doi:10.1097/00003246-198508000-00015

Cited by 42 publications

(3 citation statements)

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“…In the most recent studies in critically ill patients, when compared to three-dimensional transesophageal echocardiography, the reported bias was considered as clinically acceptable [24, 35]. Some studies [24, 28, 29, 35] report a systematic underestimation of the RVEF with thermodilution, a well-known technical limitation [25]. However, this limitation is unlikely to significantly impact our main results because we investigated echocardiographic indices as continuous physiological variables and their correlations with RVEF rather than predictors of true values.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of echocardiographic indices of right ventricular systolic function and ejection fraction obtained with continuous thermodilution in critically ill patients

et al. 2019

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Background Though echocardiographic evaluation assesses the right ventricular systolic function, which of the existing parameters best reflects the right ventricular ejection fraction (RVEF) in the critically ill patients is still uncertain. We aimed to determine the relationship between echocardiographic indices of right ventricular systolic function and RVEF. Methods Prospective observational study was conducted in a mixed Surgical Intensive Care Unit (Hôpital Lariboisière, Paris, France) from November 2017 to November 2018. All critically ill patients monitored with a pulmonary artery catheter were assessed. We collected echocardiographic indices of right ventricular function (tricuspid annular plane systolic excursion, TAPSE; peak systolic velocity of pulsed tissue Doppler at lateral tricuspid annulus, S′; fractional area change, FAC; right ventricular index of myocardial performance, RIMP; isovolumic acceleration, IVA; end-diastolic diameter ratio, EDDr) and compared them with the RVEF obtained from continuous volumetric pulmonary artery catheter. Results Twenty-five patients were analyzed. Admission diagnosis was acute heart failure in 11 patients and septic shock in 14 patients. Median age was 70 years [57–80], norepinephrine median dose was 0.29 μg/kg/min [0.14–0.50], median Sequential Organ Failure Assessment score was 12 [10–14], and mortality at day 28 was 56%. When compared to RVEF, TAPSE had the highest correlation coefficient (rho = 0.78, 95% CI 0.52 to 0.89, p < 0.001). S′ was also correlated to RVEF (rho = 0.64, 95% CI 0.60 to 0.80, p = 0.001) whereas FAC, RIMP, IVA, and EDDr did not. TAPSE lower than 16 mm, S′ lower than 11 cm/s, and EDDr higher than 1 were always associated with a reduced RVEF. Conclusions We found that amongst indices of right ventricular systolic function, TAPSE and S′ were well correlated with thermodilution-derived RVEF in critically ill patients.

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Section: Discussionmentioning

confidence: 99%

“…We chose a cutoff value of 35% as proposed by Vanderpool et al [23] because it is the threshold that best predicts long-term outcomes. We also tested a lower threshold of 25% to take into account the reported bias of the continuous thermodilution method [24, 25].…”

Section: Methodsmentioning

confidence: 99%

Comparison of echocardiographic indices of right ventricular systolic function and ejection fraction obtained with continuous thermodilution in critically ill patients

et al. 2019

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“…Despite the large number of references available on thermodilution methods, there are very few studies (Marushak and Schauble 1985) on the temperature sensor dynamics and on its influence on the thermodilution-based measurements. In this study, we address these issues.…”

Section: Introductionmentioning

confidence: 99%

Effects of the time response of the temperature sensor on thermodilution measurements

et al. 2005

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Thermodilution is widely used to measure cardiac output, ejection fraction and end diastolic volume. Even though the method is based on dynamic temperature measurements, little attention has been paid to the characterization of the dynamic behavior of the temperature sensor and to its influence on the accuracy of the method. This paper presents several theoretical and empirical results related to the thermodilution method. The results show that, at flow velocities above 0.2 m s(-1), the response of temperature sensors embedded in Swan-Ganz catheters can be accurately described by a convolution operation between the true temperature of the blood and the impulse response of the sensor. The model developed is used to assess the influence of the probe response on the measurement of cardiac output, and this study leads us to the conclusion that the probe response can cause errors in the cardiac output measurement, but this error is usually small (2% in cases with a high degree of arrhythmia). The results show that these small errors appear during arrhythmias that affect the R-R interval and when the real temperature distribution at the pulmonary artery does not possess a shape with perfect temperature plateaux.

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Right Ventricular End-Diastolic Volume

Boldt¹

2005

Update in Intensive Care and Emergency Medicine

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Limitations of thermodilution ejection fraction

Cited by 42 publications

References 0 publications

Comparison of echocardiographic indices of right ventricular systolic function and ejection fraction obtained with continuous thermodilution in critically ill patients

Comparison of echocardiographic indices of right ventricular systolic function and ejection fraction obtained with continuous thermodilution in critically ill patients

Effects of the time response of the temperature sensor on thermodilution measurements

Right Ventricular End-Diastolic Volume

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