Measurement of Cardiac Output by Pulse Dye Densitometry Using Indocyanine Green 

Abstract

Pulse dye densitometry could measure CO repeatedly in patients having major surgery with the same degree of accuracy as the thermodilution method; however, a considerable degree of error was observed in some patients.

Cardiac output measurement by pulse dye densitometry in cardiac surgery

“…These results could not be confirmed by other investigators who compared pulse dye densitometry with thermodilution cardiac output in cardiac surgery patients after admission to the intensive care unit using the simultaneous injection method [9,11,13]. In contrast to our study, Imai et al used a nose probe to detect indocyanine green concentrations [12]. Fukuda et al, injecting a bolus of 20 mg of indocyanine green via a peripheral venous route, reported greater accuracy of pulse dye densitometry with a nose probe than with a finger probe, which they attributed to the decreased mean transit time for indocyanine green detection with the nose probe [10].…”

“…Our estimates of the mean error from these data are 36% [12] and 60% [11]. Imai et al assessed the accuracy and precision of pulse dye densitometry in a heterogeneous patient population by comparing single cardiac output values obtained by simultaneous injection of both dye and thermal indicator [12]. They reported a slight cardiac output overestimate by pulse dye densitometry (bias: + 0.16 l.min )1 ) and a precision of ± 0.8 l.min .…”

“…Conflicting reports have been published on the accuracy of pulse dye densitometry [7,9,[11][12][13][14]21]. Bühlmann et al [11] and Imai et al [12] reported a satisfactory agreement between pulse dye densitometry and thermodilution, but the results of the Bland-Altman analysis do not justify their conclusion. Although the mean bias was close to zero, the limits of agreement were ± 1.6 l.min )1 and ± 2.7 l.min )1 , respectively.…”

“…Although the mean bias was close to zero, the limits of agreement were ± 1.6 l.min )1 and ± 2.7 l.min )1 , respectively. Our estimates of the mean error from these data are 36% [12] and 60% [11]. Imai et al assessed the accuracy and precision of pulse dye densitometry in a heterogeneous patient population by comparing single cardiac output values obtained by simultaneous injection of both dye and thermal indicator [12].…”

“…Pulse dye densitometry is based on the principle of indocyanine green dye dilution, whereby indocyanine green is injected through a central [7] or peripheral [8] venous line and the changes in dye concentration over time are detected by pulse spectrophotometry using a finger probe [7,9] or a nose probe [10,11]. Only a few investigators [7,[12][13][14] have compared pulse dye densitometry with standard methods of cardiac output determination, and the accuracy of pulse dye densitometry is therefore in dispute.Our primary aim was to validate pulse dye densitometry in patients before and after elective coronary artery bypass graft surgery (CABG). Our secondary aim was to investigate whether different concentrations of indocyanine green would affect the accuracy of pulse dye densitometry.…”