Noninvasive Cardiac Output Determination: Broadening the Applicability of Hemodynamic Monitoring

Compton, Friederike; Schäfer, Jürgen-Heiner

doi:10.1177/1089253208330711

Cited by 19 publications

(12 citation statements)

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“…more invasive methods of cardiac output determination have yielded conflicting results [ 26 , 27 ]. In their study, Miyagawa et al did not find any significant effects of experimental condition (trial) on cardiac output or stroke volume but did note there was a significant interactive effect of [trial × time] both cardiac output and stroke volume, during exercise, (suggesting that their responses to exercise were significantly different between the experimental conditions [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

A Four-Way Comparison of Cardiac Function with Normobaric Normoxia, Normobaric Hypoxia, Hypobaric Hypoxia and Genuine High Altitude

et al. 2016

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BackgroundThere has been considerable debate as to whether different modalities of simulated hypoxia induce similar cardiac responses.Materials and MethodsThis was a prospective observational study of 14 healthy subjects aged 22–35 years. Echocardiography was performed at rest and at 15 and 120 minutes following two hours exercise under normobaric normoxia (NN) and under similar PiO2 following genuine high altitude (GHA) at 3,375m, normobaric hypoxia (NH) and hypobaric hypoxia (HH) to simulate the equivalent hypoxic stimulus to GHA.ResultsAll 14 subjects completed the experiment at GHA, 11 at NN, 12 under NH, and 6 under HH. The four groups were similar in age, sex and baseline demographics. At baseline rest right ventricular (RV) systolic pressure (RVSP, p = 0.0002), pulmonary vascular resistance (p = 0.0002) and acute mountain sickness (AMS) scores were higher and the SpO2 lower (p<0.0001) among all three hypoxic groups (GHA, NH and HH) compared with NN. At both 15 minutes and 120 minutes post exercise, AMS scores, Cardiac output, septal S’, lateral S’, tricuspid S’ and A’ velocities and RVSP were higher and SpO2 lower with all forms of hypoxia compared with NN. On post-test analysis, among the three hypoxia groups, SpO2 was lower at baseline and 15 minutes post exercise with GHA (89.3±3.4% and 89.3±2.2%) and HH (89.0±3.1 and (89.8±5.0) compared with NH (92.9±1.7 and 93.6±2.5%). The RV Myocardial Performance (Tei) Index and RVSP were significantly higher with HH than NH at 15 and 120 minutes post exercise respectively and tricuspid A’ was higher with GHA compared with NH at 15 minutes post exercise.ConclusionsGHA, NH and HH produce similar cardiac adaptations over short duration rest despite lower SpO2 levels with GHA and HH compared with NH. Notable differences emerge following exercise in SpO2, RVSP and RV cardiac function.

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Section: Discussionmentioning

confidence: 99%

A Four-Way Comparison of Cardiac Function with Normobaric Normoxia, Normobaric Hypoxia, Hypobaric Hypoxia and Genuine High Altitude

et al. 2016

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“…The devices measurements had to be compared to pulmonary artery catheter thermodilution, the gold standard for cardiac output measuring [9]. Correlation coefficients were taken from the articles, together with bias and precision analysis between the non-invasive hemodynamic monitoring device and pulmonary artery catheter thermodilution.…”

Section: Methodsmentioning

confidence: 99%

“…Pulmonary artery catheter thermodilution is considered to be the gold standard for cardiac output measurement [9]. Unfortunately, the invasive nature of this method means that it is not applicable during the initial phase in the ED [9,10].…”

Section: Introductionmentioning

confidence: 99%

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Non-invasive hemodynamic monitoring in trauma patients

2015

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BackgroundThe assessment of hemodynamic status is a crucial task in the initial evaluation of trauma patients. However, blood pressure and heart rate are often misleading, as multiple variables may impact these conventional parameters. More reliable methods such as pulmonary artery thermodilution for cardiac output measuring would be necessary, but its applicability in the Emergency Department is questionable due to their invasive nature. Non-invasive cardiac output monitoring devices may be a feasible alternative.MethodsA systematic literature review was conducted. Only studies that explicitly investigated non-invasive hemodynamic monitoring devices in trauma patients were considered.ResultsA total of 7 studies were identified as suitable and were included into this review. These studies evaluated in a total of 1,197 trauma patients the accuracy of non-invasive hemodynamic monitoring devices by comparing measurements to pulmonary artery thermodilution, which is the gold standard for cardiac output measuring. The correlation coefficients r between the two methods ranged from 0.79 to 0.92. Bias and precision analysis ranged from -0.02 +/- 0.78 l/min/m2 to -0.14 +/- 0.73 l/min/m2. Additionally, data on practicality, limitations and clinical impact of the devices were collected.ConclusionThe accuracy of non-invasive cardiac output monitoring devices in trauma patients is broadly satisfactory. As the devices can be applied very early in the shock room or even preclinically, hemodynamic shock may be recognized much earlier and therapeutic interventions could be applied more rapidly and more adequately. The devices can be used in the daily routine of a busy ED, as they are non-invasive and easy to master.

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“…However, we observed clinically relevant lower systolic and clinically relevant higher diastolic and MAP with even statistical significance for diastolic and MAP between MG and PiCCO R , which is a common finding when blood pressure levels between peripheral (non-invasive), and central (invasive) measurements have been compared in critically ill patients. Imprecise estimation of central arterial pressure during hemodynamic instability can influence the accuracy of derived CO (Compton et al, 2008;Compton and Schafer, 2009). Plenty of non-invasive CO monitoring devices, which rely on non-invasive pulse wave analysis, pulse wave transit time, or thoracic bioimpedance as a basic principle for CO calculation, have been described in the literature (Papaioannou et al, 2020).…”

Section: Discussionmentioning

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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Noninvasive Cardiac Output Determination: Broadening the Applicability of Hemodynamic Monitoring

Cited by 19 publications

References 102 publications

A Four-Way Comparison of Cardiac Function with Normobaric Normoxia, Normobaric Hypoxia, Hypobaric Hypoxia and Genuine High Altitude

A Four-Way Comparison of Cardiac Function with Normobaric Normoxia, Normobaric Hypoxia, Hypobaric Hypoxia and Genuine High Altitude

Non-invasive hemodynamic monitoring in trauma patients

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

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