Noninvasive Cardiac Output: Simultaneous Comparison of Two Different Methods with Thermodilution

Wong, David H.; Tremper, Kevin K.; Stemmer, Edward A.; O'Connor, D.; Wilbur, Steve; Zaccari, June; Reeves, C.; Weidoff, Paul; Trujillo, Robert

doi:10.1097/00000542-199005000-00002

Cited by 121 publications

(43 citation statements)

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“…After an overnight fast (8-10 h), the subjects were positioned supine and a liver venous catheter (Cournand,7 Fr) (Appel et al 1986;Wong et al 1990). Total systemic vascular resistance (TVR) was the ratio of MAP to cardiac output.…”

mentioning

confidence: 99%

Mesenteric, coeliac and splanchnic blood flow in humans during exercise

Perko

Nielsen

Skak

et al. 1998

The Journal of Physiology

140

109

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In humans subjected to intense exercise, the splanchnic blood flow is reduced to about 40% (Kjòr et al. 1993) or even as low as 20% of the resting value (Rowell, 1973). Such a substantial reduction in blood flow is not associated with symptoms of abdominal hypoperfusion, which contrasts with patients suffering abdominal angina in whom the splanchnic blood flow is reduced to only 84% of rest (0·98 vs. 1·17 l min¢ in a control group; Buchardt Hansen et al. 1977). Therefore, we hypothesized that the exercise-induced reduction in splanchnic blood flow primarily follows a decrease in the hepato-splenic flow, while the mesenteric circulation remains relatively stable. In contrast to our hypothesis, Qamar & Read (1987) noted a 43 % reduction in the superior mesenteric artery (SMA) blood flow after treadmill exercise. However, Eriksen & Waaler (1994) reported a maintained SMA flow after fasting and postprandial short-duration (4 min) cycling, corroborating observations during submaximal exercise in the dog (Herrick et al. 1940;Van Citters & Franklin, 1969;Vatner, 1975). To evaluate these contradictory results, we assessed splanchnic blood flow (SBF) during fasting and postprandial exercise in healthy volunteers by both Indocyanine Green dye-elimination (dye-elimination) and duplex ultrasound techniques, which permitted separation of the hepato-splenic from the mesenteric circulations. METHODSNineteen healthy non-medicated and non-smoking volunteers aged 28 years (range, 24-35 years), 1·82 m (1·73-1·91 m) tall and weighing 81 kg (57-85 kg) participated in the study after informed consent and approval by the Ethics Committee for Medical Research in Copenhagen (Reg. no. KA 91192). The first ten subjects underwent fasting duplex ultrasound examination of the SMA and 1. Exercise reduces splanchnic blood flow, but the mesenteric contribution to this response is uncertain. 2. In nineteen humans, superior mesenteric and coeliac artery flows were determined by duplex ultrasonography during fasting and postprandial submaximal cycling and compared with the splanchnic blood flow as assessed by the Indocyanine Green dye-elimination technique. 3. Cycling increased arterial pressure, heart rate and cardiac output, while it reduced total vascular resistance. These responses were not altered in the postprandial state. During fasting, cycling increased mesenteric, coeliac and splanchnic resistances by 76, 165 and 126%, respectively, and it reduced corresponding blood flows by 32, 50 and 43% (by 0·18 ± 0·04, 0·42 ± 0·03 and 0·60 ± 0·04 l min¢). Postprandially, mesenteric and splanchnic vascular resistances decreased, thereby elevating regional blood flow, while the coeliac circulation was not influenced. Postprandial cycling did not influence the mesenteric resistance significantly, but its blood flow decreased by 22% (0·46 ± 0·28 l min¢). Coeliac and splanchnic resistance increased by 150 and 63%, respectively, and the corresponding regional blood flow decreased by 51 and 31% (0·49 ± 0·07 and 0·96 ± 0·28 l min¢). Splanchnic blood flow va...

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mentioning

confidence: 99%

Mesenteric, coeliac and splanchnic blood flow in humans during exercise

Perko

Nielsen

Skak

et al. 1998

The Journal of Physiology

140

109

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“…These devices assume that impedance is exclusively a function of changes in intrathoracic blood; they are susceptible to electrical noise, electrode positioning, and pulmonary edema, and are not particularly accurate. [116][117][118][119][120][121][122][123][124] Bioreactance, in which the phase shift between the applied and measured voltage is correlated to stroke volume, was developed in an effort to reduce the sensitivity to artifact. 125 Advantages of bioimpedance and bioreactance devices include their completely noninvasive nature as well as their ability to provide continuous measurements.…”

Section: Technological Assessmentmentioning

confidence: 99%

Inter-device differences in monitoring for goal-directed fluid therapy

Thiele

Bartels

Gan

2014

Can J Anesth/J Can Anesth

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“…Results from comparative studies have been poor, with reported limits of agreement of 40-60% [29][30][31]. This failure is probably caused by excessive lung fluid [9].…”

Section: Clinical Applicationsmentioning

confidence: 99%

“…In patients who have suffered acute myocardial infarction [26], undergoing cardiac catheterisation [27] or neurosurgery [20,28], agreement with thermodilution has been acceptable (Ϯ 20-30%). However, unacceptable limits of agreement of Ϯ 40-60% have been repeatedly found in critically ill patients [29][30][31]. In general, results from studies in critically ill patients have shown that TEB cardiac output, when compared to thermodilution, over-estimates at low cardiac outputs and under-estimates at high cardiac outputs [32].…”

Section: A Summary Of Evaluation Studiesmentioning

confidence: 99%

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Impedance cardiographyThe impact of new technology

Critchley

1998

Anaesthesia

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SummaryThe 1990s have witnessed major advances in impedance cardiography technology. Problems existed with the methods used to calculate cardiac output. Excessive lung fluid, as often found in critically ill patients, may also invalidate measurements. The signal processing and measurement techniques used in older systems were deficient. The newer systems, of which there are at least six, incorporate novel and improved signal processing techniques. They also offer analog visual displays, personal computer interfacing, sophisticated analytical software and haemodynamic patient management systems. Evaluation of these systems is difficult because no true 'gold standard' method of cardiac output measurement exists. When compared with thermodilution techniques, limits of agreement of Ϯ 20-30% seem acceptable. These limits can be achieved in normal subjects but not in critically ill patients. Validation data are available for only half of the new systems. Until recently, the main application for impedance cardiography has been research but improved accuracy should lead to increased clinical usage.

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Noninvasive Cardiac Output: Simultaneous Comparison of Two Different Methods with Thermodilution

Cited by 121 publications

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Mesenteric, coeliac and splanchnic blood flow in humans during exercise

Mesenteric, coeliac and splanchnic blood flow in humans during exercise

Inter-device differences in monitoring for goal-directed fluid therapy

Impedance cardiographyThe impact of new technology

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