The accuracy of PiCCO® in measuring cardiac output in patients under therapeutic hypothermia: Comparison with transthoracic echocardiography

Moura, Teresa Souto; Rosa, Sílvia Aguiar; Germano, Nuno; Cavaco, Raquel; Sequeira, Tiago Neves; Alves, Marta; Papoila, Ana Luísa; Bento, Luís

doi:10.1016/j.medin.2017.03.007

Cited by 10 publications

(8 citation statements)

References 13 publications

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“…The consensus on circulatory shock and hemodynamic monitoring by the Task Force of the European Society of Intensive Care Medicine provides a similar recommendation as well [9]. Besides its recommendation, it is important to note that there is conflicting evidence regarding the interchangeability between echocardiography and the pulmonary artery catheter or CO monitors for estimating the SV or CO, with some studies not showing a good correlation between them [10][11][12][13] and many studies showing the opposite [14][15][16][17][18].…”

Section: Introductionmentioning

confidence: 91%

Rationale for using the velocity–time integral and the minute distance for assessing the stroke volume and cardiac output in point-of-care settings

Blanco¹

2020

Ultrasound J

115

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Background: Stroke volume (SV) and cardiac output (CO) are basic hemodynamic parameters which aid in targeting organ perfusion and oxygen delivery in critically ill patients with hemodynamic instability. While there are several methods for obtaining this data, the use of transthoracic echocardiography (TTE) is gaining acceptance among intensivists and emergency physicians. With TTE, there are several points that practitioners should consider to make estimations of the SV/CO as simplest as possible and avoid confounders. Main body: With TTE, the SV is usually obtained as the product of the left ventricular outflow tract (LVOT) crosssectional area (CSA) by the LVOT velocity-time integral (LVOT VTI); the CO results as the product of the SV and the heart rate (HR). However, there are important drawbacks, especially when obtaining the LVOT CSA and thus the impaction in the calculated SV and CO. Given that the LVOT CSA is constant, any change in the SV and CO is highly dependent on variations in the LVOT VTI; the HR contributes to CO as well. Therefore, the LVOT VTI aids in monitoring the SV without the need to calculate the LVOT CSA; the minute distance (i.e., SV × HR) aids in monitoring the CO. This approach is useful for ongoing assessment of the CO status and the patient's response to interventions, such as fluid challenges or inotropic stimulation. When the LVOT VTI is not accurate or cannot be obtained, the mitral valve or right ventricular outflow tract VTI can also be used in the same fashion as LVOT VTI. Besides its pivotal role in hemodynamic monitoring, the LVOT VTI has been shown to predict outcomes in selected populations, such as in patients with acute decompensated HF and pulmonary embolism, where a low LVOT VTI is associated with a worse prognosis. Conclusion: The VTI and minute distance are simple, feasible and reproducible measurements to serially track the SV and CO and thus their high value in the hemodynamic monitoring of critically ill patients in point-of-care settings. In addition, the LVOT VTI is able to predict outcomes in selected populations.

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Section: Introductionmentioning

confidence: 91%

Rationale for using the velocity–time integral and the minute distance for assessing the stroke volume and cardiac output in point-of-care settings

Blanco¹

2020

Ultrasound J

115

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“…Under normothermia, in contrast to our findings, they found a good cor-relation between measurements with all the measurements differing by <0.5 L/min. However, during hypothermia defined as <36°C, the bias and precision fell; the mean bias was -0.43 L/min, with LOA of -1.60 to 0.75, and 44% (8/18) of the paired measurements were within 0.5 L/min (Souto Moura et al, 2018).…”

Section: Discussionmentioning

confidence: 94%

“…However, in some scenarios, such as high CO, low sedation, or with physiological structural changes, the accuracy of measurement by Doppler-CO was questionable. Of note, only one study investigated cardiac arrest patients (Souto Moura et al, 2018).…”

Section: Discussionmentioning

confidence: 99%

Comparing Doppler Echocardiography and Thermodilution for Cardiac Output Measurements in a Contemporary Cohort of Comatose Cardiac Arrest Patients Undergoing Targeted Temperature Management

Grand

Kjærgaard

Hassager

et al. 2022

Therapeutic Hypothermia and Temperature Management

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“…CO measurements were performed using TTE in 19 studies[2, 13, 23, 26, 27, 41, 44–46, 49–51, 58, 64, 68, 70, 73, 75], TEE in 24 [6–8, 18, 20, 30–32, 34, 42, 47, 48, 52–57, 59–63, 77], USCOM in 14 [4, 19, 22, 25, 28, 39, 40, 43, 65–67, 69, 72, 74], UD in 4 [29, 33, 36, 71], and other types of echocardiography in 7 [10, 21, 24, 35, 37, 38, 61]. CO measurements were performed in the AA in 13 studies [2, 4, 19, 24, 27, 28, 32, 35, 37, 41, 45, 47, 70], AOV in 18 […”

Section: Resultsmentioning

confidence: 99%

Cardiac output measurements via echocardiography versus thermodilution: A systematic review and meta-analysis

et al. 2019

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Echocardiography, as a noninvasive hemodynamic evaluation technique, is frequently used in critically ill patients. Different opinions exist regarding whether it can be interchanged with traditional invasive means, such as the pulmonary artery catheter thermodilution (TD) technique. This systematic review aimed to analyze the consistency and interchangeability of cardiac output measurements by ultrasound (US) and TD. Five electronic databases were searched for studies including clinical trials conducted up to June 2019 in which patients’ cardiac output was measured by ultrasound techniques (echocardiography) and TD. The methodological quality of the included studies was evaluated by two independent reviewers who used the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2), which was tailored according to our systematic review in Review Manager 5.3. A total of 68 studies with 1996 patients were identified as eligible. Meta-analysis and subgroup analysis were used to compare the cardiac output (CO) measured using the different types of echocardiography and different sites of Doppler use with TD. No significant differences were found between US and TD (random effects model: mean difference [MD], -0.14; 95% confidence interval, -0.30 to 0.02; P = 0.08). No significant differences were observed in the subgroup analyses using different types of echocardiography and different sites except for ascending aorta (AA) (random effects model: mean difference [MD], -0.37; 95% confidence interval, -0.74 to -0.01; P = 0.05) of Doppler use. The median of bias and limits of agreement were -0.12 and ±0.94 L/min, respectively; the median of correlation coefficient was 0.827 (range, 0.140–0.998). Although the difference in CO between echocardiography by different types or sites and TD was not entirely consistent, the overall effect of meta-analysis showed that no significant differences were observed between US and TD. The techniques may be interchangeable under certain conditions.

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The accuracy of PiCCO® in measuring cardiac output in patients under therapeutic hypothermia: Comparison with transthoracic echocardiography

Cited by 10 publications

References 13 publications

Rationale for using the velocity–time integral and the minute distance for assessing the stroke volume and cardiac output in point-of-care settings

Rationale for using the velocity–time integral and the minute distance for assessing the stroke volume and cardiac output in point-of-care settings

Comparing Doppler Echocardiography and Thermodilution for Cardiac Output Measurements in a Contemporary Cohort of Comatose Cardiac Arrest Patients Undergoing Targeted Temperature Management

Cardiac output measurements via echocardiography versus thermodilution: A systematic review and meta-analysis

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