The Influence of Acute Pulmonary Hypertension on Cardiac Output Measurements

Abstract

TPTD compared with FICK was able to track all changes induced during the study period, including those by PH. It yielded better agreement than PATD both compared with FICK. PiCCO and CCO were not mapping all changes correctly, and when used clinically in unstable patients, regular controls with intermittent techniques are required. Acute pharmacologically induced PH did influence the difference between FICK and PiCCO.

Right ventricular stroke volume assessed by pulmonary artery pulse contour analysis

“…We found no correlation between the bias and the pulmonary artery elastance, but increasing precision with increasing elastance. This is in contrast to reports suggesting reduced accuracy of thermodilution measurements in pulmonary hypertension [ 32 ] and may, if verified in further studies, be a particular strength of our method in patients with acute or chronic pulmonary hypertension. Our calibration constants seemed to change with changing volume state, particularly with retransfusion .…”

“…Since we also show that the beat-by-beat tracking is—even though acceptable—less favorable than averaging one hundred beats, the optimal running average or filtering rate would still need to be determined and might depend on the clinical scenario. Continuous thermodilution offers practical advantages and is less operator dependent, but also less accurate than intermittent thermodilution [ 31 , 32 ] and limited by varying time delays of cardiac output results, which may render rapid clinical deteriorations undetectable [ 12 , 33 ]. A method as ours, based on pulmonary pulse contour could help to circumvent these inherent limitations to the PAC.…”