Thermodilution vs Estimated Fick Cardiac Output Measurement in Clinical Practice

Opotowsky, Alexander R.; Hess, Edward; Maron, Bradley A.; Brittain, Evan L.; Barón, Anna E.; Maddox, Thomas M.; Alshawabkeh, Laith; Wertheim, Bradley M.; Xu, Meng; Assad, Tufik R.; Rich, Jonathan D.; Choudhary, Gaurav; Tedford, Ryan J.

doi:10.1001/jamacardio.2017.2945

Cited by 107 publications

(60 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Linear regression analysis showed only a modest correlation between TD and eFM among all three VO 2 estimation formulas. The coefficient of determination in the current study was higher than described in two other studies with a similarly sized cohort of patients affected by PH[17,21], as well as in a large retrospective study of all-comers[20] (S7 Table). CI as assessed by the formulas of LaF and Be resulted in higher values than CI-TD in patients with low CI-states.…”

Section: Resultscontrasting

confidence: 60%

“…[22–24] Similar trials comparing eFM and TD often did not report the formulas behind VO 2 calculations due to their retrospective design. [17,20] An extensive analysis comparing the eFM and TD-method suggested that age is a major contributor to differences between the two methods, but did not further investigate the relevance of this observation. [20] As sarcopenia is frequent among elderly patients, especially in heart failure, VO 2 assumptions based on young patient study-cohorts might be misleading.…”

Section: Resultsmentioning

confidence: 99%

“…[17,20] An extensive analysis comparing the eFM and TD-method suggested that age is a major contributor to differences between the two methods, but did not further investigate the relevance of this observation. [20] As sarcopenia is frequent among elderly patients, especially in heart failure, VO 2 assumptions based on young patient study-cohorts might be misleading. [16] Our study cohort differs from the derivation cohorts of LaF, De and Be concerning the estimation of VO 2 as displayed in S1 Table.…”

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Thermodilution vs estimated Fick cardiac output measurement in an elderly cohort of patients: A single-centre experience

et al. 2019

View full text Add to dashboard Cite

AimsPatients referred to the cath-lab are an increasingly elderly population. Thermodilution (TD, gold standard) and the estimated Fick method (eFM) are interchangeably used in the clinical routine to measure cardiac output (CO). However, their correlation in an elderly cohort of cardiac patients has not been tested so far.MethodsA single, clinically-indicated right heart catheterization was performed on each patient with CO estimated by eFM and TD in 155 consecutive patients (75.1±6.8 years, 57.7% male) between April 2015 and August 2017. Whole Body Oxygen Consumption (VO2) was assumed by applying the formulas of LaFarge (LaF), Dehmer (De) and Bergstra (Be). CO was indexed to body surface area (Cardiac Index, CI).ResultsCI-TD showed an overall moderate correlation to CI-eFM as assessed by LaF, De or Be (r2 = 0.53, r2 = 0.54, r2 = 0.57, all p < .001, respectively) with large limits of agreement (-0.64 to 1.09, -1.07 to 0.77, -1.38 to 0.53 l/m2/min, respectively). The mean difference of CI between methods was 0.22, -0.15 and -0.42 (all p<0.001 for difference to TD), respectively. A rate of error ≥20% occurred with the equations by LaF, De or Be in 40.6%, 26.5% and 36.1% of patients, respectively. A CI <2.2 l/m2min was present in 42.6% of patients according to TD and in 60.0%, 31.0% and in 16.1% of patients according to eFM by the formulas of LaF, De or Be.ConclusionAlthough CI-eFM shows an overall reasonable correlation with CI-TD, the predictive value in a single patient is low. CI-eFM cannot replace CI-TD in elderly patients.

show abstract

Section: Resultscontrasting

confidence: 60%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Thermodilution vs estimated Fick cardiac output measurement in an elderly cohort of patients: A single-centre experience

et al. 2019

View full text Add to dashboard Cite

show abstract

“…Hemodynamic assessment involves measuring cardiac function through several parameters such as heart rate (HR), blood pressure (BP), stroke volume (SV) and cardiac output (CO). Hemodynamic monitoring primarily relies on the current gold standard—thermodilution (using pulmonary artery catheter (PAC)) [ 1 , 2 , 3 , 4 ]—which is an invasive method along with semi- or minimally invasive techniques employing Doppler echocardiography [ 5 , 6 , 7 , 8 , 9 ]. Due to concerns around patient comfort and continuous measurements, alternatives to the existing hemodynamic assessment methods have always been of interest [ 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

Investigating Electrical Impedance Spectroscopy for Estimating Blood Flow-Induced Variations in Human Forearm

Anand

Lowe

2020

Sensors

View full text Add to dashboard Cite

This work aims to investigate the feasibility of employing multi-frequency bioimpedance analysis for hemodynamic assessment. Towards this, we aim to explore one of its implementations, electrical impedance spectroscopy (EIS), for estimating changes in radial artery diameter due to blood flow. Following from our previous investigations, here, we use a commercial device—the Quadra® Impedance Spectroscopy device—for impedance measurements of the forearm of three subjects under normal conditions and occluding the artery with a cuff. This was performed simultaneously with ultrasound measurements as a reference. The impedance spectra were measured over time, yielding waveforms reflecting changes due to blood flow. Contributions from the fat/muscle domains were accounted for using the occluded impedance response, resulting in arterial impedance. A modified relationship was approximated to calculate the diameter from the arterial impedance, which showed a similarity with ultrasound measurements. Comparison with the ultrasound measurements revealed differences in phase and amplitude, primarily due to the approximated relationship between impedance and diameter and neglecting the impedance phase analysis. This work shows the potential of EIS, with improvements, towards estimating blood flow-induced variation in arteries. Further analysis and improvements could help place this technology in mainstream clinical practice for hemodynamic monitoring.

show abstract

“…A very recent retrospective study, in more than 12,000 patients who underwent right heart catheterization but were not necessarily hospitalized in ICU, found between thermodilution and an oxygen-uptake-based Fick method, an acceptable systematic bias of 0.4% but poor limits of agreement from −1.31 to +1.27 l/min; and a difference of more than 20% between measured CO in 40% of patients ( 45 ).…”

Section: Respiratory Derived Co Monitoring System: Partial Co mentioning

confidence: 99%

Non-Invasive Monitoring of Cardiac Output in Critical Care Medicine

Nguyen

Squara

2017

Front. Med.

View full text Add to dashboard Cite

Critically ill patients require close hemodynamic monitoring to titrate treatment on a regular basis. It allows administering fluid with parsimony and adjusting inotropes and vasoactive drugs when necessary. Although invasive monitoring is considered as the reference method, non-invasive monitoring presents the obvious advantage of being associated with fewer complications, at the expanse of accuracy, precision, and step-response change. A great many methods and devices are now used over the world, and this article focuses on several of them, providing with a brief review of related underlying physical principles and validation articles analysis. Reviewed methods include electrical bioimpedance and bioreactance, respiratory-derived cardiac output (CO) monitoring technique, pulse wave transit time, ultrasound CO monitoring, multimodal algorithmic estimation, and inductance thoracocardiography. Quality criteria with which devices were reviewed included: accuracy (closeness of agreement between a measurement value and a true value of the measured), precision (closeness of agreement between replicate measurements on the same or similar objects under specified conditions), and step response change (delay between physiological change and its indication). Our conclusion is that the offer of non-invasive monitoring has improved in the past few years, even though further developments are needed to provide clinicians with sufficiently accurate devices for routine use, as alternative to invasive monitoring devices.

show abstract

Thermodilution vs Estimated Fick Cardiac Output Measurement in Clinical Practice

Abstract: There is only modest agreement between Td and eFick CI estimates. Thermodilution CI better predicts mortality and should be favored over eFick in clinical practice.

Cited by 107 publications

References 34 publications

Thermodilution vs estimated Fick cardiac output measurement in an elderly cohort of patients: A single-centre experience

Thermodilution vs estimated Fick cardiac output measurement in an elderly cohort of patients: A single-centre experience

Investigating Electrical Impedance Spectroscopy for Estimating Blood Flow-Induced Variations in Human Forearm

Non-Invasive Monitoring of Cardiac Output in Critical Care Medicine

Contact Info

Product

Resources

About