Original articleComparison of esophageal Doppler, pulse contour analysis, and real-time pulmonary artery thermodilution for the continuous measurement of cardiac output
Section snippets
Methods
After approval of the institutional review board committee and after written informed consent, 10 American Society of Anesthesiologists physical status IV patients with impaired left ventricular function (ejection fraction <50%) scheduled for elective cardiac surgery (coronary artery bypass grafting) were enrolled in the study. Patients with valvular heart disease, intracardiac shunts, or peripheral vascular disease, as well as emergency cases, were excluded. Only patients with sinus rhythm in
Results
Ten patients (aged 56–78 years; 6 male, 4 female) were enrolled in the study. A total of 113 PCCO, 107 UCCO, and 113 CCO measurements were analyzed. CO measurements ranged from 1.89 to 8.6 L/min for PCCO, 1.5 to 8.2 L/min for UCCO, and 2.4 to 5.7 L/min for CCO.
The Bland-Altman plot for CCO and PCCO is shown in Figure 1, for UCCO and CCO in Figure 2, and for PCCO and UCCO in Figure 3. Bias between CCO and PCCO was −0.71 L/min (precision 1 L/min), between CCO and UCCO −0.15 L/min (precision
Discussion
Perioperative determination of cardiac output is of great interest in the critically ill. Since 1970, PAC thermodilution has become the clinical “gold standard” in the field of anesthesia and intensive care. However, right heart catheterization for CO monitoring has been questioned for various reasons. First, ICO shows remarkable variance and has proved to be no real reference method in comparison studies.8, 9 Second, until recently, there was no real CCO measurement by PA thermodilution. The
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