Comparison of cardiac output as assessed by transesophageal echo-Doppler and transpulmonary thermodilution in patients undergoing thoracic surgery

Intensive care in thoracic oncology

“…ASA: American Society of Anesthesiologists; S-MPM: surgical mortality probability model; RCRI: revised cardiac risk index; ThRCRI: thoracic RCRI; ARISCAT: Assess Respiratory Risk in Surgical Patients in Catalonia risk index; FEV1: forced expiratory volume in 1 s; ppo: predictive postoperative; DLCO: diffusing capacity of the lung for carbon monoxide; V′O 2 : oxygen uptake. # : refractory hypotension and/or hypoxaemia, myocardial ischaemia, cardiac arrhythmias requiring treatment, major haemorrhage or bronchial aspiration; ¶ : according to [8][9][10]. The Charlson comorbidity index (CCI), composed of 19 weighted medical diagnoses, is a valid predictor of 1-year mortality in medical patients; a score >5 being associated with 1-year mortality >50% [12].…”

“…Improving patient outcome can be achieved by implementing perioperative risk minimisation strategies [8][9][10]: 1) titration of anaesthetic agents, based on monitoring brain activity; 2) adoption of lung-protective ventilatory settings; 3) control of haemodynamics and achievement of optimal oxygen transport to match metabolic demands (cerebral oxygen saturation by near-infrared spectroscopy); 4) control of normothermia and haemostasis; and 5) efficient pain control. The type and quality of postoperative pain control influences postoperative triage, since it influences the risk of postoperative cardiopulmonary complications and length of stay [41].…”

Update on minimally invasive hemodynamic monitoring in thoracic anesthesia

“…Only limited data are however available on the validity of the esophageal Doppler technique in thoracic surgery. For pulmonary resections, this CO monitoring technique has been shown to exhibit acceptable clinical accuracy [23,24]. Despite the successful clinical implementation some limitations have to be considered: due to flow measurement within the descending aorta the mathematical algorithms implemented in the devices need to presume a fixed partition between cephalic and caudal blood flow in order to calculate total CO.…”

Invited Commentary

“…Importantly, the effectiveness of goal-directed approach using blood flow monitors has been demonstrated in decreasing morbidity and mortality in high-risk surgical patients [5]. Unfortunately, none of these studies has involved any patients undergoing lung resection although the use of semiinvasive hemodynamic monitoring devices has been validated during one-lung ventilation [6]. Likewise, bedside application of thromboelastography is better than conventional coagulation assays to monitor perioperative coagulopathy and to predict transfusion requirements [7].…”