Continuous and intermittent cardiac output measurement: pulmonary artery catheter versus aortic transpulmonary technique

Rocca, Giorgio Della; Costa, M. G.; Pompei, Livia; Coccia, Cecilia; Pietropaoli, P

doi:10.1093/bja/88.3.350

Cited by 205 publications

(41 citation statements)

References 29 publications

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“…For measurements of the central venous pressure, the cardiac index, the stroke volume and the systemic vascular resistance index (SVRI), either a four-lumen balloon-tipped, thermodilution, pulmonary artery catheter (Swan-Ganz; Baxter) was used or a pulse contour continuous cardiac output catheter (PiCCO; Pulsion Medical Systems AG, Munich, Germany) was used. It is currently accepted that measurement with this aortic transpulmonary thermodilution technique gives continuous and intermittent values that agree with the pulmonary thermodilution method, but in a less invasive manner [25,26]. …”

Section: Methodsmentioning

confidence: 99%

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et al. 2006

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Section: Methodsmentioning

confidence: 99%

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et al. 2006

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“…The transpulmonary thermodilution (TPTD) technique is a multi-parametric advanced cardiopulmonary monitoring technique that enables measurement of important variables required for making decisions in critically ill patients (Della Rocca et al, 2002;Heid et al, 2008;Cannesson et al, 2011;Vincent et al, 2011;Sakka et al, 2012). The TPTD is based on a cold saline bolus injection through a central venous catheter (CVC) in the central venous circulation, and the subsequent blood temperature change is picked up by a thermistor placed in the descending aorta through the femoral artery.…”

Section: Introductionmentioning

confidence: 99%

Impact of misplaced subclavian vein catheter into jugular vein on transpulmonary thermodilution measurement variables

Zhang

et al. 2016

J. Zhejiang Univ. Sci. B

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Abstract:Objective: The subclavian vein (SCV) is usually used to inject the indicator of cold saline for a transpulmonary thermodilution (TPTD) measurement. The SCV catheter being misplaced into the internal jugular (IJV) vein is a common occurrence. The present study explores the influence of a misplaced SCV catheter on TPTD variables. Methods: Thirteen severe acute pancreatitis (SAP) patients with malposition of the SCV catheter were enrolled in this study. TPTD variables including cardiac index (CI), global end-diastolic volume index (GEDVI), intrathoracic blood volume index (ITBVI), and extravascular lung water index (EVLWI) were obtained after injection of cold saline via the misplaced SCV catheter. Then, the misplaced SCV catheter was removed and IJV access was constructed for a further set of TPTD variables. Comparisons were made between the TPTD results measured through the IJV and misplaced SCV accesses. Results: A total of 104 measurements were made from TPTD curves after injection of cold saline via the IJV and misplaced SCV accesses. Bland-Altman analysis demonstrated an overestimation of +111.40 ml/m 2 (limits of agreement: 6.13 and 216.70 ml/m 2 ) for GEDVI and ITBVI after a misplaced SCV injection. There were no significant influences on CI and EVLWI. The biases of +0.17 L/(min·m 2 ) for CI and +0.17 ml/kg for EVLWI were revealed by Bland-Altman analysis. Conclusions: The malposition of an SCV catheter does influence the accuracy of TPTD variables, especially GEDVI and ITBVI. The position of the SCV catheter should be confirmed by chest X-ray in order to make good use of the TPTD measurements.

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Section: Resultsmentioning

confidence: 99%

“…The validity of PCCO measurements has been studied extensively [3,5,6,9]. However, most of these validation studies have been performed in cardiac surgical patients requiring only low-to-moderate doses of vasoactive support [3,5,6,9]. In contrast we analyzed the validity and accuracy of PCCO measurements in a setting outside of cardiac surgery and as recently demanded [31], in a select patient group under extreme cardiocirculatory conditions, that is, in neurosurgical patients requiring high-dose vasopressor support for the prevention/treatment of DCI due to SAH.…”

Section: Resultsmentioning

confidence: 99%

Accuracy and precision of calibrated arterial pulse contour analysis in patients with subarachnoid hemorrhage requiring high-dose vasopressor therapy: a prospective observational clinical trial

et al. 2014

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IntroductionCalibrated arterial pulse contour analysis has become an established method for the continuous monitoring of cardiac output (PCCO). However, data on its validity in hemodynamically instable patients beyond the setting of cardiac surgery are scarce. We performed the present study to assess the validity and precision of PCCO-measurements using the PiCCO™-device compared to transpulmonary thermodilution derived cardiac output (TPCO) as the reference technique in neurosurgical patients requiring high-dose vasopressor-therapy.MethodsA total of 20 patients (16 females and 4 males) were included in this prospective observational clinical trial. All of them suffered from subarachnoid hemorrhage (Hunt&Hess grade I-V) due to rupture of a cerebral arterial aneurysm and underwent high-dose vasopressor therapy for the prevention/treatment of delayed cerebral ischemia (DCI). Simultaneous CO measurements by bolus TPCO and PCCO were obtained at baseline as well as 2 h, 6 h, 12 h, 24 h, 48 h and 72 h after inclusion.ResultsPCCO- and TPCO-measurements were obtained at baseline as well as 2 h, 6 h, 12 h, 24 h, 48 h and 72 h after inclusion. Patients received vasoactive support with (mean ± standard deviation, SD) 0.57 ± 0.49 μg · kg-1 · min-1 norepinephrine resulting in a mean arterial pressure of 103 ± 13 mmHg and a systemic vascular resistance of 943 ± 248 dyn · s · cm-5. 136 CO-data pairs were analyzed. TPCO ranged from 5.2 to 14.3 l · min-1 (mean ± SD 8.5 ± 2.0 l · min-1) and PCCO ranged from 5.0 to 14.4 l · min-1 (mean ± SD 8.6 ± 2.0 l · min-1). Bias and limits of agreement (1.96 SD of the bias) were −0.03 ± 0.82 l · min-1 and 1.62 l · min-1, resulting in an overall percentage error of 18.8%. The precision of PCCO-measurements was 17.8%. Insufficient trending ability was indicated by concordance rates of 74% (exclusion zone of 15% (1.29 l · min-1)) and 67% (without exclusion zone), as well as by polar plot analysis.ConclusionsIn neurosurgical patients requiring extensive vasoactive support, CO values obtained by calibrated PCCO showed clinically and statistically acceptable agreement with TPCO-measurements, but the results from concordance and polar plot analysis indicate an unreliable trending ability.

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Continuous and intermittent cardiac output measurement: pulmonary artery catheter versus aortic transpulmonary technique

Abstract: Measurement with the aortic transpulmonary thermodilution technique gives continuous and intermittent values that agree with the pulmonary thermodilution method.

Cited by 205 publications

References 29 publications

Untitled

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Impact of misplaced subclavian vein catheter into jugular vein on transpulmonary thermodilution measurement variables

Accuracy and precision of calibrated arterial pulse contour analysis in patients with subarachnoid hemorrhage requiring high-dose vasopressor therapy: a prospective observational clinical trial

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