Effect of lower limb compression devices on thermodilution cardiac output measurement*

Killu, Keith; Oropello, John; Manasia, Anthony; Kohli‐Seth, Roopa; Bassily‐Marcus, Adel; Leibowitz, Andrew B.; DelGiudice, Rosanna; Murgolo, Victor; Benjamin, Ernest

doi:10.1097/01.ccm.0000262387.37554.2e

Cited by 10 publications

(5 citation statements)

References 23 publications

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“…Less invasive methods are being used more often at the bedside to assess the patient's hemodynamics and avoid inherited risks, complications and some limitations associated with the invasive methods [3,12,13]. A pre-requisite of any method of monitoring is its accuracy, reproducibility and ease of use [4,5].…”

Section: Discussionmentioning

confidence: 99%

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Feasibility of common carotid artery point of care ultrasound in cardiac output measurements compared to invasive methods

et al. 2014

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Background Cardiac output (CO) measurement in the intensive care unit (ICU) requires invasive devices such as the pulmonary artery (PA) catheter or arterial waveform pulse contour analysis (PCA). This study tests the accuracy and feasibility of point of care ultrasound (POCUS) of the common carotid artery to estimate the CO non-invasively and compare it to existing invasive CO measurement modalities. Methods Patients admitted to the surgical and cardiothoracic ICU in a tertiary university-affiliated academic center during a 4-month period, with invasive hemodynamic monitoring devices for management, were included in this cohort study. Common carotid artery POCUS was performed to measure the CO and the results were compared to an invasive device. Results Intensivists and ICU fellows, using ultrasound of the common carotid artery, obtained the CO measurements. Images of the Doppler flow and volume were obtained at the level of the thyroid gland. Concurrent CO measured via invasive devices was recorded. The patient cohort comprised 36 patients; 52 % were females. The average age was 59 ± 13 years, and 66 % were monitored via PCA device and 33 % via PA catheter. Intraclass correlation coefficient (ICC) analysis demonstrated almost perfect correlation (0.8152) between measurements of CO via ultrasound vs. invasive modalities. The ICC between PO-CUS and the invasive measurement via PCA was 0.84 and via PA catheter 0.74, showing substantial agreement between the ultrasound and both invasive modalities. Conclusions Common carotid artery POCUS offers a non-invasive method of measuring the CO in the critically ill population.Keywords Cardiac output Á Ultrasound Á Carotid doppler Á Pulmonary artery catheter Á Pulse contour analysis Á Point of care ultrasound Abstract Background La misurazione della gittata cardiaca (CO) in Unità di Terapia Intensiva (ICU) richiede dispositivi invasivi come il cateterismo dell'arteria polmonare (PA) o l'analisi dell'onda dell'impulso arterioso (PCA). Questo studio si propone di valutare l'accuratezza e la fattibilità dell'ecografia (POCUS) della carotide comune per stimare la CO in modo non invasivo e confrontarla con le modalità esistenti di misurazione della CO effettuate in maniera invasiva. Metodi I pazienti ricoverati in terapia intensiva chirurgica e cardiotoracica in un centro accademico, affiliato con l'università, nel corso di un periodo di quattro mesi, sottoposti a dispositivi di monitoraggio emodinamico invasivo sono stati inclusi in questo studio. E' stata eseguita l'ecografia dell'arteria carotide comune per misurare la CO ed i risultati sono stati confrontati con una tecnica invasiva. Risultati Medici di terapia intensiva e borsisti, utilizzando l'ecografia della carotide comune, hanno ottenuto le misurazioni della CO. Immagini del flusso Doppler e di volume sono state ottenute a livello della ghiandola tiroidea. Contemporaneamente è è stata registrata la CO mediante dispositivi invasivi. Il gruppo era costituito da 36 Ultrasound (2015) 18:127-133 DOI 10.1007 pazien...

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Section: Discussionmentioning

confidence: 99%

“…In the early 1970s, we were introduced to the PA catheter. Its use has been in decline over the last 20 years, due to inherited risks of invasive procedures and limitations [1][2][3]. Newer less invasive methods are becoming available, such as the arterial waveform PCA, which has become very common in many ICUs across the globe.…”

Section: Introductionmentioning

confidence: 99%

Feasibility of common carotid artery point of care ultrasound in cardiac output measurements compared to invasive methods

et al. 2014

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“…The 65% to 100% incidence of severe thrombosis reported by Hoar et al appeared to support that logic. 2 Alternatively, one could conclude that the thrombosis observed by Hoar et al was partially the result of non-heparinbonded catheters. Although the protection conferred by heparin coating was not observed by Mollenholt et al 48 hours after placement, its use makes intuitive sense, and our recent experience with non-heparin-bonded catheters in the operating room advocates for its utility in the immediate postplacement period.…”

Section: To the Editormentioning

confidence: 97%

“…It is, perhaps, not surprising that MCDs are the most likely source of these observed tCCO observations. Previous studies in patients with bolus thermodilution cardiac output monitoring have demonstrated that inflation of lower limb MCDs decrease pulmonary artery (PA) temperature by 0.14 o C to 0.2 o C. 1,2 This phenomenon appears to occur due to a central "bolus" of cool blood from the lower extremity causing a transient but significant decrease in the PA blood temperature and an increase in the area under the thermodilution washout curve with a resulting low CO measurement. In application of this observed principle, Akinci and colleagues demonstrated in 2007 that these PA temperature variations appeared to be dependent on the timing between the MCD inflation and the cold saline bolus injection.…”

Section: To the Editormentioning

confidence: 99%

Oscillating Continuous Cardiac Output in Postoperative Critically Ill Patients: Is this Phenomenon Accurate, Artifact, or Error?

Hatton

Yalamuri

McCartney

et al. 2017

Journal of Cardiothoracic and Vascular Anesthesia

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of neuroimaging. Immediate recognition of the symptoms, cause, and discontinuation of the facemask nebulization therapy can effectively mitigate the patient's symptoms. It is essential to know which phenomena potentially can exacerbate acute-angle-closure glaucoma with blurring of vision in susceptible individuals. Correct positioning of the facemask to avoid leakage, use of protective eye wear and use of oral catheter atomizing inhalation can be advised to prevent such complication. It is advisable to discontinue facemask nebulization if the patient feels a foreign body sensation in the eyes due to vaporized flow of the nebulization. Unilateral mydriasis in the absence of other neurologic deficits should make the clinician aware of the fact that cholinergic antagonist agents like ipratropium bromide and beta 2-stimulants like salbutamol sulphate administered via nebulizers can produce such unusual effect.

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“…30 Lower limb compression devices, ubiquitous in the ICU, have even been shown to confound thermodilution cardiac output measurement. 31 Low basal blood temperature, for example, during therapeutic hypothermia, may also introduce error in measured cardiac output by the thermodilution technique.…”

Section: Cardiac Outputmentioning

confidence: 99%

The Pulmonary Artery Catheter in 2015

Gidwani

Goel²

2016

Cardiology in Review

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The pulmonary artery catheter (PAC) has revolutionized the care of critically ill patients by allowing physicians to directly measure important cardiovascular variables at the bedside. The relative ease of placement and the important physiological data obtained by PAC led to its incorporation as a central tool in the management of critically ill patients in intensive care units. Given the lack of demonstrable benefit in randomized clinical trials, persistent questions about safety, and recent advancements in noninvasive imaging modalities that purport to more accurately estimate cardiovascular hemodynamics, the use of the PAC has declined rapidly over recent years. Devised by cardiologists to measure hemodynamic parameters in patients with acute myocardial infarction, the PAC was quickly and enthusiastically adopted by intensivists, anesthesiologists, surgeons, and other specialists. This unbridled proliferation may have resulted in negative publicity surrounding the PAC. This article systematically reviews the evolution of PACs, the results of nonrandomized and randomized studies in various clinical conditions, the reasons for its decline, and current indications of PAC.

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Effect of lower limb compression devices on thermodilution cardiac output measurement*

Abstract: Thermodilution cardiac output measurements via a pulmonary artery catheter should not be done during the inflation cycle of lower limb SCDs because they produce a falsely low cardiac output.

Cited by 10 publications

References 23 publications

Feasibility of common carotid artery point of care ultrasound in cardiac output measurements compared to invasive methods

Feasibility of common carotid artery point of care ultrasound in cardiac output measurements compared to invasive methods

Oscillating Continuous Cardiac Output in Postoperative Critically Ill Patients: Is this Phenomenon Accurate, Artifact, or Error?

The Pulmonary Artery Catheter in 2015

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