Minimally Invasive Determinations of Oxygen Delivery and Consumption in Cardiac Surgery: An Observational Study

Burtman, David; Stolze, A; Dengler, Selma E Kaffka Genaamd; Vonk, Alexander B.A.; Boer, Christa

doi:10.1053/j.jvca.2017.06.042

Cited by 5 publications

(5 citation statements)

References 26 publications

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“…(51-53) During stable intraoperative conditions, oxygen content difference is not expected to vary to a large extent whereas cardiac output can show considerable in- and between patient variability. (23) In our study, oxygen content difference and cardiac output demonstrated similar coefficients of variation.…”

Section: Discussionsupporting

confidence: 79%

“…Newer studies using non-invasive cardiac output monitors have not shown agreement with oxygen consumption measurements from indirect calorimetry(22) or pulmonary artery catheters. (23) However, the monitors used were not calibrated by transpulmonary or indicator dilution such as the PiCCO™ or LiDCO™plus systems and did not analyse changes over time.…”

Section: Discussionmentioning

confidence: 99%

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Perioperative changes in oxygen consumption: estimations from minimal-invasive cardiac output and a-cvO₂difference parallel to indirect calorimetry

Jakobsson

Norén²,

Hagel

et al. 2022

Preprint

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Feasible estimations of perioperative changes in oxygen consumption could enable larger studies of its role in postoperative outcomes. Current methods, by pulmonary artery catheterisation or breathing gas analysis, are often regarded as either invasive or technically requiring. In this pilot study, we investigated the relationship between estimations of oxygen consumption, based on minimal-invasive cardiac output and arterial-central venous blood gas sampling, and indirect calorimetry in the perioperative period using the data collected during a clinical trial on perioperative oxygen transport.In 20 patients >65 years during epidural and general anaesthesia for open abdominal surgery, Fick-based estimations of oxygen consumption(EVO2), the product of cardiac output from LiDCO™plus(LiDCO Ltd, Cambridge, UK) and arterial-central venous oxygen content difference, were compared with indirect calorimetry(GVO2) using QuarkRMR(COSMED, srl. Italy). Eighty-five simultaneous intra- and postoperative measurements at different time-points were analysed for prediction, parallelity and by traditional agreement assessment. There was an overall association between GVO2 and EVO2, 73(95% CI 62 to 83) + 0.45(95% CI 0.29 to 0.61) EVO2 ml min-1m-2, P<0.0001. GVO2 and EVO2 changed in parallel intra- and postoperatively when normalised to their respective overall means. Unadjusted mean difference between GVO2 and EVO2 indexed for body surface area was 26(95% CI 20 to 32) with limits of agreement (1.96SD) of -32 to 85 ml min-1m-2 and did not change over time. There was low correlation for absolute agreement, ICC(A,1) 0.37(95% CI 0.34 to 0.65) [F(84,10.2)=3.07, P=0.0266].Despite lack of absolute agreement, the estimated oxygen consumption changed in parallel to the metabolic measurements in the perioperative period. Prediction or trending of oxygen consumption by this or similar methods could be further evaluated in larger samples.

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Section: Discussionsupporting

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Perioperative changes in oxygen consumption: estimations from minimal-invasive cardiac output and a-cvO₂difference parallel to indirect calorimetry

Jakobsson

Norén²,

Hagel

et al. 2022

Preprint

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show abstract

“…Examples of the earlier method comparison studies are summarised in Table 1 . Newer studies using non-invasive cardiac output monitors have not shown agreement with oxygen consumption measurements from indirect calorimetry [ 20 ] or pulmonary artery catheters [ 21 ]. However, the monitors used were not calibrated by transpulmonary or indicator dilution such as the PiCCO ™ or LiDCO ™ plus systems and did not analyse changes over time.…”

Section: Discussionmentioning

confidence: 99%

“…Central and mixed venous oxygen saturation have not shown interchangeability [ 46 – 48 ] but some studies have suggested that trends in ScvO 2 can replace SvO 2 [ 49 – 51 ]. During stable intraoperative conditions, oxygen content difference is not expected to vary to a large extent whereas cardiac output can show considerable in- and between patient variability [ 21 ]. In our study, oxygen content difference and cardiac output demonstrated similar coefficients of variation.…”

Section: Discussionmentioning

confidence: 99%

Perioperative estimations of oxygen consumption from LiDCO™plus-derived cardiac output and Ca-cvO2 difference: Relationship with measurements by indirect calorimetry in elderly patients undergoing major abdominal surgery

Jakobsson,

Norén,

Hagel

et al. 2024

PLoS ONE

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Background Feasible estimations of perioperative changes in oxygen consumption (VO2) could enable larger studies of its role in postoperative outcomes. Current methods, either by reverse Fick calculations using pulmonary artery catheterisation or metabolic by breathing gas analysis, are often deemed too invasive or technically requiring. In addition, reverse Fick calculations report generally lower values of oxygen consumption. Methods We investigated the relationship between perioperative estimations of VO2 (EVO2), from LiDCO™plus-derived (LiDCO Ltd, Cambridge, UK) cardiac output and arterial-central venous oxygen content difference (Ca-cvO2), with indirect calorimetry (GVO2) by QuarkRMR (COSMED srl. Italy), using data collected 2017–2018 during a prospective observational study on perioperative oxygen transport in 20 patients >65 years during epidural and general anaesthesia for open pancreatic or liver resection surgery. Eighty-five simultaneous intra- and postoperative measurements at different perioperative stages were analysed for prediction, parallelity and by traditional agreement assessment. Results Unadjusted bias between GVO2 and EVO2 indexed for body surface area was 26 (95% CI 20 to 32) with limits of agreement (1.96SD) of -32 to 85 ml min−1m−2. Correlation adjusted for the bias was moderate, intraclass coefficient(A,1) 0.51(95% CI 0.34 to 0.65) [F (84,84) = 3.07, P<0.001]. There was an overall association between GVO2 and EVO2, in a random coefficient model [GVO2 = 73(95% CI 62 to 83) + 0.45(95% CI 0.29 to 0.61) EVO2 ml min−1m−2, P<0.0001]. GVO2 and EVO2 changed in parallel intra- and postoperatively when normalised to their respective overall means. Conclusion Based on this data, estimations from LiDCO™plus-derived cardiac output and Ca-cvO2 are not reliable as a surrogate for perioperative VO2. Results were in line with previous studies comparing Fick-based and metabolic measurements but limited by variability of data and possible underpowering. The parallelity at different perioperative stages and the prediction model can provide useful guidance and methodological tools for future studies on similar methods in larger samples.

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“…If severe peripheral vascular disease is present at both femoral artery and axillary artery, central cannulation could be performed as an alternative. 25,26 Fortunately, we did not transfer the cannulation site to the axillary artery or aorta till now, the shifting of femoral arterial cannulation from right side to left side in only one case from Group B. Importantly, a highly experienced anesthetist and perfusionist is crucially necessary in teamwork in order to well control the heart rate, myocardial contractility, arterial perfusion, and venous drainage during the CPB.…”

Section: Discussionmentioning

confidence: 99%

Modified unicaval drainage in reoperative isolated tricuspid valve repair via totally thoracoscopic approach

Zhou

et al. 2020

Perfusion

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Aim: The aim of this study was to investigate the feasibility, safety, and clinical effect of modified unicaval drainage for thoracoscopic reoperative isolated tricuspid valve repair, compared with conventional bicaval drainage. Methods: A total of 45 consecutive cases of patients who underwent thoracoscopic reoperative isolated tricuspid valve repair on beating-heart were enrolled and divided into two groups according to the different venous drainage (Group A: modified unicaval drainage, Group B: conventional bicaval drainage). A retrospective analysis of perioperative data and clinical outcomes were performed and all the surviving cases were followed up. Re-evaluation of echocardiography and electrocardiogram was performed prior to discharge, and at first month, sixth month, and every year follow-up. Results: The overall postoperative 30-day mortality was 4.5% in Group A and 8.7% in Group B. The postoperative tricuspid valve regurgitation grade of both groups decreased significantly from preoperative regurgitation grade, p < 0.001, without intergroup significant difference, p = 0.815. Follow-up duration ranged from 6 to 38 months, there was one death at 24 months in Group A, and another at 9 months in Group B, respectively. Nobody from both groups experienced reintervention for residual tricuspid regurgitation. No significant difference could be identified about the incidence of postoperative morbidities and follow-up adverse events. Conclusion: Both strategies of caval venous drainage can provide satisfactory exposure for thoracoscopic reoperative isolated tricuspid valve repair and equivalent favorable postoperative outcome. And the modified unicaval drainage group may even preserve the anesthetic time and decrease the risk of iatrogenic jugular injury, achieving a more simplified procedure with better cosmetic outcome.

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Minimally Invasive Determinations of Oxygen Delivery and Consumption in Cardiac Surgery: An Observational Study

Abstract: Agreement between minimally invasive and invasive DO and VO determinations is, moderate and poor, respectively. These findings may be explained by the poor agreement between minimally invasive and invasive cardiac output measurements.

Cited by 5 publications

References 26 publications

Perioperative changes in oxygen consumption: estimations from minimal-invasive cardiac output and a-cvO₂difference parallel to indirect calorimetry

Perioperative changes in oxygen consumption: estimations from minimal-invasive cardiac output and a-cvO₂difference parallel to indirect calorimetry

Perioperative estimations of oxygen consumption from LiDCO™plus-derived cardiac output and Ca-cvO2 difference: Relationship with measurements by indirect calorimetry in elderly patients undergoing major abdominal surgery

Modified unicaval drainage in reoperative isolated tricuspid valve repair via totally thoracoscopic approach

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Minimally Invasive Determinations of Oxygen Delivery and Consumption in Cardiac Surgery: An Observational Study

Abstract: Agreement between minimally invasive and invasive DO and VO determinations is, moderate and poor, respectively. These findings may be explained by the poor agreement between minimally invasive and invasive cardiac output measurements.

Cited by 5 publications

References 26 publications

Perioperative changes in oxygen consumption: estimations from minimal-invasive cardiac output and a-cvO2difference parallel to indirect calorimetry

Perioperative changes in oxygen consumption: estimations from minimal-invasive cardiac output and a-cvO2difference parallel to indirect calorimetry

Perioperative estimations of oxygen consumption from LiDCO™plus-derived cardiac output and Ca-cvO2 difference: Relationship with measurements by indirect calorimetry in elderly patients undergoing major abdominal surgery

Modified unicaval drainage in reoperative isolated tricuspid valve repair via totally thoracoscopic approach

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Product

Resources

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Perioperative changes in oxygen consumption: estimations from minimal-invasive cardiac output and a-cvO₂difference parallel to indirect calorimetry

Perioperative changes in oxygen consumption: estimations from minimal-invasive cardiac output and a-cvO₂difference parallel to indirect calorimetry