Minimally invasive or noninvasive cardiac output measurement: an update

Abstract

Although cardiac output (CO) by pulmonary artery catheterization (PAC) has been an important guideline in clinical management for more than four decades, some studies have questioned the clinical efficacy of CO in certain patient populations. Further, the use of CO by PAC has been linked to numerous complications including dysrhythmia, infection, rupture of pulmonary artery, injury to adjacent arteries, embolization, pulmonary infarction, cardiac valvular damage, pericardial effusion, and intracardiac catheter knotting. The use of PAC has been steadily declining over the past two decades. Minimally invasive and noninvasive CO monitoring have been studied in the past two decades with some evidence of efficacy. Several different devices based on pulse contour analysis are available currently, including the uncalibrated FloTrac/Vigileo system and the calibrated PiCCO and LiDCO systems. The pressure-recording analytical method (PRAM) system requires only an arterial line and is commercially available as the MostCare system. Transesophageal echocardiography (TEE) can measure CO by non-Doppler- or Doppler-based methods. The partial CO2 rebreathing technique, another method to measure CO, is marketed by Novametrix Medical Systems as the NICO system. Thoracic electrical bioimpedance (TEB) and electric bioreactance (EB) are totally noninvasive CO monitoring. Nexfin HD and the newer ClearSight systems are examples of noninvasive CO monitoring devices currently being marketed by Edwards Lifesciences. The developing focus in CO monitoring devices appears to be shifting to tissue perfusion and microcirculatory flow and aimed more at markers that indicate the effectiveness of circulatory and microcirculatory resuscitations.

Comparing Clinical Efficacy of Artificial Intelligence-powered Ultrasound with Pulse Index Continuous Cardiac Output for Monitoring Critically ill Patients

“…Monitoring these parameters can enable a clinician to optimize volume status, myocardial contractility, and tissue perfusion. It has been recognized as an invasive hemodynamic monitoring method in the eld of critical care medicine [5][6][7]. However, PiCCO is an invasive procedure, and it is not highly appropriate for patients with severe bleeding, coagulation disorders, peripheral vascular disease, severe cardiopulmonary disease, the risk of catheterrelated infection, and being costly.…”

Impact of deep breathing on predictability of stroke volume variation in spontaneous breathing patients

“…The cuff attached to the finger is repeatedly inflated and deflated to keep the diameter of the finger artery constant, and BP values are calculated. The waveform of the finger artery is converted to that of the brachial artery, using information from a clinical database . For SV estimation, a pulse contour analysis is utilized, and is calculated from the afterload estimated using the Windkessel model and the measured systolic pressure time integral .…”

“…14 The cuff attached to the finger is repeatedly inflated and deflated to keep the diameter of the finger artery constant, and BP values arecalculated. The waveform of the finger artery is converted to that of the brachial artery, using information from a clinical database 13.…”

Perioperative Fluid Management in the Enhanced Recovery after Surgery (ERAS) Pathway

“…54,55 Several commercial devices have used arterial pressure waveform to provide continuous cardiac output measurement (FloTrac/Vigileo, Edwards Lifesciences, Irvine, CA; PiCCO, Pulsion Medical Systems, Munich, Germany; LiDCOrapid, LiDCO Group, plc., London, UK). 57,58 These devices use technology that expands on observations by Erlanger and Hooker in 1904 that stroke volume and pulse pressure are directly proportional. 59 Using the arterial pressure waveform from an arterial line, these systems can provide information on cardiac output, stroke volume, stroke volume variation, and systemic vascular resistance.…”