Non-invasive Cardiac Output by Transthoracic Electrical Bioimpedence in Post-cardiac Surgery Patients: Comparison with Thermodilution Method

Gujjar, Arunodaya R.; Kanchi, Muralidhar; Banakal, Sanjay; Gupta, Rishabh; Sathyaprabha, Talakad N.; Jairaj, P. S.

doi:10.1007/s10877-008-9119-y

Cited by 54 publications

(29 citation statements)

References 13 publications

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“…The percentage error of TEB (T-1) when the chest was closed is 30% and at T-2 when chest was open is 32% which demonstrate that sternotomy had little or no effect on the cardiac output reading which remain consistently same and comparable with that of TDCO [16]. Our results are similar from those reported by Sageman et al [17], Gujjar et al [18], Suttner et al [19], and Chakravarthy et al [20], who found TEB technology accurate and interchangeable with TD in post cardiac surgical patients.…”

Section: Discussionsupporting

confidence: 89%

Comparison of Cardiac Output Measurement by Noninvasive Method with Electrical Cardiometry and Invasive Method with Thermodilution Technique in Patients Undergoing Coronary Artery Bypass Grafting

Rajput¹,

Das²,

Chauhan³

et al. 2014

WJCS

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Objective: This study was conducted to compare the cardiac output by using Electrical Cardiometry (EC), a noninvasive method of continuous cardiac output monitoring during cardiac surgery with pulmonary artery catheter (PAC) derived cardiac output. Design: Prospective observational clinical study. Setting: Cardiac surgery operating room of a tertiary care cardiac center. Participants: Twenty five patients undergoing coronary artery bypass surgery with cardiopulmonary bypass. Measurements and Main Results: A total of 150 double data of cardiac output were compared with Thermodilution Cardiac Output (TDCO) and Thoracic Electrical Bioimpedance (TEBCO). The TDCO value ranges from 1.8 -6.9 litre·min −1 with a mean of 4.39 ± 1.16 litre·min −1 and TEBCO ranges from 1.8 -7.1 litre·min −1 with a mean of 4.21 ± 1.16 litre·min −1 . The averaged Bland-Altman analysis for TDCO and TEBCO revealed that a mean bias was 0.18 and limit of agreement was −1.25 -0.89 litre·min −1 and the percentage error (PE) ranged from 22% -32%. The precision for the TDCO was measured to be ±16.2% and the precision for TEBCO was ±19.6%. Receiver Operating Characteristic (ROC) curve analysis between TDCO and TEBCO with a cutoff of 15% shows a sensitivity of 84% and specificity of 63 and area under ROC curve of 0.80. Mountain plot between TDCO and TEBCO shows that a median percentile is 0.25 and value of 97.5 percentile is 1.525. R. S. Rajput et al. 124Conclusions: The present study indicates that the electric cardiometry device yields numerically comparable results to cardiac outputs derived from the PAC during the cardiac surgery. Therefore, electrical cardiometry can be used to evaluate haemodynamic variables with clinically acceptable accuracy, when invasive methods are to be avoided or not available.

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Section: Discussionsupporting

confidence: 89%

Comparison of Cardiac Output Measurement by Noninvasive Method with Electrical Cardiometry and Invasive Method with Thermodilution Technique in Patients Undergoing Coronary Artery Bypass Grafting

Rajput¹,

Das²,

Chauhan³

et al. 2014

WJCS

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“…[21,22] TEB monitoring has shown inaccurate results in COPD patients, as changes in pulmonary vascular flow and intrathoracic pressure along with hyperinflation, may change the passage of current emitted by TEB device through chest and thus modify the aortic component of dZ/dt. [23] Our results are somewhat different from those reported by Sageman et al, [9] Gujjar et al, [24] Suttner et al, [25] and Chakravarthy et al, [26] who found TEB technology to be accurate and interchangeable with TD in post-cardiac surgical patients. However, assessment of CO during spontaneous breathing was not done in their studies.…”

Section: Discussioncontrasting

confidence: 89%

Comparison of transthoracic electrical bioimpedance cardiac output measurement with thermodilution method in post coronary artery bypass graft patients

et al. 2011

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Transthoracic electrical bioimpedance (TEB) has been proposed as a non-invasive, continuous, and cost-effective method of cardiac output (CO) measurement. In this prospective, non-randomized, clinical study, we measured CO with NICOMON (Larsen and Toubro Ltd., Mysore, India) and compared it with thermodilution (TD) method in patients after off-pump coronary artery bypass (OPCAB) graft surgery. We also evaluated the effect of ventilation (mechanical and spontaneous) on the measurement of CO by the two methods. Forty-six post-OPCAB patients were studied at five predefined time points during controlled ventilation and at five time points when breathing spontaneously. A total of 230 data pairs of CO were obtained. During controlled ventilation, TD CO values ranged from 2.29 to 6.74 L/min (mean 4.45 ± 0.85 L/min), while TEB CO values ranged from 1.70 to 6.90 L/min (mean 4.43 ± 0.94 L/min). The average correlation (r) was 0.548 (P = 0.0002), accompanied by a bias of 0.015 L/min and precision of 0.859 L/min. In spontaneously breathing patients, TD CO values ranged from 2.66 to 6.92 L/min (mean 4.66 ± 0.76 L/min), while TEB CO values ranged from 3.08 to 6.90 L/min (mean 4.72 ± 0.82 L/min). Their average correlation was relatively poor (r = 0.469, P= 0.002), accompanied by a bias of -0.059 L/min and precision of 0.818 L/min. The overall percent errors between TD CO and TEB CO were 19.3% (during controlled ventilation) and 17.4% (during spontaneous breathing), respectively. To conclude, a fair correlation was found between TD CO and TEB CO measurements among post-OPCAB patients during controlled ventilation. However, the correlation was weak in spontaneously breathing patients.

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“…The accuracy and reproducibility of the results have repeatedly been confirmed in studies demonstrating that CO measured by TEB correlate closely, and with clinically acceptable agreement and precision, compared with CO measurements obtained by pulmonary artery thermodilution among both stable and unstable post-cardiac surgery patients [12, 13]. Advantages of TEB are that it is non-invasive in nature, it is not as time consuming as echocardiography, and does not require the training or skill required for either PAC or echocardiography [14].…”

Section: Introductionmentioning

confidence: 82%

Use of Bioimpedance to Assess Changes in Hemodynamics During Acute Administration of CPAP

et al. 2011

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BackgroundAttempts to investigate the mechanisms by which continuous positive airway pressure (CPAP) therapy improves heart function in patients with obstructive sleep apnea (OSA) have been limited by the lack of non-invasive methods to assess cardiac performance. We used transthoracic electrical bioimpedance (TEB) to assess acute hemodynamic changes including heart rate (HR), stroke volume (SV), cardiac output (CO) and cardiac index (CI) during PAP titration in (1) post-operative cardiac surgery patients, (2) patients with severe OSA, and (3) normal healthy volunteers.MethodsPost-operative cardiac surgery patients were studied via TEB and pulmonary artery catheter (PAC) during acute titration of positive end-expiratory pressure (PEEP) while mechanically ventilated. Patients with severe OSA were studied non-invasively by TEB during acute CPAP titration in supine stage 2 sleep, and normal subjects while awake and recumbent.ResultsIn post-operative cardiac surgery patients (n = 3), increasing PEEP to 18 cmH2O significantly reduced SV and CI relative to baseline. There was no difference between TEB and PAC in terms of ability to assess variations in hemodynamic parameters. In patients with severe OSA (n = 3), CPAP titration to optimal pressure to alleviate obstructive apneas reduced HR, SV, CO and CI significantly compared to without CPAP. In three healthy subjects, maximal tolerated CPAP reduced SV and CO significantly compared to baseline.ConclusionsAcute administration of CPAP causes a decrease in CO and CI, apparently a consequence of a reduction in SV. TEB appears to be an accurate and reproducible non-invasive method of detecting changes in hemodynamics.

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Non-invasive Cardiac Output by Transthoracic Electrical Bioimpedence in Post-cardiac Surgery Patients: Comparison with Thermodilution Method

Cited by 54 publications

References 13 publications

Comparison of Cardiac Output Measurement by Noninvasive Method with Electrical Cardiometry and Invasive Method with Thermodilution Technique in Patients Undergoing Coronary Artery Bypass Grafting

Comparison of Cardiac Output Measurement by Noninvasive Method with Electrical Cardiometry and Invasive Method with Thermodilution Technique in Patients Undergoing Coronary Artery Bypass Grafting

Comparison of transthoracic electrical bioimpedance cardiac output measurement with thermodilution method in post coronary artery bypass graft patients

Use of Bioimpedance to Assess Changes in Hemodynamics During Acute Administration of CPAP

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