The Effectiveness of Right Heart Catheterization in the Initial Care of Critically Ill Patients

Connors, Alfred F.; Speroff, Theodore; Dawson, Neal V.; Thomas, Charles L.; Harrell, Frank E.; Wagner, Douglas P.; Desbiens, Norman A.; Goldman, Lee; Wu, Albert W.; Califf, Robert M.; Fulkerson, W. J.; Vidaillet, Humerto; Broste, Steven K.; Bellamy, Paul E.; Lynn, Joanne; Knaus, William A.

doi:10.1097/00132586-199708000-00004

Cited by 248 publications

(309 citation statements)

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“…The method of cardiac output measurement in these reports, pulmonary artery catheterisation, is not commonly used for bowel surgery. Pulmonary artery catheter insertion can be time consuming and has been implicated with complications and excess mortality [6]. Furthermore some trials involving pulmonary artery catheter optimisation of oxygen delivery required pre-operative admission to intensive care which is currently not practical for colorectal resection.…”

Section: Discussionmentioning

confidence: 99%

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Randomised controlled trial investigating the influence of intravenous fluid titration using oesophageal Doppler monitoring during bowel surgery*

et al. 2002

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SummaryOesophageal Doppler monitoring allows non-invasive estimation of stroke volume and cardiac output. We studied the impact of Doppler guided fluid optimisation on haemodynamic parameters, peri-operative morbidity and hospital stay in patients undergoing major bowel surgery. Fifty-seven patients were randomly assigned to Doppler (D) or control (C) groups. All patients received intraoperative fluid therapy at the discretion of the non-investigating anaesthetist. In addition, Group D were given fluid challenges (3 ml.kg Surgical patients undergoing major bowel resection are at high risk of peri-operative complications and death. Centres in the UK report mortality rates in this group of between 4 and 9% [1, 2]. Many of these patients are elderly and suffer comorbid medical conditions as well as the local and systemic effects of colorectal disease. Studies of similar patient groups having major surgery have used fluid, inotrope and oxygen therapy to optimise cardiac output and oxygen delivery; these studies demonstrated reductions in mortality and length of hospital stay [3][4][5]. The method of cardiac output measurement in these reports, pulmonary artery catheterisation, is not commonly used for bowel surgery. Pulmonary artery catheter insertion can be time consuming and has been implicated with complications and excess mortality [6]. Furthermore some trials involving pulmonary artery catheter optimisation of oxygen delivery required pre-operative admission to intensive care which is currently not practical for colorectal resection.The minimally invasive oesophageal Doppler monitor permits real time assessment of cardiac output [7]. Haemodynamic parameters estimated by this device can be used to guide fluid therapy during surgery [8]. A study of patients undergoing repair of femoral neck fracture demonstrated a reduction in length of hospital stay when oesophageal Doppler was used to guide fluid therapy [9].The aim of this study was to examine the effect of oesophageal Doppler guided fluid administration during colorectal resection on haemodynamic performance, hospital stay and postoperative complications.

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Section: Discussionmentioning

confidence: 99%

“…Recent studies have questioned the safety of pulmonary artery catheterisation and highlighted the time taken to insert the device [6,13]. Oesophageal Doppler is comparable with other methods for estimating cardiac output and stroke volume [7].…”

Section: Discussionmentioning

confidence: 99%

Randomised controlled trial investigating the influence of intravenous fluid titration using oesophageal Doppler monitoring during bowel surgery*

et al. 2002

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“…In the 1990's a number of non-randomized cohort and case-control studies associating the use of PAC with increased mortality were published with increasing concern raised about its widespread use. 1, 3,4 Sandham and colleagues on behalf of the Canadian Critical Care Clinical Trials Group recently reported on a randomized controlled trial of PAC use in 1994 high-risk geriatric surgical patients. 5 They found no difference in the mortality rate (7.8% PAC vs 7.7% control) or length of hospitalization among patients treated with the aid of a PAC as compared to those managed without this device.…”

Section: Conclusion : Le Do Est Un Appareil De Mesure Périopératoire mentioning

confidence: 99%

Utility of esophageal Doppler as a minimally invasive hemodynamic monitor: a review

Laupland

Bands

2002

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : The current bedside "gold standard" for cardiac output (CO) monitoring is thermodilution using a pulmonary artery catheter (PAC) but there is a number of risks associated with its use. The primary objective of this review was to evaluate the utility of esophageal Doppler (ED) as a minimally invasive monitor of CO. S So ou ur rc ce e: : Medline literature search from 1966 to 2001 with citation review for studies comparing ED to PAC thermodilution for CO in perioperative and critically ill patients. P Pr ri in nc ci ip pa al l f fi in nd di in ng gs s: : Twenty-five publications were identifed comparing ED and PAC measurement of CO in a broad range of patients. There was a good overall correlation between CO determined by ED and thermodilution (n = 18 studies, median R = 0.89, range 0.52 to 0.98) and minimal bias (n = 13, median -0.01, range 1.38 to 2 L·min -1 ). The precision of ED was only fair overall as assessed by limits of agreement. The ED technique was found to be responsive in detecting changes in thermodilution CO and was reliable demonstrating both low intra-and inter-observer variation. ED was reportedly easy to insert after minimal training and was safe, with no significant complications identified. C Co on nc cl lu us si io on n: : ED is a practical, reliable, and valid device for measuring CO in perioperative and critically ill patients. Further studies with larger numbers of patients are needed to determine if the limited precision observed is inherent to the technique, the diagnoses of patients studied, or the small sample sizes.

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“…The thermodilution technique of determining CO using a pulmonary artery catheter is standard. 1 However, the thermodilution technique requires several stable cardiac beats to calculate CO from the temperature time curve. In contrast, the PulseCO™ (Lidco Ltd., London, UK) calculates CO from the arterial pressure waveform of a peripheral artery such as the radial artery using autocorrelation by nonlinear transformation of the input analogue arterial pressure.…”

mentioning

confidence: 99%

Cardiothoracic Anesthesia, Respiration and Airway Cardiac output by PulseCO™ is not interchangeable with thermodilution in patients undergoing OPCAB

Yamashita

Nishiyama

Yokoyama

et al. 2005

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : To investigate the reliability of cardiac output assessed by arterial pressure waveform (PulseCO™) in comparison with bolus thermodilution measurements in patients undergoing off-pump coronary artery bypass grafting (OPCAB).M Me et th ho od ds s: : 23 patients who underwent OPCAB were enrolled in this study. After premedication with oral diazepam 10 mg, anesthesia was induced with midazolam, fentanyl and vecuronium. After induction, radial artery and pulmonary artery catheters were inserted. Cardiac output was measured simultaneously by the PulseCO™ and the bolus thermodilution method using the Vigilance™ monitor: 1) after sternotomy, 2) after opening the mediastinum, and 3) at the end of surgery. The PulseCO™ was calibrated initially with cardiac output determined by the thermodilution method after induction of anesthesia.

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The Effectiveness of Right Heart Catheterization in the Initial Care of Critically Ill Patients

Cited by 248 publications

References 0 publications

Randomised controlled trial investigating the influence of intravenous fluid titration using oesophageal Doppler monitoring during bowel surgery*

Randomised controlled trial investigating the influence of intravenous fluid titration using oesophageal Doppler monitoring during bowel surgery*

Utility of esophageal Doppler as a minimally invasive hemodynamic monitor: a review

Cardiothoracic Anesthesia, Respiration and Airway Cardiac output by PulseCO™ is not interchangeable with thermodilution in patients undergoing OPCAB

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