To Swan or Not to Swan: Indications, Alternatives, and Future Directions

Rozental, Olga; Thalappillil, Richard; White, Robert S.; Tam, Christopher W.

doi:10.1053/j.jvca.2020.07.067

Cited by 16 publications

(12 citation statements)

References 130 publications

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Section: Discussionmentioning

confidence: 99%

“…CO TPTD does not provide a continuous measurement and needs calibration after acute haemodynamic changes (Monnet and teboul, 2017;Rozental et al, 2021). However, the reproducibility of CO TPTD is higher (7% precision) than that of CO PTD (15% precision) (Giraud el al., 2017;Rozental et al, 2021). The good reproducibility of transpulmonary thermodilution is related to the longer transit time of the thermal bolus (20 s), which reduces the artefacts produced by respiration, compared to pulmonary thermodilution (3-4 s).…”

Section: Discussionmentioning

confidence: 99%

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Cardiac output monitoring with pulmonary versus trans-cardiopulmonary thermodilution in left ventricular assist devices: Interchangeable methods?

et al. 2022

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Cardiac output (CO) measurement is mandatory in patients with left ventricular assist devices (LVADs). Thermodilution with pulmonary artery catheter (PAC) remains the clinical gold standard to measure CO in these patients, however it is associated with several complications. Therefore, the agreement between PAC and new, minimally invasive monitoring methods in LVAD needs to be further investigated. The aim of this study was to assess the accuracy and reliability of transpulmonary thermodilution with a PiCCO2 monitor compared with pulmonary artery thermodilution with PAC in a LVAD. Continuous-flow LVADs were implanted in six mini-pigs to assist the left ventricle. We studied two methods of measuring CO—intermittent transpulmonary thermodilution (COTPTD) by PiCCO2 and intermittent pulmonary artery thermodilution by CAP, standard technique (COPTD)—obtained in four consecutive moments of the study: before starting the LVAD (basal moment), and with the LVAD started in normovolemia, hypervolemia (fluid overloading) and hypovolemia (shock hemorrhage). A total of 72 paired measurements were analysed. At the basal moment, COTPTD and COPTD were closely correlated (r2 = 0.89), with a mean bias of −0.085 ± 0.245 L/min and percentage error of 16%. After 15 min of partial support LVAD, COTPTD and COPTD were closely correlated (r2 = 0.79), with a mean bias of −0.040 ± 0.417 L/min and percentage error of 26%. After inducing hypervolemia, COTPTD and COPTD were closely correlated (r2 = 0.78), with a mean bias of −0.093 ± 0.339 L/min and percentage error of 13%. After inducing hypovolemia, COTPTD and COPTD were closely correlated (r2 = 0.76), with a mean bias of −0.045 ± 0.281 L/min and percentage error of 28%. This study demonstrates a good agreement between transpulmonary thermodilution by PiCCO monitor and pulmonary thermodilution by PAC in the intermittent measurement of CO in a porcine model with a continuous-flow LVAD.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Cardiac output monitoring with pulmonary versus trans-cardiopulmonary thermodilution in left ventricular assist devices: Interchangeable methods?

et al. 2022

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“…The use of pulmonary artery catheter (PAC) has been the gold standard of cardiac output measurement for the last decades. Although its use in critical ill patients has been questioned heavily in the last years, PAC remains an effective means of monitoring RV performance in the perioperative setting [81]. It is still a frequently used monitoring tool in cardiac surgery [82].…”

Section: Comparison To Other Techniques Of Rv Function Assessmentmentioning

confidence: 99%

Role of Echocardiography for the Perioperative Assessment of the Right Ventricle

Labus

Uhlig

2021

Curr Anesthesiol Rep

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Purpose of Review This review aims to highlight the perioperative echocardiographic evaluation of right ventricular (RV) function with strengths and limitations of commonly used and evolving techniques. It explains the value of transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) and describes the perioperative changes of RV function echocardiographers should be aware of. Recent Findings RV dysfunction is an entity with strong influence on outcome. However, its definition and assessment in the perioperative interval are not well-defined. Moreover, values assessed by TTE and TEE are not interchangeable; while some parameters seem to correlate well, others do not. Myocardial strain analysis and three-dimensional echocardiography may overcome the limitations of conventional echocardiographic measures and provide further insight into perioperative cardiac mechanics. Summary Echocardiography has become an essential part of modern anesthesiology in patients with RV dysfunction. It offers the opportunity to evaluate not only global but also regional RV function and distinguish alterations of RV contraction.

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“…Se le ha atribuido desde una mayor mortalidad vinculado a su uso, hasta dificultades en su colocación e interpretación. No obstante y especialmente en cirugía cardíaca este sigue ocupando un lugar preponderante [19], dado que las medidas de la variables hemodinámicas (GC y resistencias sistémicas y pulmonares) han demostrado ser más fiables que las denominadas "no invasivas" y la medida de la SvO 2 y las derivadas del Co 2 han demostardo ser más confiables que aquellas obtenidas en la vena cava superior [20].…”

Section: Técnicas De Monitoreo De La Microcirculaciónunclassified