Transoesophageal echo-Doppler vs. thermodilution cardiac output measurement during hepatic vascular exclusion in liver transplantation

Boucaud, Catherine; Bouffard, Y.; Dumortier, Jérôme; Gaillac, N.; Sagnard, Pierre; Graber, Michael; Adham, Mustapha; Boillot, Olivier

doi:10.1017/s0265021508003670

Cited by 18 publications

(11 citation statements)

References 23 publications

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“…Other methods for measuring continuous CO have been evaluated during orthotopic liver transplantation. Transesophageal echo Doppler–determined CO values30 are different from those measured by TDCO, but the method seems to detect the changes in CO more rapidly than TDCO. Measurements of CO by transesophageal echocardiography (TOE)31 seem promising.…”

Section: Discussionmentioning

confidence: 84%

Techniques of cardiac output measurement during liver transplantation: Arterial pulse wave versus thermodilution

et al. 2009

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In this study, we compared continuous cardiac output (CO) obtained from the femoral arterial pressure by simulation of an aortic input impedance model [model-simulated cardiac output (MCO)] to thermodilution cardiac output (TDCO) determined by bolus injection during liver transplantation. Both variables were measured in 39 adult patients (13 females) every 10th minute during liver transplant surgery. Paired measurements were compared during the 4 phases of surgery-dissection, anhepatic phase, early reperfusion (the first 15 minutes after reperfusion), and late reperfusion (15-60 minutes after reperfusion)-without the detection of any significant difference between the 2 estimates of CO. TDCO ranged from 2.3 to 17.2 L/minute, and the bias (the mean difference between MCO and TDCO) prior to calibration was Ϫ0.4 Ϯ 1.6 L/minute (mean Ϯ standard deviation; 1309 paired measurements; 95% limits of agreement: Ϫ3.4 to 2.6 L/minute). After calibration of the first determined MCO by the simultaneously determined TDCO, the bias was 0.1 Ϯ 1.5 L/minute, with 57% (n ϭ 744) of the comparisons being less than 1 L/minute and 35% (n ϭ 453) being less than 0.5 L/minute; this was independent of the level of CO, and the mutual correlation coefficient was 0.812 (P Ͻ 0.001). This study indicates that during liver transplantation surgery, MCO reflects TDCO throughout the operation. Thus, for CO, this less invasive method appears to provide a reliable uninterrupted measurement during orthotopic liver transplantation. The preparation of liver transplant patients for general anesthesia involves thorough monitoring of respiratory and circulatory variables. In particular, during the hepatectomy and reperfusion phases of the operation, the circulation is vulnerable because of potentially rapid changes in the central blood volume and total peripheral resistance. For the determination of cardiac output (CO), techniques that make use of dye or thermodilution, 1 rebreathing of inert gas or CO 2 , 2,3 and Fick's equation 4 have in common that the hemodynamic values obtained are averages over a period of time, so changes in the left ventricular stroke volume (SV) or CO cannot be assessed with a high time resolution. Also, the inhomogeneous washout temperature of the transplant effluent renders a thermodilution-based continuous determination 1,5 and even a bolus determination of CO [thermodilution cardiac output (TDCO)] 1,5-9 unreliable during early reperfusion of the liver.Several alternative continuous methods have been introduced for the determination of CO, including arterial pulse contour analysis, Most of these methods appear, however, to suffer from Abbreviations: CO, cardiac output; HR, heart rate; MAP, mean arterial pressure; MCO, model-simulated cardiac output; SD, standard deviation; SV, stroke volume; S v O 2 , mixed venous oxygen saturation; TDCO, thermodilution cardiac output; TOE, transesophageal echocardiography. The abstract of this article was presented as a poster at the

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Section: Discussionmentioning

confidence: 84%

Techniques of cardiac output measurement during liver transplantation: Arterial pulse wave versus thermodilution

et al. 2009

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“…Indeed, using TEE and transesophageal echo-Doppler techniques, values similar to those obtained by PRAM are reported [7,8]. Unfortunately, however, intracardiac volumes using TEE and SV determined by the echoDoppler-velocimetry method underestimate by 20-30% SV obtained by magnetic resonance imaging, cineventriculography, and TDCO [11][12][13][14][15][16]. With respect to CI/CO determination by means of ICG in the morbidly obese patient during ppn, Aloni et al [9] reported values essentially equivalent to the TDCO studies of Nguyen et al and Artuso et al Review of the literature, however, shows that ICG systematically underestimates TDCO/ TDCI in the morbidly obese and critically ill patient by 15-20% [17,18].…”

mentioning

confidence: 66%

Reply to Letter: Agreed: “PRAM May be Useful to Assess the Cardiovascular Changes in Obese Patients During Laparoscopy”

Bernstein

2008

OBES SURG

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“…The accuracy of ultrasonic imaging is partly operator-dependent and a training period for handling the transesophageal probe and optimizing the Doppler flow signals improves the reliability of the hemodynamic measurements [31]. Other studies reporting greater percentage errors and a wider range in limits of agreements for CO values did not emphasize the need to verify or optimize probe position before each measurement, nor did they mention the rejection rate of unsatisfactory results [32,33].…”

Section: Discussionmentioning

confidence: 99%

Comparison of cardiac output as assessed by transesophageal echo-Doppler and transpulmonary thermodilution in patients undergoing thoracic surgery

Diaper

Ellenberger

Villiger

et al. 2010

Journal of Clinical Anesthesia

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Transoesophageal echo-Doppler vs. thermodilution cardiac output measurement during hepatic vascular exclusion in liver transplantation

Cited by 18 publications

References 23 publications

Techniques of cardiac output measurement during liver transplantation: Arterial pulse wave versus thermodilution

Techniques of cardiac output measurement during liver transplantation: Arterial pulse wave versus thermodilution

Reply to Letter: Agreed: “PRAM May be Useful to Assess the Cardiovascular Changes in Obese Patients During Laparoscopy”

Comparison of cardiac output as assessed by transesophageal echo-Doppler and transpulmonary thermodilution in patients undergoing thoracic surgery

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