Hostname: page-component-586b7cd67f-rdxmf Total loading time: 0 Render date: 2024-11-26T23:10:08.589Z Has data issue: false hasContentIssue false
  • English
  • Français

Comparison of cardiac output measurements by arterial trans-cardiopulmonary and pulmonary arterial thermodilution with direct Fick in septic shock

Published online by Cambridge University Press:  13 April 2005

G. Marx ,
T. Schuerholz ,
R. Sümpelmann ,
T. Simon  and
M. Leuwer
G. Marx
Affiliation:
Friedrich-Schiller University, Department of Anaesthesiology and Intensive Care Medicine, Jena, Germany
T. Schuerholz
Affiliation:
Friedrich-Schiller University, Department of Anaesthesiology and Intensive Care Medicine, Jena, Germany
R. Sümpelmann
Affiliation:
Hannover Medical School, Department of Anaesthesia, Hannover, Germany
T. Simon
Affiliation:
Friedrich-Schiller University, Department of Anaesthesiology and Intensive Care Medicine, Jena, Germany
M. Leuwer
Affiliation:
University of Liverpool, University Department of Anaesthesia, Liverpool, UK
Get access

Abstract

Summary

Background and objective: The aim of this study was to compare cardiac output (CO) measurements by arterial trans-cardiopulmonary thermodilution (ATD) and pulmonary arterial thermodilution (PATD) with CO estimated on the basis of the Fick calculation via a metabolic monitor in septic shock.

Methods: In a prospective animal study 20 anaesthetized, ventilated pigs (20.9 ± 1.9 kg) were investigated. Septic shock was induced with faecal peritonitis. A pulmonary artery catheter was used for conventional measurement of CO. Simultaneously ATD was measured with a thermistor tipped catheter inserted into right carotid artery. Whole body oxygen consumption was measured by indirect calorimetry. Eighty data pairs of simultaneous CO measurements were analysed.

Results: CO measured with Fick and that measured with PATD were significantly correlated (r = 0.94, r2 = 0.87, P < 0.001). Mean CO measured by PATD was 94.3 ± 40.1 mL min−1 kg−1. Bias was 10.1 mL min−1 kg−1 (95% confidence interval (CI): 6.0–14.2 mL min−1 kg−1) with limits of agreement of −26.8 to 47.0 mL min−1 kg−1 . Correlation between Fick derived CO estimation and ATD CO was similar (r = 0.91, r2 = 0.83, P < 0.001). Mean CO measured by trans-cardiopulmonary thermodilution was 104.3 ± 43.2 mL min−1 kg−1 . Bias was 0.75 mL min−1 kg−1 (95% CI: −3.8 to 5.3 mL min−1 kg−1) with limits of agreement of −39.7 to 41.2 mL min−1 kg−1.

Conclusions: Even during haemodynamic instability in septic shock the correlation of arterial trans-cardiopulmonary thermodilution and PATD derived CO with direct Fick was good. As arterial trans-cardiopulmonary thermodilution is less invasive than PATD, the former may offer practical advantages.

Keywords

HEART FUNCTION TESTS, cardiac outputINDICATOR DILUTION TECHNIQUES, thermodilutionSHOCK, septicCALORIMETRY, indirectDISEASE MODELS, animal
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 22 , Issue 2 , February 2005 , pp. 129 - 134
Copyright
2005 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Sakka S, Meier-Hellmann A. Evaluation of cardiac output and cardiac preload. In: Vincent J, ed. Yearbook of Intensive Care and Emergency Medicine.Berlin, Germany: Springer, 2000: 671–679.
Perel A, Berkenstedt H, Segal E. Continuous arterial thermodilution cardiac output and derived variables. In: Vincent J, ed. Yearbook of Intensive Care and Emergency Medicine.Berlin, Germany: Springer, 1999: 459–467.
Böck J, Barker W, Mackersie R, Tranbaugh R, Lewis F. Cardiac output measurement using femoral arterial artery thermodilution in patients. J Crit Care 1989; 4: 105–111.Google Scholar
Reinhart K, Sakka SG, Meier-Hellmann A. Haemodynamic management of a patient with septic shock. Eur J Anaesth 2000; 17: 6–17.Google Scholar
Buhre W, Weyland A, Kazmaier S, et al. Comparison of cardiac output assessed by pulse-contour analysis and thermodilution in patients undergoing minimally invasive direct coronary artery bypass grafting. J Cardiothorac Vasc Anesth 1999; 13: 437–440.Google Scholar
Goedje O, Hoeke K, Lichtwarck-Aschoff M, et al. Continuous cardiac output by femoral arterial thermodilution calibrated pulse contour analysis: comparison with pulmonary arterial thermodilution. Crit Care Med 1999; 27: 2407–2412.Google Scholar
Hoeper MM, Maier R, Tongers J, et al. Determination of cardiac output by the Fick method, thermodilution, and acetylene rebreathing in pulmonary hypertension. Am J Res Crit Care Med 1999; 160: 535–541.Google Scholar
Sherman MS, Kosinski R, Paz HL, Campbell D. Measuring cardiac output in critically ill patients: disagreement between thermodilution-, calculated-, expired gas-, and oxygen consumption-based methods. Cardiology 1997; 88: 19–25.Google Scholar
Dhingra VK, Fenwick JC, Walley KR, Chittock DR, Ronco JJ. Lack of agreement between thermodilution and fick cardiac output in critically ill patients. Chest 2002; 122: 990–997.Google Scholar
Tibby SM, Hatherill M, Marsh MJ, et al. Clinical validation of cardiac output measurements using femoral artery thermodilution with direct Fick in ventilated children and infants. Intens Care Med 1997; 23: 987–991.Google Scholar
Gonzalez J, Delafosse C, Fartoukh M, et al. Comparison of bedside measurement of cardiac output with the thermodilution method and the Fick method in mechanically ventilated patients. Crit Care 2003; 7: 171–178.Google Scholar
Sandham JD, Hull RD, Brant RF, et al. A randomized, controlled trial of the use of pulmonary-artery catheters in high-risk surgical patients. New Engl J Med 2003; 348: 5–14.Google Scholar
Connors JrAF, Speroff T, Dawson NV, et al. The effectiveness of right heart catheterization in the initial care of critically ill patients. SUPPORT Investigators. JAMA 1996; 276: 889–897.Google Scholar
Makita K, Nunn JF, Royston B. Evaluation of metabolic measuring instruments for use in critically ill patients. Crit Care Med 1990; 18: 638–644.Google Scholar
Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986; 1: 307–310.Google Scholar
Segal E, Katzenelson R, Berkenstadt H, Perel A. Transpulmonary thermodilution cardiac output measurement using the axillary artery in critically ill patients. J Clin Anesth 2002; 14: 210–213.Google Scholar
Hanique G, Dugernier T, Laterre PF, et al. Evaluation of oxygen uptake and delivery in critically ill patients: a statistical reappraisal. Intens Care Med 1994; 20: 19–26.Google Scholar
Bizouarn P, Blanloeil Y, Pinaud M. Comparison between oxygen consumption calculated by Fick's principle using a continuous thermodilution technique and measured by indirect calorimetry. Br J Anaesth 1995; 75: 719–723.Google Scholar
Sakka SG, Reinhart K, Wegscheider K, Meier-Hellmann A. Is the placement of a pulmonary artery catheter still justified solely for the measurement of cardiac output? J Cardiothorac Vasc Anesth 2000; 14: 119–124.Google Scholar
Caruso LJ, Layon AJ, Gabrielli A. What is the best way to measure cardiac output? Who cares, anyway? Chest 2002; 122: 771–774.Google Scholar
Lewis FR, Elings VB, Hill SL, Christensen JM. The measurement of extravascular lung water by thermal-green dye indicator dilution. Ann NY Acad Sci 1982; 384: 394–410.Google Scholar
Harris AP, Miller CF, Beattie C, Rosenfeld GI, Rogers MC. The slowing of sinus rhythm during thermodilutioncardiac output determination and the effect of altering injectate temperature. Anesthesiology 1985; 63: 540–541.Google Scholar
von Spiegel T, Wietasch G, Bursch J, Hoeft A. Cardiac output determination with transpulmonary thermodilution. An alternative to pulmonary catheterization? Anaesthesist 1996; 45: 1045–1050.Google Scholar