Abstract
The authors prospectively compared three techniques of continuous cardiac index measurements. They were, invasive Continuous Cardiac Index using thermodilution flow-directed Swan-Ganz pulmonary artery catheters, semi invasive Flotrac™—arterial pressure derived cardiac index and the non invasive cardiac index measurement—body impedance plethsmography. The cardiac index measurements were made simultaneously in the postoperative period in 20 patients who underwent elective uncomplicated off pump coronary artery bypass graft. The values were collected once in 5 min over a period of 30–40 min. A set of 140 values were obtained from the cohorts in our study. Inter-changeability of the values of cardiac index was analysed using Bland-Altman and mountain plots. The cardiac index values ranged from 1.6 to 3.6 l/min/m2. The values obtained were interchangeable. The bias and precision respectively were 0.02 and ±0.06 for continuous cardiac index and Flotrac™, 0.18 and ±0.08 for Flotrac™ and body impedance plethysmography and 0.16 and ±0.08 for continuous cardiac index and body impedance plethysmography. Flotrac™ appears to be more useful during off pump coronary artery bypass surgery.
Similar content being viewed by others
References
Chakravarthy M, editor. Cardiac output–have we found the ‹gold standard’? Ann Card Anaesth 2008;11:1–2.
Mayer J, Boldt J, Schöllhorn T, Röhm KD, Mengistu AM, Suttner S. Semi-invasive monitoring of cardiac output by a new device using arterial pressure waveform analysis: a comparison with intermittent pulmonary artery thermodilution in patients undergoing cardiac surgery. Br J Anaesth 2007;98:176–82.
Larsson A. Pulmonary artery catheter monitoring does not reduce morbidity and or mortality in major surgery. Ugeskr Laeger 2001;163:5212.
Bossert T, Gummert JF, Bittner HB, Barten M, Walther T, Falk V, et al. Swan-Ganz catheter-induced severe complications in cardiac surgery: right ventricular perforation, knotting, and rupture of a pulmonary artery. J Card Surg 2006;21:292–5.
Ramsay J. Pro: Is the pulmonary artery catheter dead? J Cardiothorac Vasc Anesth 2007;21:144–6.
Peyton PJ, Venkatesan Y, Hood SG, Junor P, May C. Noninvasive, automated and continuous cardiac output monitoring by pulmonary capnodynamics: breath-by-breath comparison with ultrasonic flow probe. Anesthesiology. 2006;105:72–80.
Langewouters GJ, Wesseling KH, Goedhard WJ. The pressure dependent dynamic elasticity of 35 thoracic and 16 abdominal human aortas in vitro described by a five component model. J Biomech.. 1985;18(8):613–20.
Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986;1:307–10.
Krouwer JS, Monti KL. A simple, graphical method to evaluate laboratory assays. Eur J Clin Chem Clin Biochem 1995;33:525–7.
Manecke GR Jr, Auger WR. Cardiac output determination from the arterial pressure wave: clinical testing of a novel algorithm that does not require calibration. J Cardiothorac Vasc Anesth 2007;21:3–7.
Chakravarthy M, Patil TA, Jayaprakash K, Kalligudd P, Prabhakumar D, Jawali V. Comparison of simultaneous estimation of cardiac output by four techniques in patients undergoing off-pump coronary artery bypass surgery—a prospective observational study. Ann Card Anaesth 2007;10:121–6.
Tsutsui M, Mori T, Aramaki Y, Fukuda I, Kazama T. A comparison of two methods for continuous cardiac output measurement: Pulse CO VS CCI. Masui. 2004;53:929–33.
Schulz K, Abel HH, Werning P. Comparison between continuous and intermittent thermodilution measurement of cardiac output during coronary artery bypass operation. Anaesthesiol Intensivmed Notfallmed Schmerzther 1997;32:226–33.
Jonas MM, Tanser SJ. Lithium dilution measurement of cardiac output and arterial pulse waveform analysis: an indicator dilution calibrated beat-by-beat system for continuous estimation of cardiac output. Curr Opin Crit Care. 2002;8:257–61.
Su NY, Huang CJ, Tsai P, Hsu YW, Hung YC, Cheng CR. Cardiac output measurement during cardiac surgery: esophageal Doppler versus pulmonary artery catheter. Acta Anaesthesiol Sin 2002;40:127–33.
Biais M, Nouette-Gaulain K, Cottenceau V, Vallet A, Cochard JF, Revel P, et al. Cardiac output measurement in patients undergoing liver transplantation: pulmonary artery catheter versus uncalibrated arterial pressure waveform analysis. Anesth Analg 2008;106(5):1480–6.
Mayer J, Boldt J, Wolf MW, Lang J, Suttner S. Cardiac output derived from arterial pressure waveform analysis in patients undergoing cardiac surgery: validity of a second generation device. Anesth Analg 2008;106:867–72.
Frazier SK, Skinner GJ. Pulmonary artery catheters: state of the controversy. J Cardiovasc Nurs 2008;23:113–21.
Author information
Authors and Affiliations
Corresponding author
Additional information
Chakravarthy M, Rajeev S, Jawali V. Cardiac index value measurement by invasive, semi-invasive and non invasive techniques: a prospective study in postoperative off pump coronary artery bypass surgery patients.
Rights and permissions
About this article
Cite this article
Chakravarthy, M., Rajeev, S. & Jawali, V. Cardiac index value measurement by invasive, semi-invasive and non invasive techniques: a prospective study in postoperative off pump coronary artery bypass surgery patients. J Clin Monit Comput 23, 175–180 (2009). https://doi.org/10.1007/s10877-009-9179-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10877-009-9179-7