The effect of haemodynamic and peripheral vascular variability on cardiac output monitoring: thermodilution and non-invasive pulse contour cardiac output during cardiothoracic surgery
| Autor: | Wim J. Stok, Berend E. Westerhof, M. W. Hollmann, Jasper Truijen, B. A. J. M. de Mol, J. J. van Lieshout, Benedikt Preckel, Y.-S. Kim |
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| Přispěvatelé: | Amsterdam Cardiovascular Sciences, Medical Biology, ACS - Atherosclerosis & ischemic syndromes, Cardiothoracic Surgery, Anesthesiology, ACS - Diabetes & metabolism, APH - Quality of Care, ACS - Heart failure & arrhythmias, General Internal Medicine, ACS - Microcirculation, Pulmonary medicine, Nephrology, ACS - Pulmonary hypertension & thrombosis |
| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
Male
Cardiac output medicine.medical_specialty Mean arterial pressure Thermodilution Hemodynamics 030204 cardiovascular system & hematology Fingers 03 medical and health sciences Coronary artery bypass surgery 0302 clinical medicine 030202 anesthesiology Heart Rate Internal medicine Monitoring Intraoperative Heart rate medicine Humans Arterial Pressure Cardiac Output Cardiac Surgical Procedures Coronary Artery Bypass Pulse Aged Aged 80 and over business.industry Extracorporeal circulation Middle Aged Thoracic Surgical Procedures Anesthesiology and Pain Medicine Blood pressure Cardiothoracic surgery Regional Blood Flow Cardiology Female business |
| Zdroj: | Anaesthesia, 73(12), 1489-1499. Wiley-Blackwell Truijen, J, Westerhof, B E, Kim, Y-S, Stok, W J, de Mol, B A, Preckel, B, Hollmann, M W & van Lieshout, J J 2018, ' The effect of haemodynamic and peripheral vascular variability on cardiac output monitoring : thermodilution and non-invasive pulse contour cardiac output during cardiothoracic surgery ', Anaesthesia, vol. 73, no. 12, pp. 1489-1499 . https://doi.org/10.1111/anae.14380 |
| ISSN: | 0003-2409 |
| DOI: | 10.1111/anae.14380 |
| Popis: | While haemodynamic variability interferes with the assumption of constant flow underlying thermodilution cardiac output calculation, variability in (peripheral) arterial vascular physiology may affect pulse contour cardiac output methods. We compared non-invasive finger arterial pressure-derived continuous cardiac output measurements (Nexfin® ) with cardiac output measured using thermodilution during cardiothoracic surgery and determined the impact of cardiovascular variability on either method. We compared cardiac output derived from non-invasive finger arterial pressure with cardiac output measured by thermodilution at four grades (A-D) of cardiovascular variability. We defined Grade A data as heart rate and mean arterial pressure variability < 5% and the absence of arrhythmias (implying stable flow) and Physiocal® interval (as measure of variability in finger arterial physiology) > 30 beats. Grade B included all levels of heart rate/mean arterial pressure variability and arrhythmias (Physiocal < 30 excluded). Grade C included all Physiocal intervals (heart rate/mean arterial pressure variability > 5% and arrhythmias excluded). Grade D included all data. Comparison results were quantified as percentage errors. We analysed measurements in 27 patients undergoing coronary artery bypass surgery. Before extracorporeal circulation, the percentage error was 23% (n = 14 patients) in grade A, 28% (n = 20) in grade B, 32% (n = 22) in grade C and 37% (n = 26) in grade D, with a significant increase in variance (p = 0.035). Bias did not differ between grades. After extracorporeal circulation (n = 27), percentage errors became larger, but were not different between grades. Variability during cardiothoracic surgery affected the comparison between thermodilution and non-invasive finger arterial pressure-derived cardiac output. When the main sources of variability were included, percentage errors were large. Future cardiac output methodology comparison studies should report haemodynamic variability. |
| Databáze: | OpenAIRE |
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