Cardiac output estimation by visual inspection vs thermodilution during cardiac surgery.
OBJECTIVE
The objectives of this study were: 1) to compare the estimated cardiac output (CO) by visual inspection with objective measurements by thermodilution: 2) to compare the estimated systemic vascular resistance (SVR) with objective measurements by thermodilution; and 3) to assess whether management of the patient, based on subjective values, would have differed from the management of the patient based on the objective values.


METHODS
A non-randomized, prospective, blinded study was conducted at a tertiary care university hospital. Following institutional ethics approval, 35 patients undergoing cardiac surgery, with pulmonary artery catheter (PAC) monitoring, were studied. Prior to the measurement of CO by thermodilution, but after separation from cardiac pulmonary bypass, the CO and SVR were estimated by the anaesthetist and the surgeon. Bland and Altman's method was used for statistical analysis.


RESULTS
Surgeons' estimates of CO were comparable with the objectively measured thermodilution measures: in each case (100%), the difference between the subjective estimate and the objective measurement was less than two standard deviations from the mean difference of the two methods. Anaesthetists' estimates, by visual inspection, were also comparable with the objectively measured thermodilution values; 94.6% of cases. The surgeons' and anaesthetists' estimates of SVR were also comparable with the thermodilution measures in all cases. Management based on subjective values would have differed from those based on objective values in only 8.6% of cases.


CONCLUSIONS
An advantage of cardiac surgery is the ability to observe the heart and assess its performance visually. This study demonstrated that estimates of CO and SVR by clinical observation are comparable with the pulmonary artery catheter's derived values.
Aye
T
T
Department of Anaesthesia, Queen's University, Kingston, Ontario.
Milne
B
B
Ballantyne
M
M
D000368:Aged; D002302:Cardiac Output; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013815:Thermodilution; D014655:Vascular Resistance