Noninvasive measurement of cardiac output by an acetylene uptake technique and simultaneous comparison with thermodilution in ICU patients.
A simple, accurate, and noninvasive method of cardiac output measurement can be an extremely useful tool for the clinician and researcher. This study used the acetylene gas uptake technique to measure the absorption of acetylene into the pulmonary circulation during a constant exhalation, which is proportional to the pulmonary capillary blood flow and to the cardiac output, assuming no anatomic shunts. We compared cardiac output measured simultaneously by this and by the standard thermodilution (TD) technique in 21 patients in the ICU with a variety of medical and surgical conditions and a wide range of cardiac outputs. We also compared the two techniques in 19 ambulatory patients with a 2-h interval between the invasive and noninvasive test to assess variability over time. The two tests had an excellent correlation when done simultaneously with a correlation coefficient of 0.89 (p < 0.001). With a 2-h interval between the two tests, the correlation coefficient was 0.66 (p = 0.0018). Nine patients in the simultaneous group had cardiomyopathy. When they were excluded, the correlation coefficient increased to 0.96. Most of these patients had documented tricuspid regurgitation (TR), which may underlie the greater difference between acetylene uptake and TD values, with consistently higher TD values in these patients. This study confirms the correlation between the acetylene uptake and the standard invasive TD techniques in sick patients with various medical and surgical conditions and a wide range of cardiac outputs. Furthermore, we believe this would be a more accurate method for measuring cardiac output in patients with cardiomyopathy and TR because it is based only on pulmonary capillary blood flow.
Sadeh
J S
JS
Division of Cardiology, Mount Sinai Medical Center, New York, NY 10029, USA.
Miller
A
A
Kukin
M L
ML
D000042:Absorption; D000114:Acetylene / Q000008:administration & dosage / Q000097:blood / Q000493:pharmacokinetics; D000280:Administration, Inhalation; D000328:Adult; D000368:Aged; D002196:Capillaries / Q000502:physiology; D002302:Cardiac Output; D009202:Cardiomyopathies / Q000097:blood / Q000503:physiopathology; D001026:Coronary Artery Bypass; D003422:Critical Care; D005260:Female; D016027:Heart Transplantation / Q000502:physiology; D006801:Humans; D016031:Liver Transplantation / Q000502:physiology; D008297:Male; D008875:Middle Aged; D018670:Monitoring, Ambulatory; D011650:Pulmonary Alveoli / Q000378:metabolism; D011652:Pulmonary Circulation; D012119:Respiration; D013815:Thermodilution; D014262:Tricuspid Valve Insufficiency / Q000097:blood / Q000503:physiopathology; D014656:Vascular Surgical Procedures
D000114:Acetylene