Transpulmonary thermodilution cardiac output measurement using the axillary artery in critically ill patients.
OBJECTIVE
To compare cardiac output (CO) as measured by the arterial thermodilution technique using only a central venous catheter and an arterial catheter inserted into the axillary artery, with conventional CO measurement with thermodilution using a pulmonary artery (PA) catheter (PAC).


METHODS
Prospective clinical study in which each patient served as his/her own control.


METHODS
General ICU of a large tertiary-care teaching hospital.


METHODS
22 patients who required invasive hemodynamic monitoring in the ICU.


METHODS
CO measurements made using the PAC (COpa) were compared to bolus arterial thermodilution measurements (COax). The significance of acute changes in the continuous CO measurements during acute hemodynamic episodes was observed.


RESULTS
The correlation between the two techniques (COpa and COax) was R(2) = 0.82. There was a tendency for 5% overestimation of COpa by the COax. The SEM% (SEM/average CO) for COax and COpa was 2.6% and 3.2%, respectively. The bias between measurements was 0.27 +/- 0.67 L/min, and the limits of agreement (mean difference +/- 2 SD) from minus 1.07 L/min to 1.63 L/min.


CONCLUSIONS
In critically ill patients, in whom the measurement of CO is required, arterial thermodilution, using a central vein and the axillary artery is accurate and reproducible.
Segal
Eran
E
General Intensive Care Unit, Department of Anesthesiology and Intensive Care, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. e_segal@sheba.health.gov.il
Katzenelson
Rita
R
Berkenstadt
Haim
H
Perel
Azriel
A
D000328:Adult; D000368:Aged; D001366:Axillary Artery / Q000502:physiology*; D002302:Cardiac Output / Q000502:physiology*; D002405:Catheterization, Central Venous; D002406:Catheterization, Peripheral; D002407:Catheterization, Swan-Ganz; D016638:Critical Illness; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013815:Thermodilution