Comparison of continuous cardiac output measurements in patients after cardiac surgery.
OBJECTIVE
To investigate in a direct comparison accuracy and precision of continuous cardiac output measurements assessed by continuous pulmonary artery thermodilution technique (TDCCO), continuous pulse contour analysis (PCCO), and noninvasive partial CO(2)-rebreathing technique (NICO) in patients after coronary artery bypass grafting (CABG) during the postoperative period.


METHODS
Prospective, controlled clinical study.


METHODS
University hospital.


METHODS
Twenty-two patients undergoing elective CABG surgery.


METHODS
Hemodynamic measurements were performed after admission to the ICU and in sequence every 2 hours during the subsequent 6-hour period. Simultaneously, cardiac output (CO) was measured using a TDCCO, PCCO, and NICO. After the continuous cardiac output measurements were read, bolus thermodilution-derived cardiac output was obtained from thermodilution curves detected in the pulmonary artery (TDBCO(pa)). Four intermittent consecutive boli consisting of 10 mL of ice-cold saline were randomly injected over the ventilatory cycle.


RESULTS
The comparison between the continuous cardiac output measurement methods TDCCO versus PCCO showed a bias of -0.12 L/min, between TDCCO versus NICO -0.17 L/min, and between PCCO versus NICO -0.44 L/min. The comparison to the reference technique between TDBCO(pa) versus TDCCO revealed a bias of -0.28 L/min, between TDBCO(pa) versus PCCO -0.40 L/min, and between TDBCO(pa) versus NICO -0.64 L/min.


CONCLUSIONS
The results of this clinical investigation show agreement between TDCCO and PCCO to satisfy clinical requirements in a setting of postoperative patients after cardiac surgery. In contrast, the NICO monitor is of very limited use in these patients.
Mielck
Frank
F
Departments of Anesthesiology, and Medical Statistics, University of Goettingen, Germany. fmielck@gwdg.de
Buhre
Wolfgang
W
Hanekop
Gunnar
G
Tirilomis
Theodor
T
Hilgers
Reinhard
R
Sonntag
Hans
H
D000368:Aged; D015982:Bias; D002245:Carbon Dioxide / Q000378:metabolism; D002302:Cardiac Output / Q000502:physiology*; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000706:statistics & numerical data; D011184:Postoperative Period; D011446:Prospective Studies; D011652:Pulmonary Circulation / Q000502:physiology; D011674:Pulse / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D012119:Respiration; D013815:Thermodilution / Q000706:statistics & numerical data; D013997:Time Factors
D002245:Carbon Dioxide