Performance of noninvasive partial CO2 rebreathing cardiac output and continuous thermodilution cardiac output in patients undergoing aortic reconstruction surgery.
BACKGROUND
In the partial CO(2) rebreathing method, monitored changes in CO(2) elimination and end-tidal CO(2) in response to a brief rebreathing period are used to estimate cardiac output. However, dynamic changes in CO(2) production during ischemia and reperfusion may affect the accuracy of these estimates. This study was designed to compare measurements of cardiac output as produced by the partial CO(2) rebreathing (NICO), bolus (BCO), and continuous thermodilution (CCO) methods of monitoring cardiac output.


METHODS
Cardiac output was continuously monitored using both NICO and CCO in 28 patients undergoing aortic reconstruction. BCO measurements were taken at the following intervals when hemodynamic stability was achieved: (1) after anesthetic induction; (2) during aortic cross-clamp; (3) at reperfusion of the iliac artery; and, (4) during peritoneal closure.


RESULTS
The bias and precision (1 SD) derived from all the measurements between NICO and BCO was -0.58 +/- 0.9 l/min, whereas for CCO and BCO it was 0.38 +/- 1.17 l/min. The bias between NICO and BCO was small after anesthetic induction and during cross-clamp, but increased following reperfusion. The bias between CCO and BCO was relatively small until reperfusion but increased significantly at peritoneal closure.


CONCLUSIONS
Results indicate that in aortic reconstruction surgery the performance of NICO monitoring is comparable with that of CCO; however, the direction of bias in these continuous measurement devices is the opposite.
Kotake
Yoshifumi
Y
Department of Anesthesiology, Keio University, Tokyo, Japan. ykotake@sc.itc.keio.ac.jp
Moriyama
Kiyoshi
K
Innami
Yasushi
Y
Shimizu
Hideyuki
H
Ueda
Toshihiko
T
Morisaki
Hiroshi
H
Takeda
Junzo
J
D000368:Aged; D000758:Anesthesia; D001012:Aorta, Abdominal / Q000601:surgery*; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery; D002245:Carbon Dioxide; D002302:Cardiac Output / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D013815:Thermodilution / Q000379:methods*; D014656:Vascular Surgical Procedures
D002245:Carbon Dioxide