Pulse contour analysis for cardiac output monitoring in cardiac surgery for congenital heart disease.
Conventional methods of cardiac output monitoring using pulmonary artery catheters may not be feasible in patients with congenital heart disease because of patients' small size or aberrant anatomy. We studied the accuracy of a new device, which uses pulse contour analysis to measure continuous cardiac output, in children and adults undergoing congenital heart surgery. Sixteen patients, median ages 7 yr old, were included in this prospective study. One-hundred-ninety-one data points were obtained in the pre- and postcardiopulmonary bypass periods and in the first 12 h after intensive care unit admission. We evaluated the relationship between cardiac index (CI) derived from transpulmonary thermodilution (TDCI) and CI derived from pulse contour analysis (PCCI). Bias and limits of agreement between TDCI and PCCI over all time periods were 0.1 +/- 1.94, indicating a wide dispersion of the data. Coefficient of correlation (r) between the TDCI and PCCI was 0.7. Although in previous studies, PCCI has been suggested to be accurate in adult cardiac surgery, we found it to be less reliable in our study patients, even after shunt correction. The relationships of the volume and pressure based measures of preload, intrathoracic blood volume index (ITBI), and central venous pressure with CI were also investigated. After repair, correlation (r) between PCCI or TDCI and ITBI (0.56 and 0.71, respectively) was better than that between PCCI or TDCI and CVP (0.16 and 0.11, respectively), indicating greater validity of ITBI as a measure of preload.


CONCLUSIONS
Our results suggest that the pulse contour analysis cardiac output (CO) monitoring in patients undergoing congenital heart surgery may not provide as accurate or reliable measures of CO as previously suggested. The volume-based variable of preload intrathoracic blood volume index (ITBI) has better correlation with cardiac index (CI) than the central venous pressure, suggesting that ITBI may be a better indicator of preload.
Mahajan
Aman
A
Department of Anesthesiology, David Geffen School of Medicine, University of California Los Angeles.
Shabanie
Afshin
A
Turner
Judi
J
Sopher
Michael J
MJ
Marijic
Jure
J
D000293:Adolescent; D000328:Adult; D001810:Blood Volume; D002302:Cardiac Output; D006348:Cardiac Surgical Procedures; D002496:Central Venous Pressure / Q000502:physiology; D002648:Child; D002675:Child, Preschool; D003422:Critical Care; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D007430:Intraoperative Care; D008297:Male; D016343:Monitoring, Intraoperative / Q000379:methods*; D011182:Postoperative Care; D011446:Prospective Studies; D015203:Reproducibility of Results; D013815:Thermodilution