Comparison of cardiac outputs of major burn patients undergoing extensive early escharectomy: esophageal Doppler monitor versus thermodilution pulmonary artery catheter.
BACKGROUND
After major burn injury, severe hemodynamic fluctuations occur in a relatively short time, requiring invasive hemodynamic monitoring. The noninvasive esophageal Doppler monitor offers an alternative to the pulmonary artery catheter. This study compares the cardiac output of the esophageal Doppler monitor with that of a pulmonary artery catheter during the large volume shifts seen in extensive early escharectomy.


METHODS
This study recruited 20 critically ill, major burn patients scheduled for elective early escharectomy. A thermodilution pulmonary artery catheter and esophageal Doppler monitor probes were inserted to measure cardiac output simultaneously at regular intervals. The results were analyzed by simple linear regression and Bland and Altman plots.


RESULTS
The analysis included 92 data pairs from 20 patients, most of whom were critically ill with major burns. Escharectomy caused large intraoperative fluid shifts. The cardiac output of the esophageal Doppler monitor correlated moderately well with the cardiac output of the pulmonary artery, although it showed a mean of 15% less than the output of the pulmonary artery catheter. The mean bias was 0.77 L/minute, and the limits of agreement were +/-2.74 L/min.


CONCLUSIONS
For major burn patients undergoing early escharectomy, the esophageal Doppler monitor allows changes in hemodynamics to be followed, but does not accurately measure the absolute values of cardiac output.
Kim
KwangMin
K
Department of Anesthesiology and Pain Medicine, Hangang Sacred Heart Hospital, Hallym University, School of Medicine, Seoul 150-719, Korea.
Kwok
InSuk
I
Chang
HyunMook
H
Han
TaeHyung
T
D000328:Adult; D002056:Burns / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery*; D002302:Cardiac Output / Q000502:physiology*; D002407:Catheterization, Swan-Ganz; D003646:Debridement; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D013815:Thermodilution / Q000379:methods*