Comparison of two methods for enhanced continuous circulatory monitoring in patients with septic shock.
OBJECTIVE
To compare a modified pulmonary artery catheter (PAC) and pulse-contour analysis by the PiCCO (Pulsion Medical Systems, Munich, Germany) system for continuous assessment of cardiac output in patients with septic shock. In addition, to assess the relationships between an index of global end-diastolic volume (GEDV) derived by the PiCCO system with traditional PAC-derived indicators of filling: central venous pressure; pulmonary artery occlusion pressure; and right ventricular end-diastolic volume (RVEDV).


METHODS
Prospective cohort study.


METHODS
Surgical intensive care unit of a university hospital.


METHODS
14 patients with septic shock.


METHODS
None.


RESULTS
A significant correlation was found between continuous cardiac output by PAC (CCO(PAC)) and by pulse-contour analysis (r (2) = 0.714, p < 0.0001), accompanied by a bias of 0.1 l min(-1) and a precision of 2.7 l min(-1). The correlation between CCO(PAC) and cardiac output measured by transcardiopulmonary thermodilution was also significant (r (2) = 0.781, p < 0.0001). There was a bias for the two methods of 0.2 l min(-1), and a precision of 2.2 lmin(-1). The GEDV showed no correlation with central venous pressure, pulmonary artery occlusion pressure, or RVEDV.


CONCLUSIONS
In patients with septic shock, the averaged bias in continuous measurement of cardiac output by both a modified pulmonary artery catheter and pulse-contour analysis was small, but variability was large. No correlation was found between GEDV and RVEDV. The clinical importance of different cardiac filling parameters needs further investigation.
Spöhr
F
F
Department of Anaesthesiology, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany. Fabian.Spoehr@med.uni-heidelberg.de
Hettrich
P
P
Bauer
H
H
Haas
U
U
Martin
E
E
Böttiger
B W
BW
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002302:Cardiac Output; D002407:Catheterization, Swan-Ganz; D002496:Central Venous Pressure; D006785:Hospitals, University; D006801:Humans; D007362:Intensive Care Units; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D011446:Prospective Studies; D011669:Pulmonary Wedge Pressure; D012772:Shock, Septic / Q000503:physiopathology*; D016278:Ventricular Function, Right