Therapeutic optimization of atrioventricular delay in cardiosurgical ICU patients by noninvasive cardiac output measurements versus pulse contour analysis.
BACKGROUND
Optimizing atrioventricular (AV) delay improves cardiac output and postoperative outcome. Impedance cardiography (ICG) is a non-invasive method for CO measurement. This study evaluates the ability of two ICG methods to determine the optimal AV delay (OAVD) and to compare ICG with invasive PICCO measurements.


METHODS
In 14 cardiosurgical ICU patients (age 70.4 +/- 12.0 yrs) with temporary pacing wires, OAVD was determined by pulse contour analysis (PICCO) and ICG (conventional ICG [CI] and electrical velocimetry [EV] ICG monitors). Cardiac output (CO) and stroke volume (SV) were measured during DDD pacing with AVD varying from 70 to 270 ms in 20-ms increments.


RESULTS
Measured OAV showed a linear correlation between PICCO and ICG: CI (r = 0.82, P < 0.0002) and EV (r = 0.84, P < 0.0002). The mean OAVD deviation between PICCO and ICG was 15.7 +/- 21.0 ms (CI) and 17.1 +/- 20.5 ms (EV). Hemodynamic parameters (SV increase OAVD against worst case) improved significantly (+ 11.7 +/- 7.2 %, P < 0.0001).


CONCLUSIONS
Inappropriate selection of AVD can compromise the hemodynamic situation of cardiosurgical patients. As it is totally noninvasive, ICG is a reliable and effective tool for tailoring AVD. Both systems (CI and EV) offer valid OAV determination.
Mellert
F
F
Klinik und Poliklinik für Herzchirurgie, Universität Bonn, Sigmund-Freud-Strasse 25, Bonn, Germany. fritz.mellert@uni-bonn.de
Lindner
P
P
Schiller
W
W
Gersing
E
E
Heinze
I
I
Kreuz
J
J
Welz
A
A
Preusse
C J
CJ
D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D054537:Atrioventricular Block / Q000503:physiopathology*; D001794:Blood Pressure; D002302:Cardiac Output; D002304:Cardiac Pacing, Artificial; D006348:Cardiac Surgical Procedures; D002307:Cardiography, Impedance / Q000295:instrumentation / Q000379:methods*; D004867:Equipment Design; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015203:Reproducibility of Results