[Continuous and bolus thermodilution cardiac output measurement during off-pump coronary artery bypass surgery.].
OBJECTIVE
Off-pump CABG surgery is related to major and abrupt hemodynamic changes that may not be immediately detected by continuous cardiac output measurement (CCO). This study aimed at comparing results of cardiac index measurement with pulmonary artery catheter (PAC) with thermal filament (Baxter Edwards Critical Care, Irvine, CA) versus standard bolus thermodilution method during distal coronary anastomosis.


METHODS
Participated in this study 10 patients undergoing off-pump CABG who were monitored with PAC with thermal filament. Measurements of cardiac index were obtained in four moments: at anesthetic induction with the chest still closed (M1), after sternotomy (M2), after heart stabilization with the octopus device (M3) and at distal anastomosis completion (M4).


RESULTS
There has been significant cardiac index decrease (p < 0.05) during coronary anastomosis, detected when measurements were taken with bolus thermodilution method. Cardiac index has varied 2.8 +/- 0.7 to 2.3 +/- 0.8 L.min.m-2 in the beginning and 2.5 +/- 0.8 L.min.m-2 at the end of anastomosis. This variation was not detected by the continuous method (from 3 +/- 0.6 to 3.2 +/- 0.5 to 3.1 +/- 0.6 L.min.m-2 during anastomosis).


CONCLUSIONS
CCO measurement with PAC was late in detecting acute hemodynamic changes due to changes in heart position during off-pump CABG.
Kim
Sílvia M
SM
FM, USP.
Oliveira
Sílvia D S
SD
Fonseca
Ubirajara S
US
Malbouisson
Luiz Marcelo Sá
LM
Auler Júnior
José Otávio Costa
JO
Carmona
Maria José Carvalho
MJ