title: Cardiac index assessment by the pressure recording analytic method in critically ill unstable patients after cardiac surgery.
abstract: OBJECTIVE
  The authors measured cardiac index in unstable patients after cardiac surgery with the Pressure Recording Analytic Method (PRAM) and compared it with the reference method of thermodilution (ThD) with the pulmonary artery catheter; using the hypothesis that there were no significant differences between the 2 methods.
  
  
  METHODS
  A prospective study.
  
  
  METHODS
  Cardiac surgery intensive care unit in a teaching hospital.
  
  
  METHODS
  Ninety-four measurements from 59 patients with ongoing high doses of inotropic drugs and/or an intra-aortic balloon pump for low-cardiac-output syndrome after cardiac surgery were studied.
  
  
  METHODS
  The pulmonary artery catheter and the radial or femoral arterial catheter for measuring blood pressure were already in place for standard hemodynamic monitoring.
  
  
  RESULTS
  The mean of the total CI measurements was 2.94 ± 0.67 L/min/m(2) with PRAM and 2.95 ± 0.63 L/min/m(2) with ThD, with no significant difference according to the linear mixed models analysis. The PRAM and ThD techniques were similar in unstable patients without atrial fibrillation (mean bias 0.047 ± 0.395 L/min/m(2) and a percentage error of 29%), while no agreement between PRAM and ThD was found in unstable patients with atrial fibrillation (mean bias 0.195 ± 0.885 L/min/m(2) and a percentage error of 69%).
  
  
  CONCLUSIONS
  Cardiac index measurements after cardiac surgery performed with PRAM and with ThD showed a good agreement in hemodynamically unstable patients given high doses of inotropes and/or an IABP in patients in sinus rhythm, but not in those with atrial fibrillation.
authors.affiliation: Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Barile
authors.forename: Giovanni
authors.initials: G
authors.lastname: Landoni
authors.forename: Marina
authors.initials: M
authors.lastname: Pieri
authors.forename: Laura
authors.initials: L
authors.lastname: Ruggeri
authors.forename: Giulia
authors.initials: G
authors.lastname: Maj
authors.forename: Caetano
authors.initials: C
authors.lastname: Nigro Neto
authors.forename: Laura
authors.initials: L
authors.lastname: Pasin
authors.forename: Luca
authors.initials: L
authors.lastname: Cabrini
authors.forename: Alberto
authors.initials: A
authors.lastname: Zangrillo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000503:physiopathology; D001794:Blood Pressure / Q000502:physiology; D002302:Cardiac Output / Q000502:physiology*; D002303:Cardiac Output, Low / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D006348:Cardiac Surgical Procedures; D002316:Cardiotonic Agents / Q000627:therapeutic use; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods*; D011182:Postoperative Care / Q000379:methods*; D011446:Prospective Studies; D015203:Reproducibility of Results; D013815:Thermodilution
chemical_list: D002316:Cardiotonic Agents
keywords: PRAM; anesthesia; atrial fibrillation; cardiac index; cardiac surgery; high-risk patients; intensive care; pressure recording analytic method; pulmonary artery catheter; thermodilution; unstable patients