Comparison of cardiac output measured by oesophageal Doppler ultrasonography or pulse pressure contour wave analysis.
BACKGROUND
Maintaining adequate organ perfusion during high-risk surgery requires continuous monitoring of cardiac output to optimise haemodynamics. Oesophageal Doppler Cardiac Output monitoring (DCO) is commonly used in this context, but has some limitations. Recently, the cardiac output estimated by pulse pressure analysis- (PPCO) was developed. This study evaluated the agreement of cardiac output variations estimated with 9 non-commercial algorithms of PPCO compared with those obtained with DCO.


METHODS
High-risk patients undergoing neurosurgery were monitored with invasive blood pressure and DCO. For each patient, 9 PPCO algorithms and DCO were recorded before and at the peak effect for every haemodynamic challenge.


RESULTS
Sixty-two subjects were enrolled; 284 events were recorded, including 134 volume expansions and 150 vasopressor boluses. Among the 9 algorithms tested, the Liljestrand-Zander model led to the smallest bias (0.03 litre min(-1) [-1.31, +1.38] (0.21 litre min(-1) [-1.13; 1.54] after volume expansion and -0.13 litre min(-1) [-1.41, 1.15] after vasopressor use). The corresponding percentage of the concordance was 91% (86% after volume expansion and 94% after vasopressor use). The other algorithms, especially those using the Winkessel concept and the area under the pressure wave, were profoundly affected by the vasopressor.


CONCLUSIONS
Among the 9 PPCO algorithms examined, the Liljestrand-Zander model demonstrated the least bias and best limits of agreement, especially after vasopressor use. Using this particular algorithm in association with DCO calibration could represent a valuable option for continuous cardiac output monitoring of high risk patients.


BACKGROUND
Comité d'éthique de la Société de Réanimation de Langue Française No. 11-356.
Department of Anesthesiology and Critical Care, Hôpitaux Universitaires St-Louis-Lariboisière-Fernand Widal, Paris, France University Paris Diderot, Paris, France INSERM UMR-942, Paris, France.
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Caillard
Department of Anesthesiology and Critical Care, Hôpitaux Universitaires St-Louis-Lariboisière-Fernand Widal, Paris, France University Paris Diderot, Paris, France INSERM UMR-942, Paris, France.
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Gayat
Department of Anesthesiology and Critical Care, Hôpitaux Universitaires St-Louis-Lariboisière-Fernand Widal, Paris, France University Paris Diderot, Paris, France INSERM UMR-942, Paris, France.
A
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Tantot
Department of Anesthesiology and Critical Care, Hôpitaux Universitaires St-Louis-Lariboisière-Fernand Widal, Paris, France University Paris Diderot, Paris, France.
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Dubreuil
Department of Anesthesiology and Critical Care, Hôpitaux Universitaires St-Louis-Lariboisière-Fernand Widal, Paris, France University Paris Diderot, Paris, France.
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M'Bakulu
Department of Anesthesiology and Critical Care, Hôpitaux Universitaires St-Louis-Lariboisière-Fernand Widal, Paris, France University Paris Diderot, Paris, France.
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Madadaki
Department of Anesthesiology and Critical Care, Hôpitaux Universitaires St-Louis-Lariboisière-Fernand Widal, Paris, France University Paris Diderot, Paris, France.
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Bart
University Paris Diderot, Paris, France Department of Neurosurgery, Hôpitaux Universitaires St-Louis-Lariboisière, Paris, France.
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Bresson
University Paris Diderot, Paris, France Department of Neurosurgery, Hôpitaux Universitaires St-Louis-Lariboisière, Paris, France.
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Froelich
Department of Anesthesiology and Critical Care, Hôpitaux Universitaires St-Louis-Lariboisière-Fernand Widal, Paris, France University Paris Diderot, Paris, France INSERM UMR-942, Paris, France.
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Mebazaa
Department of Anesthesiology and Critical Care, Hôpitaux Universitaires St-Louis-Lariboisière-Fernand Widal, Paris, France University Paris Diderot, Paris, France vallee.fabrice@gmail.com.
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Vallée
D000328:Adult; D000368:Aged; D000465:Algorithms; D000768:Anesthesia, General; D062186:Arterial Pressure; D002302:Cardiac Output / Q000502:physiology*; D004947:Esophagus / Q000000981:diagnostic imaging*; D005260:Female; D005440:Fluid Therapy; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D008991:Monitoring, Physiologic; D011446:Prospective Studies; D063177:Pulse Wave Analysis; D018608:Ultrasonography, Doppler / Q000379:methods*; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
D014662:Vasoconstrictor Agents
Doppler; cardiac output; pulse wave analyses