title: Pulse Wave Transit Time Measurements of Cardiac Output in Septic Shock Patients: A Comparison of the Estimated Continuous Cardiac Output System with Transthoracic Echocardiography.
abstract: BACKGROUND
  We determined reliability of cardiac output (CO) measured by pulse wave transit time cardiac output system (esCCO system; COesCCO) vs transthoracic echocardiography (COTTE) in mechanically ventilated patients in the early phase of septic shock. A secondary objective was to assess ability of esCCO to detect change in CO after fluid infusion.
  
  
  METHODS
  Mechanically ventilated patients admitted to the ICU, aged >18 years, in sinus rhythm, in the early phase of septic shock were prospectively included. We performed fluid infusion of 500 ml of crystalloid solution over 20 minutes and recorded CO by EsCCO and TTE immediately before (T0) and 5 minutes after (T1) fluid administration. Patients were divided into 2 groups (responders and non-responders) according to a threshold of 15% increase in COTTE in response to volume expansion.
  
  
  RESULTS
  In total, 25 patients were included, average 64±15 years, 15 (60%) were men. Average SAPSII and SOFA scores were 55±21.3 and 13±2, respectively. ICU mortality was 36%. Mean cardiac output at T0 was 5.8±1.35 L/min by esCCO and 5.27±1.17 L/min by COTTE. At T1, respective values were 6.63 ± 1.57 L/min for esCCO and 6.10±1.29 L/min for COTTE. Overall, 12 patients were classified as responders, 13 as non-responders by the reference method. A threshold of 11% increase in COesCCO was found to discriminate responders from non-responders with a sensitivity of 83% (95% CI, 0.52-0.98) and a specificity of 77% (95% CI, 0.46-0.95).
  
  
  CONCLUSIONS
  We show strong correlation esCCO and echocardiography for measuring CO, and change in CO after fluid infusion in ICU patients.
authors.affiliation: Service de Réanimation, Maladies Infectieuses, Centre Hospitalier de Belfort-Montbéliard, Belfort, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Feissel
authors.affiliation: Service d'Epidémiologie et d'Hygiène Hospitalière, Centre Hospitalier Universitaire de Dijon, Bocage Central, Dijon, France.
authors.forename: Ludwig Serge
authors.initials: LS
authors.lastname: Aho
authors.affiliation: Service de Réanimation, Maladies Infectieuses, Centre Hospitalier de Belfort-Montbéliard, Belfort, France.
authors.forename: Stefan
authors.initials: S
authors.lastname: Georgiev
authors.affiliation: Service de Réanimation, Maladies Infectieuses, Centre Hospitalier de Belfort-Montbéliard, Belfort, France.
authors.forename: Romain
authors.initials: R
authors.lastname: Tapponnier
authors.affiliation: Service de Réanimation, Maladies Infectieuses, Centre Hospitalier de Belfort-Montbéliard, Belfort, France.
authors.forename: Julio
authors.initials: J
authors.lastname: Badie
authors.affiliation: Service de Réanimation Médicale, Centre Hospitalier Universitaire de Dijon, Bocage Central, Dijon, France; INSERM Centre de Recherche UMR866, Université de Bourgogne, Dijon, France.
authors.forename: Rémi
authors.initials: R
authors.lastname: Bruyère
authors.affiliation: Service de Réanimation Médicale, Centre Hospitalier Universitaire de Dijon, Bocage Central, Dijon, France; INSERM Centre de Recherche UMR1347, Université de Bourgogne, Dijon, France.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Quenot
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002302:Cardiac Output; D004452:Echocardiography; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D015588:Observer Variation; D011446:Prospective Studies; D063177:Pulse Wave Analysis; D015203:Reproducibility of Results; D012121:Respiration, Artificial; D012772:Shock, Septic / Q000503:physiopathology* / Q000628:therapy; D016896:Treatment Outcome