title: Ability of esCCO to track changes in cardiac output.
abstract: BACKGROUND
  We investigated whether cardiac output measured with pulse wave transit time (esCCO, Nihon Kohden, Tokyo, Japan) is able to track changes in cardiac output induced by an increase in preload (volume expansion/passive leg-raising) or by changes in vasomotor tone (variation in norepinephrine dosage) in critically ill patients.
  
  
  METHODS
  Eighty patients for whom the decision to give fluid (500 mL of saline over 15 min) (n=20), to perform passive leg-raising (n=20), and to increase (n=20) or to decrease (n=20) norepinephrine were included by the physician. Cardiac output was measured with pulse wave transit time (CO-esCCO) and transthoracic echocardiography (CO-TTE) before and after therapeutic intervention.
  
  
  RESULTS
  Comparison between CO-TTE and CO-esCCO showed a bias of -0.7 l min(-1) and limits of agreement of -4.4 to 2.9 l min(-1), before therapeutic intervention and a bias of -0.5 l min(-1) and limits of agreement of -4.2 to 3.2 l min(-1) after therapeutic intervention. Bias was correlated with systemic vascular resistance (r(2)=0.60, P<0.0001). Percentage error was 61% before and 59% after therapeutic intervention. Considering the overall data (n=80), the concordance rate was 84%, polar plot analysis revealed an angular bias (sd) of -11°(35°) and radial limits of agreement of (sd 50°). With regard to passive leg-raising and volume expansion groups (n=40), the concordance rate was 83%, the angular bias (sd) was -20°(36°) and radial limits of agreement ( 50°). Considering variations in norepinephrine dosage groups (n=40), the concordance rate was 86%, the angular bias (sd) was -1.8°(33°) and radial limits of agreement (40°).
  
  
  CONCLUSIONS
  esCCO was not able to track changes in cardiac output, induced by an increase in preload or by variations in vasomotor tone. Therefore, esCCO cannot guide haemodynamic interventions in critically ill patients.
authors.affiliation: Department of Anaesthesiology and Critical Care III, Bordeaux University Hospital, F-33000 Bordeaux, France INSERM, Adaptation Cardiovasculaire à L'ischémie, U1034, F-33600 Pessac, France Univ. Bordeaux, Adaptation Cardiovasculaire à L'ischémie, U1034, F-33600 Pessac, France matthieu.biais@chu-bordeaux.fr.
authors.forename: M
authors.initials: M
authors.lastname: Biais
authors.affiliation: Department of Anaesthesiology and Critical Care I, Bordeaux University Hospital, F-33000 Bordeaux, France.
authors.forename: R
authors.initials: R
authors.lastname: Berthezène
authors.affiliation: Department of Anaesthesiology and Critical Care I, Bordeaux University Hospital, F-33000 Bordeaux, France.
authors.forename: L
authors.initials: L
authors.lastname: Petit
authors.affiliation: Department of Anaesthesiology and Critical Care I, Bordeaux University Hospital, F-33000 Bordeaux, France.
authors.forename: V
authors.initials: V
authors.lastname: Cottenceau
authors.affiliation: INSERM, Adaptation Cardiovasculaire à L'ischémie, U1034, F-33600 Pessac, France Univ. Bordeaux, Adaptation Cardiovasculaire à L'ischémie, U1034, F-33600 Pessac, France Department of Anaesthesiology and Critical Care I, Bordeaux University Hospital, F-33000 Bordeaux, France.
authors.forename: F
authors.initials: F
authors.lastname: Sztark
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002302:Cardiac Output / Q000502:physiology*; D016638:Critical Illness; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D009638:Norepinephrine / Q000008:administration & dosage; D063177:Pulse Wave Analysis / Q000379:methods*; D015203:Reproducibility of Results; D012965:Sodium Chloride / Q000008:administration & dosage; D014662:Vasoconstrictor Agents / Q000008:administration & dosage; D055815:Young Adult
chemical_list: D014662:Vasoconstrictor Agents; D012965:Sodium Chloride; D009638:Norepinephrine
keywords: cardiac output; echocardiography; hemodynamics; monitoring