title: Evaluation of agreement and trending ability between transpulmonary thermodilution and calibrated pulse contour and pulse power cardiac output monitoring methods against pulmonary artery thermodilution in anesthetized dogs.
abstract: OBJECTIVE
  To assess agreement and trending ability of transpulmonary thermodilution (TPTD), calibrated pulse contour (PiCCO), and pulse power (PulseCO) methods compared to pulmonary artery thermodilution (PATD) for determination of cardiac output (CO) in anesthetized dogs.
  
  
  METHODS
  Experimental, prospective study.
  
  
  METHODS
  University teaching hospital.
  
  
  METHODS
  Six adult Beagle dogs.
  
  
  METHODS
  Dogs were anesthetized with sevoflurane and instrumented with pulmonary and femoral artery thermodilution catheters. CO was measured at baseline and at 5, 15, 30, 45, 60, 120, 180, and 240 minutes after IV administration of ketamine or s-ketamine. Baseline PATD and TPTD calibrated PulseCO and PiCCO, respectively. Agreement and trending ability was analyzed with Bland-Altman, concordance, and polar plot methodology.
  
  
  RESULTS
  Median (range) CO values of 2.27 (0.98-3.4) L/min were measured with PATD, and 2.8 (1.9-4.04) L/min with TPTD, which resulted in a mean bias (± standard deviation) of -0.66 (± 0.36) L/min. Concordance rate was 91% and radial limits of agreement (RLOA) were ±35°. PATD against PiCCO resulted in a mean bias of -0.71 (± 0.62) L/min and PATD against PulseCO in a mean bias of 0.13 (± 0.46) L/min. The continuous techniques resulted in concordance rates of 77% for PATD-PiCCO and 74% for PATD-PulseCO and RLOA of ±57° and ±60°, respectively.
  
  
  CONCLUSIONS
  Intermittent TPTD showed marginal trending ability, while continuous pulse contour and pulse power methods showed poor trending ability over a 4-hour period. The poor performance and possible side effects of the methods tested in this study suggest that they should not be recommended for use in critical patients.
authors.affiliation: Section of Anesthesiology, Equine Department, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland.
authors.forename: Annette P N
authors.initials: AP
authors.lastname: Kutter
authors.affiliation: Section of Anesthesiology, Equine Department, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland.
authors.forename: Regula
authors.initials: R
authors.lastname: Bettschart-Wolfensberger
authors.affiliation: Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy.
authors.forename: Noemi
authors.initials: N
authors.lastname: Romagnoli
authors.affiliation: Section of Anesthesiology, Equine Department, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland.
authors.forename: Rima N
authors.initials: RN
authors.lastname: Bektas
mesh_terms: D000758:Anesthesia / Q000662:veterinary; D000818:Animals; D002302:Cardiac Output / Q000502:physiology*; D004285:Dogs / Q000502:physiology*; D005260:Female; D005263:Femoral Artery / Q000502:physiology*; D008297:Male; D023421:Models, Animal; D008991:Monitoring, Physiologic / Q000662:veterinary*; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000502:physiology*; D015203:Reproducibility of Results; D013815:Thermodilution / Q000662:veterinary*
keywords: cardiac output; dog; pulse contour analysis; pulse power analysis; transpulmonary thermodilution