Document Detail


Accuracy of cardiac output measurements with pulse contour analysis (PulseCO) and Doppler echocardiography during off-pump coronary artery bypass grafting.
MedLine Citation:
PMID:  17996125     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND OBJECTIVE: During off-pump coronary bypass grafting, surgical manipulation and dislocation of the heart may cause cardiovascular instability. Monitoring of cardiac output facilitates intraoperative haemodynamic management but pulmonary artery catheters are often considered too invasive. Pulse contour analysis and transoesophageal echocardiography could serve as alternatives, but there is controversy about their accuracies. We validated pulse contour analysis using a standard radial arterial catheter (PulseCO) and aortic Doppler flowmetry with transoesophageal echocardiography in patients undergoing off-pump coronary bypass surgery. Pulmonary arterial thermodilution served as the reference technique. METHODS: In 20 patients undergoing off-pump coronary bypass, cardiac output was measured with bolus thermodilution (COTD), pulse contour analysis (COPC), and transoesophageal echocardiography (COecho) at fixed time intervals during the procedure. Data were compared using linear regression and Bland-Altman analysis. At the end of the procedure, dobutamine was infused at a rate of 2.5 microg kg(-1) min(-1) in six patients to study the agreement between methods in quantifying changes in cardiac output. RESULTS: Comparison between COPC and COTD showed a bias +/- limits of agreement of -0.03 +/- 1.30 L min(-1) (mean error 29%). Doppler echocardiography was not always feasible when the heart was displaced from the oesophagus and had lower accuracy: bias +/- limits of agreement vs. COTD was 0.45 +/- 1.93 (mean error 43%). Increases in cardiac output induced by dobutamine were well quantified both by pulse contour analysis (COPC = 0.76 x COTD + 0.58; r(2) = 0.65) and Doppler, although the latter tended to overestimate these changes (COecho = 1.58 x COTD - 0.13; r(2) = 0.53). CONCLUSIONS: Calibrated pulse contour analysis using the PulseCO system is an acceptable technique to measure cardiac output non-invasively in off-pump coronary bypass patients. Doppler echocardiography performs less well and is not always feasible with transoesophageal echocardiography when the heart is displaced.
Authors:
C Missant; S Rex; P F Wouters
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Publication Detail:
Type:  Journal Article; Validation Studies     Date:  2007-11-09
Journal Detail:
Title:  European journal of anaesthesiology     Volume:  25     ISSN:  1365-2346     ISO Abbreviation:  Eur J Anaesthesiol     Publication Date:  2008 Mar 
Date Detail:
Created Date:  2008-01-29     Completed Date:  2008-03-12     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8411711     Medline TA:  Eur J Anaesthesiol     Country:  England    
Other Details:
Languages:  eng     Pagination:  243-8     Citation Subset:  IM    
Affiliation:
Katholieke Universiteit Leuven, University Hospitals, Department of Acute Medical Sciences-Anaesthesiology, U. Z. Gasthuisberg, Leuven, Belgium.
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MeSH Terms
Descriptor/Qualifier:
Aged
Cardiac Output / physiology*
Cardiotonic Agents / administration & dosage
Catheterization / instrumentation
Coronary Artery Bypass, Off-Pump / methods*
Dobutamine / administration & dosage
Echocardiography, Doppler / methods*
Echocardiography, Transesophageal / methods
Female
Humans
Male
Monitoring, Intraoperative / instrumentation*,  methods*
Prospective Studies
Pulse*
Radial Artery / physiology
Reproducibility of Results
Surgical Procedures, Elective
Thermodilution / methods
Chemical
Reg. No./Substance:
0/Cardiotonic Agents; 34368-04-2/Dobutamine

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