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Cardiac output measurements using the bioreactance technique in critically ill patients.
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PMID:  23158055     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
ABSTRACT: Measurement of cardiac output (CO) using minimally invasive devices has gained popularity. In 11 patients we compared CO values obtained using the bioreactance technique - a new continuous, totally non-invasive CO monitor - with those obtained by semi-continuous thermodilution using a pulmonary artery catheter. We obtained CO measurements at study inclusion and after any relevant change in hemodynamic status (spontaneous or during fluid challenge, inotrope or vasopressor infusions). There was a poor correlation between the two techniques (r = 0.145). These data suggest that caution should be applied when using bioreactance devices in critically ill patients.
Authors:
David Fagnoul; Jean-Louis Vincent; De Daniel Backer
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-11-9
Journal Detail:
Title:  Critical care (London, England)     Volume:  16     ISSN:  1466-609X     ISO Abbreviation:  Crit Care     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-11-19     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9801902     Medline TA:  Crit Care     Country:  -    
Other Details:
Languages:  ENG     Pagination:  460     Citation Subset:  -    
Affiliation:
Department of Intensive Care, Erasme University Hospital, Route de Lennik 808, Université Libre de Bruxelles, B-1070 Brussels, Belgium. ddebacke@ulb.ac.be.
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Journal Information
Journal ID (nlm-ta): Crit Care
Journal ID (iso-abbrev): Crit Care
ISSN: 1364-8535
ISSN: 1466-609X
Publisher: BioMed Central
Article Information
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Copyright ©2012 BioMed Central Ltd
Print publication date: Year: 2012
Electronic publication date: Day: 9 Month: 11 Year: 2012
pmc-release publication date: Day: 9 Month: 11 Year: 2013
Volume: 16 Issue: 6
First Page: 460 Last Page: 460
PubMed Id: 23158055
ID: 3672548
Publisher Id: cc11481
DOI: 10.1186/cc11481

Cardiac output measurements using the bioreactance technique in critically ill patients
David Fagnoul1 Email: dfagnoul@ulb.ac.be
Jean-Louis Vincent1 Email: jlvincen@ulb.ac.be
De Daniel Backer1 Email: ddebacke@ulb.ac.be
1Department of Intensive Care, Erasme University Hospital, Route de Lennik 808, Université Libre de Bruxelles, B-1070 Brussels, Belgium

Measurement of cardiac output (CO) requires use of invasive or minimally invasive devices; the use of noninvasive and minimally invasive devices has gained popularity in recent years. The bioreactance technique is a relatively new, continuous, totally non-invasive technique for measuring CO that is easily implemented. This new technique involves analyzing phase shifts of a delivered oscillating current that occur when the current traverses the thoracic cavity [1], and differs from traditional bioimpedance techniques that rely on analysis of changes in signal amplitude. Most validation studies in critically ill patients have shown good correlation and/or agreement of bioreactance values compared with CO values obtained using other devices in patients admitted after cardiac surgery [2-4]. However, validation in critically ill patients is lacking.

As part of the internal evaluation of a bioreactance device before its implementation in the unit (evaluation of new non-invasive monitoring systems before introduction in the unit does not require the approval of the ethics committee in our institution), we compared CO values obtained using the bioreactance technique (NICOM system; Cheetah Medical Inc., Portland, OR, USA) with those measured using semi-continuous cardiac output by thermodilution (CCO) with a pulmonary artery catheter (Vigilance, Edwards LifeSciences, Irvine, CA, USA). In 11 patients the CO values were compared at study inclusion and each time a relevant change in hemodynamics and/or in therapeutics (for example, fluid challenge, inotrope or vasopressor infusions) was observed (Table 1).

We recorded bioreactance CO (average of five values over a 5-minute period) just after obtaining the pulmonary artery catheter CCO (average of five CCO values over a 5-minute period). We collected 141 pairs of measurements (3 to 23 per patient); the duration of monitoring was at least 3 hours but never exceeded 24 hours. The pulmonary artery catheter CCO values ranged from 3.9 to 11 l/minute. There was poor correlation between the two techniques (correlation coefficient r = 0.145) (Figure 1). To limit the time effect, we randomly selected one pair of measurements for each patient - but this did not improve the results (r = 0.13). Bland and Altman analysis with correction for multiple measurements showed wide limits of agreement (Figure 2). The time course of CO was not well tracked either, sometimes with opposite trends between the two devices. We therefore decided to stop the evaluation.

The bioreactance technique is dependent on diffusion of electrical current, so interstitial edema may interfere with measurements; we believe this is the most probable explanation for the poor correlation. Whatever the reason, these data suggest that caution should be applied when using bioreactance devices in critically ill patients.


Abbreviations

CCO: semi-continuous cardiac output by thermodilution; CO: cardiac output.


Competing interests

The authors declare that they have no competing interests.


References
Squara P,Denjean D,Estagnasie P,Brusset A,Dib JC,Dubois C,Noninvasive cardiac output monitoring (NICOM): a clinical validationIntensive Care MedYear: 2007161191119410.1007/s00134-007-0640-017458538
Marque S,Cariou A,Chiche JD,Squara P,Comparison between Flotrac-Vigileo and bioreactance, a totally noninvasive method for cardiac output monitoringCrit CareYear: 200916R7310.1186/cc788419454009
Raval NY,Squara P,Cleman M,Yalamanchili K,Winklmaier M,Burkhoff D,Multicenter evaluation of noninvasive cardiac output measurement by bioreactance techniqueJ Clin Monit ComputYear: 20081611311910.1007/s10877-008-9112-518340540
Benomar B,Ouattara A,Estagnasie P,Brusset A,Squara P,Fluid responsiveness predicted by noninvasive bioreactance-based passive leg raise testIntensive Care MedYear: 2010161875188110.1007/s00134-010-1990-620665001

Figures

[Figure ID: F1]
Figure 1 

Correlation between pulmonary artery catheter semi-continuous cardiac output by thermodilution and bioreactance cardiac output. A total of 141 measurements in 11 patients, r = 0.1455. PAC-CCO, pulmonary artery catheter semi-continuous cardiac output by thermodilution.



[Figure ID: F2]
Figure 2 

Pulmonary artery catheter semi-continuous cardiac output by thermodilution and bioreactance cardiac output: bias and agreement. A total of 141 pairs of measurements in 11 patients. Bias -1.6 L/min and limits of agreement 5.7 L/min. CO, cardiac output; PAC-CCO, pulmonary artery catheter semi-continuous cardiac output by thermodilution.



Tables
[TableWrap ID: T1] Table 1 

Patient characteristics


Characteristic n
Patients 11
 Cardiogenic shock 3
 Septic shock/distributive shock 4
 Acute respiratory distress syndrome 4
Therapies
 Norepinephrine 7 (8, 2 to 20)
 Dobutamine 4 (5, 5 to 8)
 Mechanical ventilation 5
 Hemofiltration 2

Data in parentheses represent maximal dose, range (μg/minute for norepinephrine and μg/kg.min for dobutamine).



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