Cardiac output measurement during cardiac surgery: Esophageal Doppler versus pulmonary artery catheter

Nuan Yen Su, Chun Jen Huang, Peishan Tsai, Yung Wei Hsu, Yu Chun Hung, Ching Rong Cheng

研究成果: 雜誌貢獻文章

48 引文 (Scopus)

摘要

Background: Bolus thermodilution cardiac output (BCO) measurement has been considered as the "gold standard" for cardiac output (CO) measurement. However, it requires placement of a pulmonary artery (PA) catheter, and questions have been raised regarding the risk/benefit ratio of this invasive technique. Furthermore, great variations between measurements have been reported. Continuous thermodilution CO (CCO) measurement is reported to be a better alternative, but it still requires the placement of a PA catheter. Esophageal echo-Doppler ultrasonography (ED) provides non-invasive continuous measurement of CO (ED-CO). This study was thus designed to compare the agreement between ED-CO and both thermodilution techniques (BCO and CCO). Methods: Twenty-four patients undergoing primary coronary artery bypass graft surgery were randomized to have a PA catheter placed for measurement of either BCO or CCO. All patients also had an ED probe placed. In Group I patients (n = 12), BCO measurement was carried out every 15 minutes throughout the surgery except during cardiopulmonary bypass, with concurrent ED-CO reading recorded at the same time point. In Group II patients (n = 12), CCO and ED-CO measurements were recorded at the same designated points of time as in Group I. The agreement between methods (BCO vs. ED-CO or CCO vs. ED-CO) was assessed using Bland-Altman method. Results: The range of measured CO of each method was 2.1 to 9.4 l/min for BCO, 2.4 to 9.2 l/min for CCO and 2.3 to 8.9 l/min for ED-CO. ED-CO and CCO had excellent agreement with a linear regression coefficient (r2 value) of 0.846, and a bias (mean difference) and SD of bias of 0.05 ± 0.49 l/min. In contrast, the agreement between BCO and ED-CO was poorer; correlation was low (r2 value 0.406) and both the bias and SD of bias were high (0.11 ± 1.12 l/min). Furthermore, BCO measurements had poor reproducibility, whereas both ED-CO and CCO measurements had good reproducibility. Conclusions: Esophageal echo-Doppler ultrasonography is a satisfactory alternative for cardiac output measurement because it gives a value in good agreement with CCO measurement. With significant between-measurement variations, the accuracy and precision of BCO are uncertain, and it should not be considered as the "gold standard".

原文英語
頁(從 - 到)127-133
頁數7
期刊Acta Anaesthesiologica Sinica
40
發行號3
出版狀態已發佈 - 九月 2002
對外發佈Yes

指紋

Thermodilution
Cardiac Output
Pulmonary Artery
Thoracic Surgery
Catheters
Doppler Ultrasonography
Carbon Monoxide

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

引用此文

Cardiac output measurement during cardiac surgery : Esophageal Doppler versus pulmonary artery catheter. / Su, Nuan Yen; Huang, Chun Jen; Tsai, Peishan; Hsu, Yung Wei; Hung, Yu Chun; Cheng, Ching Rong.

於: Acta Anaesthesiologica Sinica, 卷 40, 編號 3, 09.2002, p. 127-133.

研究成果: 雜誌貢獻文章

Su, Nuan Yen ; Huang, Chun Jen ; Tsai, Peishan ; Hsu, Yung Wei ; Hung, Yu Chun ; Cheng, Ching Rong. / Cardiac output measurement during cardiac surgery : Esophageal Doppler versus pulmonary artery catheter. 於: Acta Anaesthesiologica Sinica. 2002 ; 卷 40, 編號 3. 頁 127-133.
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title = "Cardiac output measurement during cardiac surgery: Esophageal Doppler versus pulmonary artery catheter",
abstract = "Background: Bolus thermodilution cardiac output (BCO) measurement has been considered as the {"}gold standard{"} for cardiac output (CO) measurement. However, it requires placement of a pulmonary artery (PA) catheter, and questions have been raised regarding the risk/benefit ratio of this invasive technique. Furthermore, great variations between measurements have been reported. Continuous thermodilution CO (CCO) measurement is reported to be a better alternative, but it still requires the placement of a PA catheter. Esophageal echo-Doppler ultrasonography (ED) provides non-invasive continuous measurement of CO (ED-CO). This study was thus designed to compare the agreement between ED-CO and both thermodilution techniques (BCO and CCO). Methods: Twenty-four patients undergoing primary coronary artery bypass graft surgery were randomized to have a PA catheter placed for measurement of either BCO or CCO. All patients also had an ED probe placed. In Group I patients (n = 12), BCO measurement was carried out every 15 minutes throughout the surgery except during cardiopulmonary bypass, with concurrent ED-CO reading recorded at the same time point. In Group II patients (n = 12), CCO and ED-CO measurements were recorded at the same designated points of time as in Group I. The agreement between methods (BCO vs. ED-CO or CCO vs. ED-CO) was assessed using Bland-Altman method. Results: The range of measured CO of each method was 2.1 to 9.4 l/min for BCO, 2.4 to 9.2 l/min for CCO and 2.3 to 8.9 l/min for ED-CO. ED-CO and CCO had excellent agreement with a linear regression coefficient (r2 value) of 0.846, and a bias (mean difference) and SD of bias of 0.05 ± 0.49 l/min. In contrast, the agreement between BCO and ED-CO was poorer; correlation was low (r2 value 0.406) and both the bias and SD of bias were high (0.11 ± 1.12 l/min). Furthermore, BCO measurements had poor reproducibility, whereas both ED-CO and CCO measurements had good reproducibility. Conclusions: Esophageal echo-Doppler ultrasonography is a satisfactory alternative for cardiac output measurement because it gives a value in good agreement with CCO measurement. With significant between-measurement variations, the accuracy and precision of BCO are uncertain, and it should not be considered as the {"}gold standard{"}.",
keywords = "Cardiac output, Catheterization, Swan-Ganz, Coronary artery bypass, Echocardiography, Doppler, Thermodilution",
author = "Su, {Nuan Yen} and Huang, {Chun Jen} and Peishan Tsai and Hsu, {Yung Wei} and Hung, {Yu Chun} and Cheng, {Ching Rong}",
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pages = "127--133",
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TY - JOUR

T1 - Cardiac output measurement during cardiac surgery

T2 - Esophageal Doppler versus pulmonary artery catheter

AU - Su, Nuan Yen

AU - Huang, Chun Jen

AU - Tsai, Peishan

AU - Hsu, Yung Wei

AU - Hung, Yu Chun

AU - Cheng, Ching Rong

PY - 2002/9

Y1 - 2002/9

N2 - Background: Bolus thermodilution cardiac output (BCO) measurement has been considered as the "gold standard" for cardiac output (CO) measurement. However, it requires placement of a pulmonary artery (PA) catheter, and questions have been raised regarding the risk/benefit ratio of this invasive technique. Furthermore, great variations between measurements have been reported. Continuous thermodilution CO (CCO) measurement is reported to be a better alternative, but it still requires the placement of a PA catheter. Esophageal echo-Doppler ultrasonography (ED) provides non-invasive continuous measurement of CO (ED-CO). This study was thus designed to compare the agreement between ED-CO and both thermodilution techniques (BCO and CCO). Methods: Twenty-four patients undergoing primary coronary artery bypass graft surgery were randomized to have a PA catheter placed for measurement of either BCO or CCO. All patients also had an ED probe placed. In Group I patients (n = 12), BCO measurement was carried out every 15 minutes throughout the surgery except during cardiopulmonary bypass, with concurrent ED-CO reading recorded at the same time point. In Group II patients (n = 12), CCO and ED-CO measurements were recorded at the same designated points of time as in Group I. The agreement between methods (BCO vs. ED-CO or CCO vs. ED-CO) was assessed using Bland-Altman method. Results: The range of measured CO of each method was 2.1 to 9.4 l/min for BCO, 2.4 to 9.2 l/min for CCO and 2.3 to 8.9 l/min for ED-CO. ED-CO and CCO had excellent agreement with a linear regression coefficient (r2 value) of 0.846, and a bias (mean difference) and SD of bias of 0.05 ± 0.49 l/min. In contrast, the agreement between BCO and ED-CO was poorer; correlation was low (r2 value 0.406) and both the bias and SD of bias were high (0.11 ± 1.12 l/min). Furthermore, BCO measurements had poor reproducibility, whereas both ED-CO and CCO measurements had good reproducibility. Conclusions: Esophageal echo-Doppler ultrasonography is a satisfactory alternative for cardiac output measurement because it gives a value in good agreement with CCO measurement. With significant between-measurement variations, the accuracy and precision of BCO are uncertain, and it should not be considered as the "gold standard".

AB - Background: Bolus thermodilution cardiac output (BCO) measurement has been considered as the "gold standard" for cardiac output (CO) measurement. However, it requires placement of a pulmonary artery (PA) catheter, and questions have been raised regarding the risk/benefit ratio of this invasive technique. Furthermore, great variations between measurements have been reported. Continuous thermodilution CO (CCO) measurement is reported to be a better alternative, but it still requires the placement of a PA catheter. Esophageal echo-Doppler ultrasonography (ED) provides non-invasive continuous measurement of CO (ED-CO). This study was thus designed to compare the agreement between ED-CO and both thermodilution techniques (BCO and CCO). Methods: Twenty-four patients undergoing primary coronary artery bypass graft surgery were randomized to have a PA catheter placed for measurement of either BCO or CCO. All patients also had an ED probe placed. In Group I patients (n = 12), BCO measurement was carried out every 15 minutes throughout the surgery except during cardiopulmonary bypass, with concurrent ED-CO reading recorded at the same time point. In Group II patients (n = 12), CCO and ED-CO measurements were recorded at the same designated points of time as in Group I. The agreement between methods (BCO vs. ED-CO or CCO vs. ED-CO) was assessed using Bland-Altman method. Results: The range of measured CO of each method was 2.1 to 9.4 l/min for BCO, 2.4 to 9.2 l/min for CCO and 2.3 to 8.9 l/min for ED-CO. ED-CO and CCO had excellent agreement with a linear regression coefficient (r2 value) of 0.846, and a bias (mean difference) and SD of bias of 0.05 ± 0.49 l/min. In contrast, the agreement between BCO and ED-CO was poorer; correlation was low (r2 value 0.406) and both the bias and SD of bias were high (0.11 ± 1.12 l/min). Furthermore, BCO measurements had poor reproducibility, whereas both ED-CO and CCO measurements had good reproducibility. Conclusions: Esophageal echo-Doppler ultrasonography is a satisfactory alternative for cardiac output measurement because it gives a value in good agreement with CCO measurement. With significant between-measurement variations, the accuracy and precision of BCO are uncertain, and it should not be considered as the "gold standard".

KW - Cardiac output

KW - Catheterization, Swan-Ganz

KW - Coronary artery bypass

KW - Echocardiography, Doppler

KW - Thermodilution

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