A comparison of endotracheal bioimpedance cardiography and transpulmonary thermodilution in cardiac surgery patients

Massimo Massetti, Jean Luc Fellahi, Marc Olivier Fischer, Olivier Rebet, Jean Louis Gérard, Jean Luc Hanouz

Risultato della ricerca: Contributo in rivistaArticolo in rivista

21 Citazioni (Scopus)

Abstract

OBJECTIVES: The authors hypothesized that bioimpedance cardiography measured by the Endotracheal Cardiac Output Monitor (ECOM; ConMed, Utica, NY) is a convenient and reliable method for both cardiac index (CI) assessment and prediction in fluid responsiveness. DESIGN: A prospective observational study. SETTING: A teaching university hospital. PARTICIPANTS: Twenty-five adult patients. INTERVENTIONS: Admission to the intensive care unit after conventional cardiac surgery and investigation before and after a fluid challenge. MEASUREMENTS AND MAIN RESULTS: Simultaneous comparative CI data points were collected from transpulmonary thermodilution (TD) and ECOM. Correlations were determined by linear regression. Bland-Altman analysis was used to compare the bias, precision, and limits of agreement. The percentage error was calculated. Pulse-pressure variations (PPVs) and stroke-volume variations (SVVs) before fluid challenge were collected to assess their discrimination in predicting fluid responsiveness. A weak but statistically significant relationship was found between CI(TD) and CI(ECOM) (r = 0.31, p = 0.03). Bias, precision, and limits of agreement between CI(TD) and CI(ECOM) were 0.08 L/min/m(2) (95% confidence interval, -0.11 to 0.27), 0.68 L/min/m(2), and -1.26 to 1.42 L/min/m(2), respectively. The percentage error was 51%. A nonsignificant positive relationship was found between percent changes in CI(TD) and CI(ECOM) after fluid challenge (r = 0.37, p = 0.06). Areas under the ROC curves for both PPV and SVV to predict fluid responsiveness were 0.86 (95% confidence interval, 0.67-1.06) and 0.89 (95% confidence interval, 0.74-1.04, respectively; p = 0.623). CONCLUSIONS: Continuous measurements of CI under dynamic conditions are consistent and easy to obtain with ECOM although not interchangeable with transpulmonary thermodilution. SVV given by ECOM is a dynamic parameter that predicts fluid responsiveness with good accuracy and discrimination.
Lingua originaleEnglish
pagine (da-a)217-222
Numero di pagine6
RivistaJournal of Cardiothoracic and Vascular Anesthesia
Volume26
DOI
Stato di pubblicazionePubblicato - 2012

Keywords

  • Aged
  • Cardiac Output
  • Cardiac Surgical Procedures
  • Cardiography, Impedance
  • Electric Impedance
  • Female
  • Humans
  • Male
  • Middle Aged
  • Prospective Studies
  • Thermodilution

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