J Clin Monit Comput - Non-invasive cardiac output evaluation in postoperative cardiac surgery patients, using a new prolonged expiration-based technique.


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The gold standard methods to measure cardiac output (CO) are invasive and expose the patient to high risks of various complications. The aim of this study is to assess an innovative non-invasive method for CO monitoring in mechanically ventilated patients after cardiac surgery and its agreement with values obtained by thermodilution technique. Continuous monitoring of respiratory gas concentrations and airflow allows the estimation of CO through a newly developed algorithm derived from a modified version of the Fick equation. It consists of two phases: the first involves measurements during steady breathing state, and the second starts when a sudden perturbation into the carbon dioxide elimination process is introduced by a prolonged expiration. This prospective clinical study involved thirty-five adult patients, undergone cardiac surgery. The measurements were performed in curarized and haemodynamically stable patients, during the post-surgery recovery in intensive care unit. The study protocol, which lasted 1?h for each patient, consisted of 20 measurements obtained by prolonged expiration-based method and 10 by thermodilution. The estimation of CO using the proposed method (COK) agreed with the thermodilution (COT) as demonstrated by: a low mean bias between COK and COT considering all patients (i.e., -0.11?L?min(-1)); a best fitting line having slope?=?0.98, r?=?0.81, p?<?0.0001; the lower and upper limits of agreement were -0.77 and +0.54?L?min(-1), respectively. COK shows a mean percentage error of 34?%. In stable mechanically ventilated patients, undergone cardiac surgery, the proposed method is reliable if compared to the thermodilution. Considering the non-invasivity of the technique, further evaluations of its performances are encouraged.

Resumo Limpo

gold standard method measur cardiac output co invas expos patient high risk various complic aim studi assess innov noninvas method co monitor mechan ventil patient cardiac surgeri agreement valu obtain thermodilut techniqu continu monitor respiratori gas concentr airflow allow estim co newli develop algorithm deriv modifi version fick equat consist two phase first involv measur steadi breath state second start sudden perturb carbon dioxid elimin process introduc prolong expir prospect clinic studi involv thirtyf adult patient undergon cardiac surgeri measur perform curar haemodynam stabl patient postsurgeri recoveri intens care unit studi protocol last h patient consist measur obtain prolong expirationbas method thermodilut estim co use propos method cok agre thermodilut cot demonstr low mean bias cok cot consid patient ie lmin best fit line slope r p lower upper limit agreement lmin respect cok show mean percentag error stabl mechan ventil patient undergon cardiac surgeri propos method reliabl compar thermodilut consid noninvas techniqu evalu perform encourag

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