J Clin Monit Comput - Continuous minimally invasive peri-operative monitoring of cardiac output by pulmonary capnotracking: comparison with thermodilution and transesophageal echocardiography.

Tópicos

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Resumo

A number of technologies are available for minimally-invasive cardiac output measurement in patients during surgery but remain little used. A system has been developed based on CO(2) elimination (VCO(2)) by the lungs for use in ventilated patients, which can be fully integrated into a modern anesthesia/monitoring platform, and provides semi-automated, continuous breath-by-breath cardiac output monitoring. A prototype measurement system was constructed to measure VCO(2) and end-tidal CO(2) concentration with each breath. A baseline measurement of non-shunt cardiac output was made during a brief change in ventilator rate, according to the differential CO(2) Fick approach. Continuous breath-by-breath monitoring of cardiac output was then performed from measurement of VCO(2), using a derivation of the Fick equation applied to pulmonary CO(2) elimination. Automated recalibration was done periodically and data was processed and cardiac output displayed in real time. Measurements were compared with simultaneous measurements by bolus thermodilution in 77 patients undergoing cardiac surgery or liver transplantation. Overall mean bias [sd] for agreement in cardiac output measurement was -0.1 [1.2] L/min, percentage error +44.2%, r?=?0.92. Concordance in measurement of changes of at least 15% in cardiac output was 80%. The method followed sudden changes in cardiac output due to arrythmias and run onto cardiopulmonary bypass in real time. The accuracy and precision were comparable to other clinical techniques. The method is relatively seamless and largely automated and has potential for continuous, cardiac output monitoring in ventilated patients during anesthesia and critical care.

Resumo Limpo

number technolog avail minimallyinvas cardiac output measur patient surgeri remain littl use system develop base co elimin vco lung use ventil patient can fulli integr modern anesthesiamonitor platform provid semiautom continu breathbybreath cardiac output monitor prototyp measur system construct measur vco endtid co concentr breath baselin measur nonshunt cardiac output made brief chang ventil rate accord differenti co fick approach continu breathbybreath monitor cardiac output perform measur vco use deriv fick equat appli pulmonari co elimin autom recalibr done period data process cardiac output display real time measur compar simultan measur bolus thermodilut patient undergo cardiac surgeri liver transplant overal mean bias sd agreement cardiac output measur lmin percentag error r concord measur chang least cardiac output method follow sudden chang cardiac output due arrythmia run onto cardiopulmonari bypass real time accuraci precis compar clinic techniqu method relat seamless larg autom potenti continu cardiac output monitor ventil patient anesthesia critic care

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