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Reliability of Continuous Pulse Contour Cardiac Output Measurement during Hemodynamic Instability

Johansson, Anders LU and Chew, Michelle LU (2007) In Journal of Clinical Monitoring and Computing 21(4). p.237-242
Abstract
Objective Arterial pulse contour analysis is gaining widespread acceptance as a monitor of continuous cardiac output (CO). While this type of CO measurement is thought to provide acceptable continuous measurements, only a few studies have tested its accuracy and repeatability under unstable hemodynamic conditions. We compared continuous CO measurement using the pulse contour method (PCCO) before and after calibration with intermittent transpulmonary thermodilution cardiac output (TpCO).

Method We compared the two methods of CO measurements in 15 Landrace pigs weighing 20–25 kg in an experimental model of sepsis. Nine pigs were given an infusion of E. coli lipopolysacchride (LPS), and six pigs acted as controls. PCCO values before... (More)
Objective Arterial pulse contour analysis is gaining widespread acceptance as a monitor of continuous cardiac output (CO). While this type of CO measurement is thought to provide acceptable continuous measurements, only a few studies have tested its accuracy and repeatability under unstable hemodynamic conditions. We compared continuous CO measurement using the pulse contour method (PCCO) before and after calibration with intermittent transpulmonary thermodilution cardiac output (TpCO).

Method We compared the two methods of CO measurements in 15 Landrace pigs weighing 20–25 kg in an experimental model of sepsis. Nine pigs were given an infusion of E. coli lipopolysacchride (LPS), and six pigs acted as controls. PCCO values before and after calibration (PCCO1 and PCCO2 respectively) were registered, and their errors relative to TpCO measurements were compared.

Results The mean coefficient of variation for repeated PCCO measurements was 6.85% for the control group, and 13.99% for the endotoxin group. The range of TpCO was 1.01–3.15 L/min. In the control group the bias ±2SD was 0.11 ± 0.53 L/min (TpCO vs PCCO1) and −0.02 ± 0.38 L/min (TpCO vs PCCO2). In the endotoxin group, the agreement was poor between TpCO and PCCO1, 0.08 ± 1.02 L/min. This improved after calibration (TpCO vs PCCO2) to 0.01 ± 0.31 L/min.

Conclusions In hemodynamically stable pigs, both pre- and post-calibration PCCO measurements agreed well with the intermittent transpulmonary thermodilution technique. However, during hemodynamic instability, and pre-calibration PCCO values had wide limits of agreement compared with TpCO. This was reflected by larger coefficients of variation for PCCO in hemodynamic instability. The error of PCCO measurement improved markedly after calibration, with bias and limits of agreement within clinically acceptable limits. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
heart, cardiac output, measurement techniques, thermodilution, anesthesia, sepsis, pulse contour analysis
in
Journal of Clinical Monitoring and Computing
volume
21
issue
4
pages
237 - 242
publisher
Springer
external identifiers
  • pmid:17541714
  • scopus:34447642740
ISSN
1573-2614
DOI
10.1007/s10877-007-9079-7
language
English
LU publication?
yes
id
580ac54d-a608-4a5c-a0e9-091947b15936 (old id 1141349)
date added to LUP
2008-04-29 12:00:55
date last changed
2017-02-05 04:23:49
@article{580ac54d-a608-4a5c-a0e9-091947b15936,
  abstract     = {Objective Arterial pulse contour analysis is gaining widespread acceptance as a monitor of continuous cardiac output (CO). While this type of CO measurement is thought to provide acceptable continuous measurements, only a few studies have tested its accuracy and repeatability under unstable hemodynamic conditions. We compared continuous CO measurement using the pulse contour method (PCCO) before and after calibration with intermittent transpulmonary thermodilution cardiac output (TpCO).<br/><br>
Method We compared the two methods of CO measurements in 15 Landrace pigs weighing 20–25 kg in an experimental model of sepsis. Nine pigs were given an infusion of E. coli lipopolysacchride (LPS), and six pigs acted as controls. PCCO values before and after calibration (PCCO1 and PCCO2 respectively) were registered, and their errors relative to TpCO measurements were compared.<br/><br>
Results The mean coefficient of variation for repeated PCCO measurements was 6.85% for the control group, and 13.99% for the endotoxin group. The range of TpCO was 1.01–3.15 L/min. In the control group the bias ±2SD was 0.11 ± 0.53 L/min (TpCO vs PCCO1) and −0.02 ± 0.38 L/min (TpCO vs PCCO2). In the endotoxin group, the agreement was poor between TpCO and PCCO1, 0.08 ± 1.02 L/min. This improved after calibration (TpCO vs PCCO2) to 0.01 ± 0.31 L/min.<br/><br>
Conclusions In hemodynamically stable pigs, both pre- and post-calibration PCCO measurements agreed well with the intermittent transpulmonary thermodilution technique. However, during hemodynamic instability, and pre-calibration PCCO values had wide limits of agreement compared with TpCO. This was reflected by larger coefficients of variation for PCCO in hemodynamic instability. The error of PCCO measurement improved markedly after calibration, with bias and limits of agreement within clinically acceptable limits.},
  author       = {Johansson, Anders and Chew, Michelle},
  issn         = {1573-2614},
  keyword      = {heart,cardiac output,measurement techniques,thermodilution,anesthesia,sepsis,pulse contour analysis},
  language     = {eng},
  number       = {4},
  pages        = {237--242},
  publisher    = {Springer},
  series       = {Journal of Clinical Monitoring and Computing},
  title        = {Reliability of Continuous Pulse Contour Cardiac Output Measurement during Hemodynamic Instability},
  url          = {http://dx.doi.org/10.1007/s10877-007-9079-7},
  volume       = {21},
  year         = {2007},
}