Comparison of cardiac output as assessed by transesophageal echo-Doppler and transpulmonary thermodilution in patients undergoing thoracic surgery

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• 作者：John Diaper ; Christoph Ellenberger ; Yann Villiger ; John Robert ; Cidgem Inan ; Jean-Marie Tschopp ; Marc Licker
• 刊名：Journal of Clinical Anesthesia
• 出版年：2010
• 出版时间：March 2010
• 年：2010
• 卷：22
• 期：2
• 页码：97-103
• 全文大小：251 K

文摘

Study Objective

To evaluate the accuracy of cardiac index (CI) as measured by echo-transesophageal Doppler monitoring (echo-TDM) with CI measured by the transpulmonary thermodilution technique.

Design

Prospective, observational study.

Setting

University hospital.

Patients

16 patients scheduled for elective lung cancer resection.

Interventions

Patients underwent two-lung ventilation (TLV) and one-lung ventilation (OLV).

Measurements and Main Results

CI measurements were analyzed using Bland-Altman plots. Absolute values of CI as measured by both devices were highly correlated (r² ranging from 0.72 to 0.77), as were relative changes in CI after the start of OLV (r² = 0.48, P = 0.006). Before, during, and after OLV, TDM-CI biases were 0.46 ± 0.28 L/min/m², 0.25 ± 0.18 L/min/m², and 0.35 ± 0.29 L/min/m², respectively. Limits of agreement remained stable throughout the three measurement periods (range −1.08 to 0.21 L/min/m²). The mean percentage error of CI measurements was 21.9 % compared with the thermodilution technique. Although no adverse events were reported, 11 % of measurement sets were incomplete due to poor signal detection.

Conclusions

Echo-TDM is a safe technique, allowing continuous semi-invasive assessment of hemodynamic changes in most patients undergoing open-chest surgery. Doppler-derived CI values showed significant biases and moderate clinical agreement with transpulmonary thermodilution during TLV and OLV.