Noninvasive monitoring of cardiac output in critically ill patients using transesophageal Doppler.

Measurement of cardiac output using thermodilution technique in mechanically ventilated patients is associated with significant morbidity. The goal of the present study was to assess the validity of cardiac output measurement using transesophageal Doppler in critically ill patients. Forty-six patients from three different intensive care units underwent 136 paired cardiac output measurements using thermodilution (COTH) and transesophageal Doppler (COTED). In addition, simultaneous suprasternal Doppler and indirect calorimetry (Fick principle) were used to measure cardiac output in 26 patients from one center. A good correlation was found between COTH and COTED (r = 0.95), with a small systematic underestimation (bias = 0.24 L/min) using transesophageal Doppler. The limits of agreement between COTH and COTED were +2 L/min and -1.5 L/min. Variations in cardiac output between two consecutive measures using either transesophageal Doppler or thermodilution techniques were similar in direction and magnitude (bias = 0 L/min; limits of agreement = +/-1.7 L/min). Suprasternal Doppler and indirect calorimetry yielded similar correlations and agreements in the subset of patients in whom they were used. These results confirm that transesophageal Doppler can provide a noninvasive, clinically useful estimate of cardiac output and detect hemodynamic changes in mechanically ventilated, critically ill patients.

[1]  M. Feinberg,et al.  Multiplane Transesophageal Echocardiographic Doppler Imaging Accurately Determines Cardiac Output Measurements in Critically III Patients , 1995 .

[2]  E. Bennett,et al.  Continuous hemodynamic monitoring by esophageal Doppler. , 1989, Critical care medicine.

[3]  J. Snyder,et al.  Effects of mechanical ventilation on the measurement of cardiac output by thermodilution , 1982, Critical care medicine.

[4]  P. Peronneau,et al.  Flow in the thoracic aorta. , 1979, Cardiovascular research.

[5]  L. Hillis,et al.  Underestimation of cardiac output by thermodilution in patients with tricuspid regurgitation. , 1989, The American journal of medicine.

[6]  B. Groves,et al.  Thermodilution method overestimates low cardiac output in humans. , 1983, The American journal of physiology.

[7]  Non-invasive ultrasonic cardiac output measurement in intensive care unit. , 1985, Ultrasound in medicine & biology.

[8]  E. Bennett,et al.  Ascending aortic blood velocity and acceleration using Doppler ultrasound in the assessment of left ventricular function. , 1984, Cardiovascular research.

[9]  J M Levett,et al.  Thermodilution cardiac output: a critical analysis and review of the literature. , 1979, The Journal of surgical research.

[10]  L. Goldman,et al.  The effectiveness of right heart catheterization in the initial care of critically ill patients. SUPPORT Investigators. , 1996, JAMA.

[11]  T. Raffin,et al.  Reliability of the thermodilution method in the determination of cardiac output in clinical practice. , 2015, The American review of respiratory disease.

[12]  J. Bogaard,et al.  Thermodilution technique for measurement of cardiac output during artificial ventilation. , 1981, Journal of applied physiology: respiratory, environmental and exercise physiology.

[13]  J. Motin,et al.  Noninvasive aortic blood flow measurement using an intraesophageal probe. , 1985, Ultrasound in medicine & biology.

[14]  J. Alpert,et al.  A community-wide assessment of the use of pulmonary artery catheters in patients with acute myocardial infarction. , 1987, Chest.

[15]  L L Huntsman,et al.  Noninvasive Doppler Determination of Cardiac Output in Man: Clinical Validation , 1983, Circulation.

[16]  D. Hokanson,et al.  Nontraumatic aortic blood flow sensing by use of an ultrasonic esophageal probe. , 1975, Journal of applied physiology.

[17]  T. Gan,et al.  The oesophageal Doppler monitor , 1997, BMJ.

[18]  R. Wetzel,et al.  Major errors in thermodilution cardiac output measurement during rapid volume infusion. , 1985, Anesthesiology.

[19]  E. Bennett,et al.  Noninvasive optimization of left ventricular filling using esophageal Doppler , 1991, Critical care medicine.

[20]  Taylor Sh.  Measurement of the cardiac output in man. , 1966 .

[21]  A. Perrino,et al.  Transesophageal Doppler cardiac output monitoring: performance during aortic reconstructive surgery. , 1991, Anesthesia and Analgesia.

[22]  P. Freund.  Transesophageal Doppler scanning versus thermodilution during general anesthesia. An initial comparison of cardiac output techniques. , 1987, American journal of surgery.

[23]  S. Taylor,et al.  Is the measurement of cardiac output useful in clinical practice? , 1988, British journal of anaesthesia.

[24]  P. Carli,et al.  Pulsed Doppler Ascending Aortic, Carotid, Brachial, and Femoral Artery Blood Flows during Caudal Anesthesia in Infants , 1987, Anesthesiology.

[25]  J. Marini.  Obtaining meaningful data from the Swan-Ganz catheter , 1985 .

[26]  M. Paul,et al.  Limitations of thermal dilution curves for cardiac output determinations. , 1971, Journal of applied physiology.

[27]  E. Schmid,et al.  Reliability of a new generation transesophageal Doppler device for cardiac output monitoring. , 1993, Anesthesia and analgesia.

[28]  J. Takala,et al.  Measurement of gas exchange in intensive care: laboratory and clinical validation of a new device. , 1989, Critical care medicine.

[29]  A. Webb,et al.  Effects of alterations in left ventricular filling, contractility, and systemic vascular resistance on the ascending aortic blood velocity waveform of normal subjects , 1991, Critical care medicine.

[30]  A C Perrino,et al.  Transesophageal Doppler Ultrasonography: Evidence for Improved Cardiac Output Monitoring , 1990, Anesthesia and analgesia.

[31]  D. Altman,et al.  STATISTICAL METHODS FOR ASSESSING AGREEMENT BETWEEN TWO METHODS OF CLINICAL MEASUREMENT , 1986, The Lancet.

[32]  J. Mark,et al.  Continuous Noninvasive Monitoring of Cardiac Output with Esophageal Doppler Ultrasound during Cardiac Surgery , 1986, Anesthesia and analgesia.

[33]  M. Singer,et al.  Intraoperative intravascular volume optimisation and length of hospital stay after repair of proximal femoral fracture: randomised controlled trial , 1997, BMJ.