Is noninvasive hemodynamic monitoring appropriate for the elderly critically injured patient?

BACKGROUND Noninvasive hemodynamic monitoring in critically ill patients using bioimpedance technology has been shown to be a reliable alternative to invasive thermodilution techniques. However, there have been some concerns that the bioimpedance method may be unreliable in elderly patients with an atherosclerotic and rigid thoracic aorta. The purpose of the present study was to evaluate the effect of age on the reliability of noninvasive bioimpedance technology in measuring cardiac index. METHODS This is a retrospective analysis of prospectively collected data in critically injured patients admitted to the surgical intensive care unit. All patients had simultaneous measurement using thermodilution cardiac index (TDCI) and bioimpedance cardiac index (BICI). The population was divided into three age groups (<55 years, 55-70 years, and >70 years). The correlation between TDCI and BICI was calculated for each age group. RESULTS There were 1,138 simultaneous measurements of TDCI and BICI in 285 patients. The BICI correlated well with TDCI in all three age groups (r = 0.82 for group <55 years, r = 0.87 for group 55-70 years, and r = 0.80 for group >70 years). CONCLUSION Noninvasive cardiac index monitoring in elderly patients is reliable and correlates well with standard thermodilution techniques.

[1]  R. Brant,et al.  A randomized, controlled trial of the use of pulmonary-artery catheters in high-risk surgical patients. , 2003, The New England journal of medicine.

[2]  W. Shoemaker,et al.  Effect on outcome of early intensive management of geriatric trauma patients , 2002, The British journal of surgery.

[3]  H Belzberg,et al.  Outcome prediction of emergency patients by noninvasive hemodynamic monitoring. , 2001, Chest.

[4]  W. Shoemaker,et al.  Noninvasive hemodynamic monitoring for early warning of adult respiratory distress syndrome in trauma patients. , 2000, Journal of critical care.

[5]  W. Shoemaker,et al.  Invasive and noninvasive haemodynamic monitoring of acutely ill sepsis and septic shock patients in the emergency department , 2000, European journal of emergency medicine : official journal of the European Society for Emergency Medicine.

[6]  H. Kittler,et al.  Simultaneous comparison of thoracic bioimpedance and arterial pulse waveform-derived cardiac output with thermodilution measurement , 2000, Critical care medicine.

[7]  W. Shoemaker,et al.  Intraoperative evaluation of tissue perfusion in high-risk patients by invasive and noninvasive hemodynamic monitoring. , 1999, Critical care medicine.

[8]  W. Shoemaker,et al.  Invasive and non-invasive physiological monitoring of blunt trauma patients in the early period after emergency admission. , 1999, International surgery.

[9]  W. Shoemaker,et al.  Early continuous noninvasive haemodynamic monitoring after severe blunt trauma. , 1999, Injury.

[10]  H Belzberg,et al.  Multicenter study of noninvasive monitoring systems as alternatives to invasive monitoring of acutely ill emergency patients. , 1998, Chest.

[11]  L. Critchley,et al.  Impedance cardiographyThe impact of new technology , 1998, Anaesthesia.

[12]  W. Shoemaker,et al.  Invasive and noninvasive hemodynamic monitoring of patients with cerebrovascular accidents. , 1998, The Western journal of medicine.

[13]  W. Shoemaker,et al.  Continuous intraoperative noninvasive cardiac output monitoring using a new thoracic bioimpedance device. , 1997, Journal of cardiothoracic and vascular anesthesia.

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

[15]  W C Shoemaker,et al.  Noninvasive physiologic monitoring of high-risk surgical patients. , 1996, Archives of surgery.

[16]  D. Altman,et al.  Comparing methods of measurement: why plotting difference against standard method is misleading , 1995, The Lancet.

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

[18]  R. Patterson,et al.  The Minnesota impedance cardiograph- theory and applications. , 1974, Biomedical engineering.

[19]  A. Beckett,et al.  AKUFO AND IBARAPA. , 1965, Lancet.

[20]  Hun H. Sun,et al.  An impedance cardiography system: A new design , 2006, Annals of Biomedical Engineering.