Ability of pulse power, esophageal Doppler, and arterial pulse pressure to estimate rapid changes in stroke volume in humans

José Marquez, Kenneth McCurry, Donald A Severyn, Michael R Pinsky, José Marquez, Kenneth McCurry, Donald A Severyn, Michael R Pinsky

Abstract

Introduction: Measures of arterial pulse pressure variation and left ventricular stroke volume variation induced by positive-pressure breathing vary in proportion to preload responsiveness. However, the accuracy of commercially available devices to report dynamic left ventricular stroke volume variation has never been validated.

Methods: We compared the accuracy of measured arterial pulse pressure and estimated left ventricular stroke volume reported from two Food and Drug Administration-approved aortic flow monitoring devices, one using arterial pulse power (LiDCOplus) and the other esophageal Doppler monitor (HemoSonic). We compared estimated left ventricular stroke volume and their changes during a venous occlusion and release maneuver to a calibrated aortic flow probe placed around the aortic root on a beat-to-beat basis in seven anesthetized open-chested cardiac surgery patients.

Results: Dynamic changes in arterial pulse pressure closely tracked left ventricular stroke volume changes (mean r .96). Both devices showed good agreement with steady-state apneic left ventricular stroke volume values and moderate agreement with dynamic changes in left ventricular stroke volume (esophageal Doppler monitor -1 +/- 22 mL, and pulse power -7 +/- 12 mL, bias +/- 2 sd). In general, the pulse power signals tended to underestimate left ventricular stroke volume at higher left ventricular stroke volume values.

Conclusion: Arterial pulse pressure, as well as, left ventricular stroke volume estimated from esophageal Doppler monitor and pulse power reflects short-term steady-state left ventricular stroke volume values and tract dynamic changes in left ventricular stroke volume moderately well in humans.

Conflict of interest statement

Potential Conflicts of Interest: Michael R. Pinsky, MD is a member of the medical advisory board for LiDCO Ltd and was a medical advisory board for Arrow International. He has stock options with LiDCO Ltd. The remaining authors have not declared any conflicts of interest.

Figures

Figure 1
Figure 1
Trend display from one subject of radial arterial pressure, Cineflo™ aortic flow probe and HemoSonic™ esophageal Doppler monitor changes over a 20 second interval starting from apneic baseline and during inferior vena caval obstruction.
Figure 1
Figure 1
Trend display from one subject of radial arterial pressure, Cineflo™ aortic flow probe and HemoSonic™ esophageal Doppler monitor changes over a 20 second interval starting from apneic baseline and during inferior vena caval obstruction.
Figure 1
Figure 1
Trend display from one subject of radial arterial pressure, Cineflo™ aortic flow probe and HemoSonic™ esophageal Doppler monitor changes over a 20 second interval starting from apneic baseline and during inferior vena caval obstruction.
Figure 1
Figure 1
Trend display from one subject of radial arterial pressure, Cineflo™ aortic flow probe and HemoSonic™ esophageal Doppler monitor changes over a 20 second interval starting from apneic baseline and during inferior vena caval obstruction.
Figure 1
Figure 1
Trend display from one subject of radial arterial pressure, Cineflo™ aortic flow probe and HemoSonic™ esophageal Doppler monitor changes over a 20 second interval starting from apneic baseline and during inferior vena caval obstruction.
Figure 1
Figure 1
Trend display from one subject of radial arterial pressure, Cineflo™ aortic flow probe and HemoSonic™ esophageal Doppler monitor changes over a 20 second interval starting from apneic baseline and during inferior vena caval obstruction.
Figure 1
Figure 1
Trend display from one subject of radial arterial pressure, Cineflo™ aortic flow probe and HemoSonic™ esophageal Doppler monitor changes over a 20 second interval starting from apneic baseline and during inferior vena caval obstruction.
Figure 1
Figure 1
Trend display from one subject of radial arterial pressure, Cineflo™ aortic flow probe and HemoSonic™ esophageal Doppler monitor changes over a 20 second interval starting from apneic baseline and during inferior vena caval obstruction.
Figure 2
Figure 2
Regression analysis for arterial pulse pressure versus aortic flow probe-derived stroke volume (Cineflo™ stroke volume) for all subjects.
Figure 3
Figure 3
Regression analysis for arterial pulse power-derived stroke volume (LiDCO™) versus aortic flow probe-derived stroke volume (Cineflo™ stroke volume) for all subjects.
Figure 4
Figure 4
Regression analysis for esophageal Doppler monitor-derived stroke volume versus aortic flow probe-derived stroke volume (Cineflo™ stroke volume) for all subjects.
Figure 5
Figure 5
Bland-Altman Analysis for all subjects comparing pulse power-derived stroke volumes (LiDCO™) with aortic flow probe-derived stroke volumes during venous occlusion.
Figure 6
Figure 6
Bland-Altman Analysis for all subjects comparing esophageal Doppler monitor-derived (HemoSonic™) stroke volumes with aortic flow probe-derived stroke volumes during venous occlusion.

Source: PubMed

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