Cardiac output monitoring: Technology and choice

Jeff Kobe, Nitasha Mishra, Virendra K Arya, Waiel Al-Moustadi, Wayne Nates, Bhupesh Kumar, Jeff Kobe, Nitasha Mishra, Virendra K Arya, Waiel Al-Moustadi, Wayne Nates, Bhupesh Kumar

Abstract

The accurate quantification of cardiac output (CO) is given vital importance in modern medical practice, especially in high-risk surgical and critically ill patients. CO monitoring together with perioperative protocols to guide intravenous fluid therapy and inotropic support with the aim of improving CO and oxygen delivery has shown to improve perioperative outcomes in high-risk surgical patients. Understanding of the underlying principles of CO measuring devices helps in knowing the limitations of their use and allows more effective and safer utilization. At present, no single CO monitoring device can meet all the clinical requirements considering the limitations of diverse CO monitoring techniques. The evidence for the minimally invasive CO monitoring is conflicting; however, different CO monitoring devices may be used during the clinical course of patients as an integrated approach based on their invasiveness and the need for additional hemodynamic data. These devices add numerical trend information for anesthesiologists and intensivists to use in determining the most appropriate management of their patients and at present, do not completely prohibit but do increasingly limit the use of the pulmonary artery catheter.

Keywords: Bioreactance; cardiac output monitoring; minimally invasive monitors; thermodilution technique.

Conflict of interest statement

None

Figures

Figure 1
Figure 1
Rebreathing circuit, sequence of rebreathing, and stabilization while using NICO™ system
Figure 2
Figure 2
Calculation of cardiac output by measuring area under thermodilution curve using Stewart–Hamilton equation
Figure 3
Figure 3
Transpulmonary thermodilution technique (volume view and PiCCO plus)
Figure 4
Figure 4
LidCOplus system
Figure 5
Figure 5
Pulse pressure analysis model to calculate the stroke volume using the arterial waveform
Figure 6
Figure 6
Derivation of cardiac output from the pulse pressure analysis of the arterial waveform
Figure 7
Figure 7
Components of pulse wave transit time. PEP: preejection period, T1: PWTT through elastic artery, and T2: PWTT through peripheral arteries, PWTT = PEP + T1 + T2
Figure 8
Figure 8
Application of electrodes in impedance cardiography
Figure 9
Figure 9
Variation of ventricular, aortic and atrial pressure, aortic flow, thoracic impedance change, and first derivative of impedance (dZ/dt) as a function of time (t). Electrocardiogram and phonocardiogram taken simultaneously are also shown. The curve depicts the cardiac events/performance. B: Opening of the Aortic Valve, X: Closure of the Aortic Valve, Y: Closure of pulmonary valve, O: Mitral valve opening/rapid ventricular filling, B-X: Ventricular Ejection Time, C: Maximal deflection of dz/dt (Peak Flow), B-C: Slope-Acceleration Contractility Index, A: Atrial Systole, and Q: Start of ventricular depolarization
Figure 10
Figure 10
Bioimpedance, the analysis of transthoracic voltage amplitude changes in response to high-frequency current
Figure 11
Figure 11
The esophageal aortic Doppler probe into the esophagus manipulated to achieve the optimal velocity-time curve. The velocity time integral is calculated from the area under the curve. The cardiac output is calculated from the product of the velocity time integral, heart rate, and cross-sectional area of the aorta

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