In:
European Journal of Anaesthesiology, Ovid Technologies (Wolters Kluwer Health), Vol. 38, No. 12 ( 2021-12), p. 1242-1252
Abstract:
Cardiac output ( CO ) monitoring is the basis of goal-directed treatment for major abdominal surgery. A capnodynamic method estimating cardiac output ( CO EPBF ) by continuously calculating nonshunted pulmonary blood flow has previously shown good agreement and trending ability when evaluated in mechanically ventilated pigs. OBJECTIVES To compare the performance of the capnodynamic method of CO monitoring with transpulmonary thermodilution ( CO TPTD ) in patients undergoing major abdominal surgery. DESIGN Prospective, observational, method comparison study. Simultaneous measurements of CO EPBF and CO TPTD were performed before incision at baseline and before and after increased (+10 cmH 2 O) positive end-expiratory pressure (PEEP), activation of epidural anaesthesia and intra-operative events of hypovolemia and low CO . The first 25 patients were ventilated with PEEP 5 cmH 2 O (PEEP 5 ), while in the last 10 patients, lung recruitment followed by individual PEEP adjustment (PEEP adj ) was performed before protocol start. SETTING Karolinska University Hospital, Stockholm, Sweden. PATIENTS In total, 35 patients ( 〉 18 years) scheduled for major abdominal surgery with advanced hemodynamic monitoring were included in the study. MAIN OUTCOME MEASURES AND ANALYSIS Agreement and trending ability between CO EPBF and CO TPTD at different clinical moments were analysed with Bland--Altman and four quadrant plots. RESULTS In total, 322 paired values, 227 in PEEP 5 and 95 in PEEP adj were analysed. Respectively, the mean CO EPBF and CO TPTD were 4.5 ± 1.0 and 4.8 ± 1.1 in the PEEP 5 group and 4.9 ± 1.2 and 5.0 ± 1.0 l min −1 in the PEEP adj group. Mean bias (levels of agreement) and percentage error (PE) were −0.2 (−2.2 to 1.7) l min −1 and 41% for the PEEP 5 group and −0.1 (−1.7 to 1.5) l min −1 and 31% in the PEEP adj group. Concordance rates during changes in CO EPBF and CO TPTD were 92% in the PEEP 5 group and 90% in the PEEP adj group. CONCLUSION CO EPBF provides continuous noninvasive CO estimation with acceptable performance, which improved after lung recruitment and PEEP adjustment, although not interchangeable with C O TPTD . This method may become a tool for continuous intra-operative CO monitoring during general anaesthesia in the future. TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT03444545.
Type of Medium:
Online Resource
ISSN:
0265-0215
,
1365-2346
DOI:
10.1097/EJA.0000000000001566
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
2021
detail.hit.zdb_id:
2004964-X
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