Comparison of Continuous, Stat, and Intermittent Bolus Cardiac Output Measurements during Cardiac Surgery / 대한마취과학회지

BACKGROUND: Off-pump coronary artery bypass (OPCAB) patients often require fluid, vasopressor, or inotropic support.It is therefore important that vigilant monitoring be undertaken to guide intervention and monitor the effects of therapy.Continuous monitoring of cardiac output (CO) is advisable.The aim of this study was to compare continuous cardiac index (CCI) and stat cardiac index (SCI) with intermittent bolus cardiac index (ICI) in patients undergoing OPCAB surgery. METHODS: Matched sets of CI measurements among CCI, SCI, and ICI were collected in 35 patients undergoing elective OPCAB at specific time periods.Bland-Altman analysis was used to compare the agreement among the different methods. RESULTS: Bland-Altman analysis of CI measurements yielded a bias, precision, and percent error of 0.09 +/- 0.63 L/min/m(2) (46.2%) for CCI and 0.09 +/- 0.60 L/min/m(2) (44.0%) for SCI, compared with ICI measurements. CONCLUSIONS: We found that the agreement of CCI, SCI, and ICI was poor.This disagreement increased during periods of open thorax and open pericardium when compared to the period of closed thorax.Continuous CO measurements through pulmonary artery catheter should be interpreted with caution during OPCAB.

Does Predictors of Preload Measured from Continuous Right Ventricular End-diastolic Volume Index Monitored Pulmonary Artery Catheter Reflect Stroke Volume Index in Off Pump Coronary Artery Bypass? / 대한마취과학회지

BACKGROUND: It is important to assess cardiac preload for management of patients undergoing off pump coronary artery bypass surgery (OPCAB). Recently, several studies have documented the good correlation between right ventricular end-diastolic volume index (RVEDVI) and stroke volume index (SVI), compared with cardiac filling pressures. However, none of these studies have evaluated relationship between predictors of preload and SVI measured with volumetric pulmonary artery catheter during OPCAB. The correlation of continuous RVEDVI and SVI measured with volumetric pulmonary artery catheter during OPCAB was evaluated in this study. METHODS: Fifty three patients undergoing OPCAB were included. Hemodynamic parameters were measured 10 min after induction (T1), 10 min after Y-graft formation started (T2) and 10 min after sternum closure (T3). The correlation of parameters were assessed by simple linear regression. RESULTS: Central venous pressure (CVP) and pulmonary artery occlusion pressure (PAOP) did not correlate with SVI during OPCAB. On the other hand, a statistically significant result was found between RVEDVI and SVI at T2 (r(2)=0.133, P=0.007) and T3 (r(2)=0.380, P < 0.000). But RVEDVI and SVI were weakly correlated. And at T1, RVEDVI and SVI did not correlate. CONCLUSIONS: RVEDVI is a more reliable predictor of preload compared to CVP and PAOP during OPCAB. But in post-induction period (T2), RVEDVI did not correlate with SVI.

The use of volume pulmonary artery chtheter for critically ill patients / 中国基层医药

Objective To investigate the effects of continuous end-eiastoloc volume index(CEDVI) adjusted by right venteicular ejection fraction(RVEF) in using for volume resuscitation of critically ill patients.Methods 51 critically ill patients who Swan-Ganz volume pulmonary artery catheters were inserted in via right internal jugular or subclavian vein underwent fluid therapy.Fluid was infused according to the relationship of RVEF and CEDVI.And the relationship of RVEF and CEDVI was that when RVEF was 0.2,0.3,0.35,0.4 and 0.5,respectively,CEDVI is 200～400ml/m~2,150～180ml/m~2,125～150ml/m~2,100～120ml/m~2,50～60ml/m~2 respectively.When RVEF is