Comparative Study of Cardiac Output Measurement by Regional Impedance Cardiography and Thermodilution Method in Patients Undergoing off Pump Coronary Artery Bypass Graft Surgery

Background:An ideal CO monitor should be noninvasive, cost effective, reproducible, reliable during various physiological states. Limited literature is available regarding the noninvasive CO monitoring in open chest surgeries. Aim: The aim of this study was to compare the CO measurement by Regional Impedance Cardiography (RIC) and Thermodilution (TD) method in patients undergoing off pump coronary artery bypass graft surgery (OPCAB). Settings and Design: We conducted a prospective observational comparative study of CO measurement by the noninvasive RIC method using the NICaSHemodynamicNavigator systemand the gold standardTDmethod using pulmonary artery catheterin patients undergoingOPCAB.Atotal of 150 data pair from the two CO monitoring techniques were taken from 15 patients between 40-70 years at various predefined time intervals of the surgery. Patients and Methods: We have tried to find out the accuracy, precision and cost effectiveness of the newer RIC technique. Mean CO, bias and precision were compared for each pair i.e.TD-CO and RIC-CO as recommended by Bland and Altman.The Sensitivity and specificity of cutoff value to predict change in TD-CO was used to create a Receiver operating characteristic or ROC curve. Results: Mean TD-CO values were around 4.52 ± 1.09 L/min, while mean RIC- CO values were around 4.77± 1.84 L/min. The difference in CO change was found to be statistically not significant (p value 0.667). The bias was small (-0.25). The Bland Altman plot revealed a mean difference of -0.25 litres.The RIC method had a sensitivity of 55.56 % and specificity of 33.33 % in predicting 15% change in CO of TD method and the total diagnostic accuracy was 46.67%. Conclusion: A fair correlation was found between the two techniques. The RIC method may be considered as a promising noninvasive, potentially low cost alternative to the TD technique of hemodynamic measurement.

Noninvasive cardiac output monitoring using bioreactance in pediatric continuous blood purification patients / 中国小儿急救医学

Objective To study the influence of continuous blood purification(CBP) on cardiac out-put of pediatric patients using bioreactance. Methods Patients underwent CBP in PICU and nephrology ward from March 2014 were prospectively enrolled after approval by ethics committee. CBP therapies were all performed by Fresenius Medical Care hemodialysis machine. Cardiac output values were obtained using the non-invasive cardiac output monitoring ( NICOM) device ( Cheetah Medical). Blood pressure, heart rate, cardiac index(CI) and stroke volume index(SVI) were recorded before the therapy,at the beginning of ther-apy,during the course of therapy,and at the end of each therapy. Results Twenty-one pediatric patients (from 1. 0 year to 15. 5 years) were recruited and 69 treatments were recorded from March 2014 to Decem-ber 2016. The basic CI was 3. 4 (2. 4,6. 1) L/(min·m2),basic SVI was 43 (26,75) ml/(m2·beat). Dur-ing the beginning of therapy,mean arterial pressure(MAP),CI and SVI all dropped from the baseline ( P<0. 001),whereas heart rate increased. During the course of CBP,CI and SVI (were both recorded every 4 hours) kept on dropping and stayed at a relatively lower level. Course CI was 3. 0 (2. 4,4. 6) L/(min·m2) and course SVI was 28 (21,57) ml/(m2·beat). At the end of therapy,CI was 3. 4 (2. 5,5. 3) L/(min· m2),with no significant difference from the baseline CI (P＝0. 073). However,the SVI at the end of therapy was 35 (25,67) ml/(m2·beat),higher than the course SVI but still lower than the basic SVI,the differences were statistically significant ( P<0. 05). Conclusion CI and SVI continue to decline at the beginning of CBP treatment and remain at a lower level throughout the course of treatment. After the therapy, CI has returned to the basic level whereas SVI has not recovered.

Correlation analysis of noninvasive cardiac output monitoring and echocardiogram in evaluation of cardiac function in children with septic shock / 中国小儿急救医学

Objective To explore the application value of noninvasive cardiac output monitoring (NICOM) in children with sepsis. Methods A total of 51 children with sepsis admitted to pediatric inten-sive care unit in Chengdu Women and Children's Center Hospital were enrolled. They were divided into three groups:sepsis without cardiovascular functional disorder group( sepsis group,n＝16),septic shock compen-sation group (n＝22),septic shock decompensation group (n＝13). The cardiac function of the children was detected by NICOM and echocardiography at the time of admission 0 hours and 1 hours after admission re-spectively. Cardiac index (CI),stroke volume(SV) measured by NICOM and ejection fraction (EF),SV measured by echocardiography were recorded. The correlation between CI and EF at 0 hours and 1 hours after admission was analyzed,and the SV measured by the two methods were compared. Results (1) In the sep-sis group,the CI measured by NICOM was(3. 54 ± 0. 36) L/( min·m2) and EF measured by echocardio-graphy was (66. 9 ± 4. 4)%. There was a significant positive correlation between CI and EF(r＝0. 941,P<0.01).(2) In the septic shock compensation group,CI was (2.40 ±0.36) L/(min·m2) and EF was (51. 91 ± 4. 38)% at 0 hours after admission,and there was a positive correlation between CI and EF( r＝0. 751,P＝0. 023). CI was(2. 98 ±0. 37)L/(min·m2)and EF was(59. 41 ±4. 39)% at 1 hours after admis-sion,and there was a positive correlation between CI and EF (r＝0. 879,P＝0. 012). At 0 hours and 1 hours after admission,the value of SV measured by NICOM was very close to that measured by echocardiography, and there was no significant difference(P>0. 05). (3) In the septic shock decompensation group,CI was (1.26 ±0.28) L/(min·m2) and EF was (41.23 ±4.73)% at 0 hours after admission,and there was no positive correlation between CI and EF(r＝0. 515,P＝0. 121). CI was(1. 61 ± 0. 32)L/(min·m2)and EF was(47. 77 ± 6. 19)% at 1 hours after admission,and there was no positive correlation between CI and EF (r＝0. 531,P＝0. 085). There was significant difference between the value of SV measured by NICOM and that measured by echocardiography at 0 hours and 1 hours after admission (P<0. 05). Conclusion NICOM can accurately evaluate cardiac output when the hemodynamics is stable,but the results are not accurate when the hemodynamics is unstable. NICOM has certain application value in pediatric critical care.

Hemodynamic Changes during a Thoracoscopic Thoracic Sympathicotomy in Primary Hyperhidrosis / 대한마취과학회지

BACKGROUND: A right thoracoscopic thoracic sympathicotomy involves the removal of T2 and T3 sympathetic chains. Since part of the sympathetic fibers to the heart traverse these two ganglia, we examined the hemodynamic changes during a thoracoscopic thoracic sympathicotomy in primary hyperhidrosis. METHODS: Noninvasive cardiac output monitoring was done on the both side of the neck and chest. A physiograph for measuring of continuous blood flow was taken from the right index finger and a thermometer was placed in the right palm. Following endotracheal intubation was done with double lumen endotracheal tube, anesthesia was maintained with isoflurane. Sympathicotomies were done for T2-3 during one lung ventilation. Heart rate (HR), mean arterial pressure (MAP), systemic vascular resistance index (SVRI), cardiac index (CI), accelerated contractility index (ACI), end-diastolic index (EDI), and temperature were recorded at arrival, before sympathicotomy, after sympathicotomy at 1, 2, 3, 4 and 5 minuets. The blood flow of the right index finger was recorded before and after the sympathicotomy. RESULTS: Concurrent with initiation of the sympathicotomy, MAP and SVRI were reduced, but the CI was elevated. It was accompanied with right palmar temperature elevation and an increase in the blood flow of the right index finger. CONCLUSIONS: A thoracoscopic thoracic sympathicotomy reduces MAP and SVRI and elevates CI, palmar temperature, and blood flow. We concluded that the hemodynamic changes during a thoracoscopic thoracic sympathicotomy seems to be the peripheral vasodilatation.

Effects of Insufflation on Hemodynamics and Arterial Blood Gas during Thoracoscopic Surgery / 대한마취과학회지

BACKGROUND: To visualize adequately the intrathoracic structures, creation of an artificial pneumothorax by carbon dioxide (CO2) insufflation under positive pressures has been advocated during thoracoscopic surgery. We hypothesized that positive-pressure insufflation during thoracoscopy would cause significant hemodynamic and ventilatory compromise. METHODS: Thirty patients underwent general anesthesia with a single lumen endotracheal tube and placement of an arterial line. Noninvasive cardiac output monitoring was done on both the side of the neck and chest. Baseline measurements of hemodynamic indices and arterial blood gas analysis (ABGA) were taken before CO2 insufflation. Data was obtained at 5 minutes after CO2 insufflation. ABGA was taken 5 minutes after CO2 deflation. RESULTS: Insufflation of CO2 resulted in an increase in heart rate (HR), mean arterial pressure (MAP), and systemic vascular resistance index (SVRI). Whereas cardiac index (CI), accelerated contractility index (ACI), PH, and arterial oxygen saturation (SaO2) were decreased. CONCLUSIONS: Positive pressure insufflation of CO2 during thoracoscopy resulted in hemodynamic and arterial blood gas changes. Therefore, we propose that low pressure (< 10 mmHg) insufflation is a safe adjunct to routine thoracoscopic surgical procedures.

Effect of Intravenous Lidocaine on Circulatory Response to Tracheal Intubation / 대한마취과학회지

A randomised trial was conducted in 13 patients to assess the circulatory response to endotracheal intubation. None of the patient suffered from heart or lung disease, all were premedicated with lorazepam 0.4 mg/kg, glycopyrrolate 0. 004 mg/kg intramuscularly 30-60 min. beforehand. Patients received vecuronium 0.01mg/kg intravenously for precrurarization and 2 min. later 6 patients received lidocaine 2 mg/kg intravenously and 7 patients received saline 1 ml/20 kg intravenously. Blood pressure and pulse rate were measured repeatedly by an automatic recording device (Datascope 2100A) and cardiac output was measured by noninvasive cardiac output monitor with suprasternal doppler ultrasound. After laryngoscopy and intubation, systolic arterial pressure increased 19.7% mean arterial pressure 18.8% from baseline values in lidocaine group (p<0.05), and systolic arterial pressure increased 21.4% mean artereal pressure 19.8% from baseline values in saline group (p<0. 05). Pulse rate increased 30.9% from baseline values in lidocaine group (p<0.05) and 32.5% from baseline in saline group (p<0.05). But there was no intergroup difference in systolic arterial pressure, mean arterial pressure and pulse rate. Diastolic pressure of both group did not increase significantly and did not show intergroup difference. Cardiac output increased 35.3% from baseline values in lidocaine group (p<0.05). We concluded that lidocaine 2 mg/kg infusion intravenously 2 min prior to laryngoscopy and intubation does not prevent hemodynamic reaction evoked by endotracheal intubation.