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Arterial pulse waveform analysis has been proposed for cardiac output (CO)
determination and monitoring without calibration or thermodilution
(FloTrac™/Vigileo™; Edwards Lifesciences, Irvine, CA,
USA). The accuracy and clinical applicability of this technology has not
been fully evaluated. We designed this prospective study to compare the
accuracy of the FloTrac™ system (COFT) vs. pulmonary
artery catheter standard bolus thermodilution (COPAC) in patients
undergoing coronary artery bypass grafting.
We studied 11 patients referred for coronary artery bypass grafting.
COFT and COPAC were determined at six time points
in the operating room including before and 5 min after volume expansion (500
mL 6% hetastarch). Measurements were performed on arrival in the intensive
care unit and every 4 h afterwards. Bland–Altman analysis was
used to assess the agreement between COFT and
COPAC ranged from 2.0 to 7.6 L min−1 and
COFT ranged from 1.9 to 8.2 L min−1.
There was a significant relationship between COPAC and
COFT (r = 0.662; P < 0.001). Agreement between
COPAC and COFT was −0.26 ±
0.87 L min−1. Volume expansion induced a significant
increase in both COPAC and COFT (from 3.4 ±
0.8 to 4.4 ± 1.0 L min−1; P < 0.001 and from 3.9 ±
1.2 to 5.0 ± 1.1 L min−1; P < 0.001, respectively) and there
was a significant relationship between percent change in COPAC
and COFT following volume expansion (r = 0.722; P = 0.01).
We found clinically acceptable agreement between COFT and
COPAC in this setting. This new device has potential clinical
The death of patients treated by ventricular assist device is usually related to multiorgan failure for which a disorder of splanchnic circulation is blamed. Gastric tonometry (measurement of gastric intra-mucosal pressure of CO2) has already been studied in many fields and especially in cardiac surgery. The aim of this study was to investigate the prognostic value of gastric tonometry monitoring after implantation of a ventricular assist device.
In this prospective study, all consecutive patients scheduled for a ventricular assist device were included. Gastric tonometry was added to standard monitoring. Data were collected (lactate, gastric CO2 (PgCO2) during cardiopulmonary bypass, at admission to ICU, 24 and 48 h later and when norepinephrine was stopped. Preoperative biologic and haemodynamic data were also collected. The primary endpoint was death.
Fifty-six patients (50 men and 6 women) were included. In 91% of the cases, the mechanical assistance was biventricular. The objective of the assistance was a bridge to transplant in 93% (n = 27). Twenty-seven deaths (48%) occurred during the study, 59% (n = 16) of them took place before the cardiac transplantation (mean time = 18 ± 16 days after assist device insertion). Many factors were found to be associated with death: weight (P = 0.018), red cells administration (P = 0.025), length of surgery (P = 0.016), PgCO2 on admission to ICU (P = 0.040) and norepinephrine dose at 24 h.
Gastric tonometry has a prognostic value in the early postoperative hours after the implantation of a ventricular assist device.
Respiratory variations in pulse oximetry plethysmographic waveform amplitude (ΔPOP) are related to respiratory variations in arterial pulse pressure (ΔPP) in the critical care setting. The aims of this study were to test the hypothesis that in mechanically ventilated patients undergoing general anaesthesia, ΔPOP calculation is feasible and can detect changes in preload.
Twenty-five mechanically ventilated patients were studied immediately after induction of general anaesthesia. Haemodynamic data (mean arterial pressure [MAP], central venous pressure [CVP], ΔPP and ΔPOP) were recorded at baseline, before and after tilting the patient from anti-Trendelenburg to Trendelenburg position in order to induce preload changes.
Change from anti-Trendelenburg to Trendelenburg position induced changes in MAP (58 ± 9 to 67 ± 10 mmHg, P < 0.05), CVP (4 ± 4 to 13 ± 5 mmHg, P < 0.05), ΔPP (14 ± 8 to 7 ± 5%, P < 0.05) and ΔPOP (17 ± 12 to 9 ± 5%, P < 0.05). There was a significant relationship between ΔPOP in anti-Trendelenburg position and percent change in MAP after volume expansion (r = 0.82; P < 0.05).
ΔPOP can be determined in the operating room and is influenced by changes in preload. This new index has potential clinical applications for the prediction of fluid responsiveness.
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