Simultaneous intraoperative measurements of eardiac output were obtained in twenty one patients with thoracic electric bioimpedance(TEB) and transesophageal Doppler, two patients with transesophageal Doppler and thermodilution, one patient with TEB and thermodilution, and three patients with TEB, transesophageal Doppler and thermodilution techniques to evaluate the utility of noninvasive methods. Pairs of measurments were obtained 6S times with TEB and thermodilution, 109 times with transesophageal Doppler and thermodilution, and 373 times with TEB and transesophageal Doppler techniques. Correlation of the measurements was poor, with r=0.39 for TEB and thermodilution, r=0.44 for transesophageal Doppler and thermodilution, and r=0.39 for TEB and transesophageal Doppler. The mean difference between TEB and thermodilution, transesophageal Doppler and thermodilution, and TEB and transesophageal Doppler values was -2.41+/-1.79 L/min(mean+/-SD), -0.98+/-1.70 L/min, and -0.69+/-1.01 L/min, respectively. The scattergrams with confidence band lines showed that 22.0% of the scattergram points fell within +/-20% band and 51.5% within +/-40% band in TEB and thermodilution, 55.0% of the scattergram points fell within +/-20% band and 77.9% within +/-40% band in transesophageal Doppler and thermodilution, and 63.6% of the scattergram points fell within +/-20% band and 90.9 within +/-40% band in TEB and transesophageal Doppler. Therefore, it is concluded that neither noninvasive technique reliably estimated cardiac output as determined by thermodilution.
Cardiac Output* ; Humans ; Thermodilution*

OBJECTIVETo assess the accuracy of cardiac output (CO) measured by transpulmonary thermodilution technique (TPTD)and explore the validity of intrathoracic blood volume index (ITBVI) for assessment of circulatory volume status.

METHODSTen immature pigs with a mean weight of (20.6±1.9)kg were studied during the conditions including normovolemia, hypervolemia, and hypovolemia. Simultaneous CO was measured in each condition using pulmonary artery thermodilution (PATD) method and TPTD. More specifically, CO (COPA) was determined with PATD, while CO (COTP) and ITBVI were determined with TPTD. All measurements were repeated 3 times. Central venous pressure (CVP) and heart rate were measured at the same time. The potential correlations of CVP and ITBVI with cardiac index (CI) and stroke volume index (SVI) in each blood volume status were analyzed.

RESULTSA total of 90 simultaneous measurements of COPA and COTP in 3 different blood volume conditions were made. The correlation coefficient between the two measurements was 0.977 (P<0.001) and the mean difference was (0.25±0.26)L/min (95%CI:0.20-0.30 L/min, P<0.001). The coefficient of variation of COTP was 3.7%, while COPA was 5.4%. Compared with those in normovolemia, CVP and ITBVI in hypervolemia significantly increased (P=0.002, 0.019), ITBVI in hypovolemia decreased significantly (P<0.001), and CVP in hypovolemia decreased insignificantly (P=0.05). Correlation analysis revealed a significant correlation between ITBVI with CI and SVI in normovolemia (r=0.741, P=0.014; r=0.885, P=0.001). In contrast, correlations between CVP with CI and SVI were poor.

CONCLUSIONSTPTD can accurately and precisely measure CO in different blood volume conditions. ITBVI measured by TPTD has better validity for the assessment of circulatory volume status than CVP.

Cardiac output (CO) monitoring is a crucial part of the hemodynamic status monitoring. So far, thermodilution method, which is clinically recognized as the gold standard method to monitor cardiac output, still has irreplaceable advantages. This paper mainly introduces the use of platform for cardiac output measurement based on thermodilution method, mainly including three parts: the hardware platform, software design and algorithm process. A large amount of test data of this system has been got by CO simulator testing in the laboratory and preliminary clinical tests in the hospital. The testing result showed that using the proposed system can achieve good accuracy and repeatability.
Algorithms ; Cardiac Output ; Hemodynamics ; Humans ; Monitoring, Physiologic ; instrumentation ; methods ; Thermodilution

Assessment of aortic regurgutation(AR) by means of color Doppler echocardiaography is known to be a reliable noninvasive measure of regurgutation, and the laboratories grade AR primarily on the basis of the maximal length of the regurgitant jet of color Doppler flow mapping. This paper describes the influence of the cardiac output upon the regurgitant jet length. Twenty seven adult patients with AR were examined. In 17 with mild AR of 27 patients, the perioperative color Doppler control studies of AR were done because mitral valve was replaced only. The regurgitant fraction and volume obtained by the thermodilution and pulse Doppler method were compared with angiographic and color Doppler esimates of severity of AR. The results show that the length of the regurgitant jet of AR by color Doppler study became larger aith indreasing cardiac output in the same patient and correlated well with regurgitant volume rether than regurgitant fraction. Therefore the regurgutant jet length appreared to be influenced by regurgutant volume which was altered by changing caediac output. In conclusion, a color Doppler study allows noninvasive quantitative estimation of severity of AR, and its use should take into account the cardiac output.
Adult ; Aortic Valve Insufficiency* ; Cardiac Output* ; Humans ; Mitral Valve ; Thermodilution

OBJECTIVE: To assess the differences between ultrasound cardiac output monitor (USCOM) and thermodilution (TD) systematically in cardiac function monitoring of critically ill patients. METHODS: The Chinese and English literatures about the clinical trials which using USCOM and TD to monitor cardiac function published in CNKI, Wanfang database, China biomedical literature database, VIP database, China Clinical Trial Registration Center, PubMed, Embase and Cochrane Library were searched by computer from the establishment to December 2018. Some indicators, like cardiac output (CO), cardiac index (CI), stroke volume (SV) and other parameters were used to evaluate cardiac function. Literature search, quality evaluation and data extraction were conducted independently by two authors. The tailored Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) was used for literature quality evaluation. EndNote X6 was used for literature screening and management. RevMan 5.3 was used for Meta-analysis. Funnel chart analysis was used for publication bias. RESULTS: A total of 26 studies involving 772 patients were included. Among them, there were 5 literatures found that the agreements of cardiac function between the USCOM and TD methods were poor. Meta-analysis showed that there was no significant difference between the two methods in CO and CI monitoring [CO: mean difference (MD) = -0.06, 95% confidence interval (95%CI) was -0.17 to 0.05, P = 0.31; CI: MD = -0.04, 95%CI was -0.13 to 0.05, P = 0.38]. Subgroup analysis of different TD methods [pulmonary artery catheter (PAC), pulse indicator continuous cardiac output (PiCCO)] and different windows of USCOM ultrasonic probe [aorta (AA), pulmonary artery (PA)] in CO monitoring was not shown significant difference yet (PAC: MD = -0.07, 95%CI was -0.18 to 0.04, P = 0.23; PiCCO: MD = 0.09, 95%CI was -0.31 to 0.50, P = 0.65; AA windows: MD = -0.14, 95%CI was -0.31 to 0.02, P = 0.09; PA windows: MD = -0.00, 95%CI was -0.15 to 0.14, P = 0.95; AA/PA windows: MD = 0.23, 95%CI was -0.40 to 0.86, P = 0.47). However, the difference in SV was statistically significant between the USCOM and TD method (MD = 1.48, 95%CI was 0.04 to 2.92, P = 0.04). Funnel chart showed that the literature distribution of CO and CI monitoring were basically symmetrical, indicating that the bias of literature publication is small. CONCLUSIONS USCOM has good consistency with TD method in monitoring the cardiac function parameters of CO and CI, and different windows of ultrasonic probe of USCOM have no significant influence on the monitoring results, but there is significant difference in the consistency of the two methods in SV monitoring.
Cardiac Output ; China ; Humans ; Monitoring, Physiologic ; Thermodilution ; Ultrasonography

BACKGROUND: AVP (arginine vasopressin) shows unique hemodynamic characteristics, as a vasopressor. AVP has been tried in many cathecholamine refractory vasodilatory situations, and sometimes resulted in effective hemodynamic improvement. In this study, we hypothesized that low dose AVP infusion could recover the decreased SVR (systemic vascular resistance) induced by milrinone infusion with minimal effect on PVR (pulmonary vascular resistance). METHODS: Sixteen patients undergoing OPCAB participated in this study. After a loading dose milrinone was infused, low dose vasopressin infusion was started and titrated until the systemic blood pressure increased by 20%. During the study, hemodynamic factors including pulmonary capillary wedge pressure and cardiac output were measured using a continuous thermodilution technique with a Swan-Ganz catheter. RESULTS: Milrinone infusion reduced both SVR and PVR. And vasopression infusion increased SVR, but show relatively less effect on PVR. CONCLUSIONS: Low-dose vasopressin infusion could be used to recover the SVR decrease caused by milirinone infusion with little effect on PVR.
Blood Pressure ; Cardiac Output ; Catheters ; Hemodynamics* ; Humans ; Milrinone* ; Pulmonary Wedge Pressure ; Thermodilution ; Vasopressins*

AIMTo introduce a new device and catheter to be determining cardiac output through cor sinistrum with thermodilution.

METHODSOwn control was introduced in eight dogs. A pulmonary thermodilution catheter was used through the cor dextrum of the dogs; The new-design catheter was used through artery, and there were two situs to fix:its ahead in left atrium and the ahead near to aortic root. Determine cardiac output (CO) under four circumstances: controlled respiration, apnoea, in controlled hypotension, after controlled hypotension.

RESULTSThere was no significant difference among the parameters (CO and cardiac index) of all circumstances. The CO determined by the pulmonary thermodilution catheter and those by the new-design catheter in two situs were positive correlation, and the gamma were 0.986, 0.989; likewise, the cardiac index (CI) was positive correlation, and the gamma were 0.983, 0.985. The CO and CI by the new-design catheter between two situs were positive, and the gamma were 0.992, 0.988.

CONCLUSIONThe parameters by the new-design catheter and those by the pulmonary thermodilution catheter were concordant. In comparison with the pulmonary thermodilution catheter, the new-design catheter had simple device and could be easily operated.

BACKGROUND: Patients undergoing orthotopic liver transplantation(OLT) may develop significant hemodynamic instability. This study was performed to assess the role of right ventricular function in the hemodynamic alteration during 23 cases of OLT. METHODS: A thermodilution ejection fraction catheter was used to measure ejection fraction(EFrv), allowing for calculation of right ventricular(RV) end-diastolic volume index(EDVIrv), end-systolic volume index(ESVIrv), stroke volume index(SVIrv). RV stroke work index(SWIrv), maximum elastance (Emaxrv) and performance index(PIrv) as the functions of contractility were also calculated. Those RV hemodynamic measures were taken during preanhepatic phase(stage I), anhepatic phase (stage II), after reperfusion of the grafted liver and postanhepatic phase (stage III). All of measures in each surgical stage were statistically analyzed for their differences by repeated measured ANOVA. And correlation between changes from baseline of RV hemodynamic variables was determined by polynomial regression analysis. RESULTS: EFrv, SVIrv, SWIrv appeared to be well preserved throughout the prdegrees Cedure during stage I, II, III and much higher 5 min after reperfusion. No correlation was observed between right atrial pressure(Pra) and EDVIrv. There were significant correlation between EDVIrv and SVIrv, SWIrv and EFrv, Emaxrv and EFrv. CONCLUSION: RV function was well preserved during uncomplicated OLT using venovenous bypass. EDVIrv were more reliable determinants of RV preload than Pra for assessing RV contractility under conditions of this operation.
Bezafibrate ; Catheters ; Hemodynamics ; Humans ; Liver Transplantation* ; Liver* ; Reperfusion ; Stroke ; Stroke Volume ; Thermodilution ; Transplants ; Ventricular Function, Right*

BACKGROUND: Patients with end-stage liver disease have a hyperdynamic circulatory state complicated by a high right ventricular end-diastolic volume index (RVEDVI) and a low ventricular performance. These changes often make if difficult to evaluate volume status and preload. In this study, we analyzed hemodynamic profiles after a rapid fluid challenge in the recipients of a liver transplant. METHODS: Hemodynamic responses were evaluated before and after 200 ml of a 5% albumin challenge in forty patients, recipients of a liver transplant with a Swan-Ganz right-heart ejection fraction oximetry thermodilution cathether. Patients were divided into two groups, group A (responders, n=12, >or= 10% increase in stroke volume index (SVI) after fluid challenge) and group B (non-responders, n = 28, decrease or < 10% increase in SVI after fluid challenge). We analyzed hemodynamic data obtained from the two groups before and after the fluid challenge. RESULTS: Group B had a lower baseline right ventricular ejection fraction (REF) (49.9+/-5.9% vs 42.8+/-5.7%), a higher RVEDVI (120.8+/-19.4 ml/m2 vs 143.6+/-26.3 ml/m2), and a higher right ventricular end-systolic volume index (RVESVI) (60.8+/-14.0 ml/m2 vs 82.8+/-20.5 ml/m2) than group A. In group B, the cardic index (CI) and right ventricular stroke work index (RVSWI) were not increased after the fluid challenge. There was a mild decrease in the mean arterial pressure (MAP) in group B after the fluid challenge. There was a moderate negative correlation between the fluid-induced change in SVI and the baseline RVEDVI in all patients (r =-0.40, P<0.05). CONCLUSIONS: Our study suggests that there is no improvement of hemodynamic profiles after a rapid fluid challenge in many patients with end-stage liver disease, especially those with a high RVEDVI.
Arterial Pressure ; Hemodynamics* ; Humans ; Liver Diseases* ; Liver* ; Oximetry ; Stroke ; Stroke Volume ; Thermodilution ; Transplantation

BACKGROUND: Esophageal doppler is discribed as a non-invasive alternative to cardiac output (CO) estimation by thermodilution, the current bedside "gold standard". This study was designed to evaluate the accuracy of CO estimations performed by esophageal doppler (EDCO), compared to those obtained using a continuous CO pulmonary flotation catheter (TDCO). METHODS: In 16 patients undergoing off-pump coronary artery bypass surgery, CO was measured simultaneously by the esophageal doppler and the thermodilution method, after induction (A), after sternotomy (B), after coronary revascularization (C), and after sternal closure (D). Agreement between the TDCO and EDCO estimations was assessed by analyzing their mean differences and the distribution of these differences. Relative CO changes (percentages of the previous value) was analyzed by the same method. RESULTS: Both absolute CO values and relative CO changes by esophageal doppler showed a considerable scatter compared to those obtained using the thermodilution method. The bias (EDCO-TDCO) between the two mehtods was -0.8 +/- 2.7 L/min for A, -0.9 +/- 2.5 L/min for B, -0.9 +/- 3.6 L/min for C, and -0.6 +/- 2.7 (mean +/- 2 SD) L/min for D. On analyzing changes in CO, no significant method bias was found but 2 SD of the bias were +/- 74% for A to B, +/- 100% for B to C, and +/- 83% for C to D. CONCLUSIONS: These results suggest that CO estimations by esophageal doppler cannot replace estimations by the thermodilution method in patients undergoing off-pump coronary artery bypass graft surgery.
Bias (Epidemiology) ; Cardiac Output* ; Catheters ; Coronary Artery Bypass, Off-Pump* ; Humans ; Sternotomy ; Thermodilution* ; Transplants