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EDITORIAL Table of Contents   
Year : 2008  |  Volume : 11  |  Issue : 1  |  Page : 1-2
Cardiac output - Have we found the 'gold standard'?


Department of Anaesthesiology, Critical Care and Pain Medicine, Wockhardt Hospitals, Bannerghatta Road, Bangalore, India

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How to cite this article:
Chakravarthy M. Cardiac output - Have we found the 'gold standard'?. Ann Card Anaesth 2008;11:1-2

How to cite this URL:
Chakravarthy M. Cardiac output - Have we found the 'gold standard'?. Ann Card Anaesth [serial online] 2008 [cited 2020 May 30];11:1-2. Available from: http://www.annals.in/text.asp?2008/11/1/1/38441


Monitoring cardiac output during cardiac surgery seems logical and its ability to objectively assess responses to interventions justifies the use. Currently, more than eight manufacturers have their products in market to measure cardiac output, and each one of them claims that the measurements achieved are accurate and the technique is user-friendly. However, each one has one or more drawbacks. Furthermore, most of these devices cannot measure cardiac output in real time and are not non-invasive. Even the so-called gold standard - the thermodilution cardiac output - is actually an average of three values obtained over 3-5 min. 'Continuous cardiac output' measured through pulmonary artery catheter is also displayed after a delay of 2-3 min. Impedance plethysomography may probably be the only non-invasive technique in true sense; partial carbon dioxide re-breathing and the oesophageal Doppler are true semi-invasive ones, but are also fraught with disadvantages. [1] These 'semi-invasive' techniques are not very user-friendly. The newer techniques, which measure cardiac output using arterial pulse contour, such as FlowtracTM, pulse contour cardiac output and lithium dilution cardiac output, use either an algorithm or a few assumptions to derive the value of cardiac output. Although these newer techniques have been validated against thermodilution technique, in conditions of low cardiac output states, the values may be erroneous about 20% of times, suggesting inadequacies in the formulae and assumptions. [2] It is during periods of low cardiac output states that accurate measurement is most desirable. Furthermore, in patients with valvular heart diseases and intracardiac shunts, the value of cardiac output measured by the already available techniques may, at best, be an approximation of the actual. While assessing such patients, physicians have continued to rely on surrogate measures of cardiac output such as measuring urine output, mixed venous saturation and peripheral temperature. Therefore, clinicians do not yet have a 'gold standard'. However, advances in biomedical engineering will certainly bring in more user-friendly equipment, which will address the shortcomings of the presently available ones. Refinements are being done to the software of these equipments, which use arterial waveforms to compute cardiac output in order to overcome inadequacies as mentioned earlier.

This issue of the Annals of Cardiac Anaesthesia carries a tutorial on cardiac output and another original work on the role of early goal-directed therapy in high-risk cardiac surgical patients. [1],[3] Malhotra and co-workers have used predetermined values of cardiac output to set the goals for postoperative treatment of high-risk cardiac surgical patients. [3] A wider use of this concept in postoperative management may herald the use of protocol-based approach in this high-risk group of patients and help eliminate fancies of individuals in patient care. Large, multi-centric, randomized controlled studies may enhance the knowledge of clinicians on such approaches.

My predecessor, Professor Tempe, had wished that submissions, reviews and proofs of submission to this journal should be online in order to keep in tune with improvements in information technology. I assure that it will soon be a reality. In near future, authors intending to submit their works to this journal may do so just by logging on to the website www.annals.in. They may also see previews and check status and proofs online. This will render the process of submission easy and promote wider global access and visibility of the journal.

 
   References Top

1.Mathews L, Singh SR. Cardiac output monitoring. Ann Card Anaesth 2008;11:56-68.  Back to cited text no. 1    
2.Chakravarthy M, Patil TA, Jayaprakash K, Kalligudd P, Prabhakumar D, Jawali V. Comparison of simultaneous estimation of cardiac output by four techniques in patients undergoing off-pump coronary artery bypass surgery: A prospective observational study. Ann Card Anaesth 2007;10: 121-6.  Back to cited text no. 2    
3.Kapoor PM, Kakani M, Chowdhury U, Choudhury M, Lakshmy R, Kiran U. Early goal-directed therapy in moderate to high-risk cardiac surgery patients. Ann Card Anaesth 2008;11:27-34.  Back to cited text no. 3    

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Correspondence Address:
Murali Chakravarthy
Department of Anaesthesiology, Critical Care and Pain Medicine, Wockhardt Hospitals, Bannerghatta Road, Bangalore
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9784.38441

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