ACA App
Annals of Cardiac Anaesthesia Annals of Cardiac Anaesthesia Annals of Cardiac Anaesthesia
Home | About us | Editorial Board | Search | Ahead of print | Current Issue | Archives | Submission | Subscribe | Advertise | Contact | Login 
Users online: 326 Small font size Default font size Increase font size Print this article Email this article Bookmark this page
 


 

 
     
    Advanced search
 

 
 
     
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Email Alert *
    Add to My List *
* Registration required (free)  


    References
    Article Tables

 Article Access Statistics
    Viewed2780    
    Printed103    
    Emailed2    
    PDF Downloaded192    
    Comments [Add]    
    Cited by others 1    

Recommend this journal

 


 
Table of Contents
LETTER TO EDITOR  
Year : 2011  |  Volume : 14  |  Issue : 2  |  Page : 163-164
Comparison of cardiac output estimation by FloTrac/Vigileo TM and intermittent pulmonary artery thermodilution in patient with Takayasu arteritis


Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India

Click here for correspondence address and email

Date of Web Publication25-May-2011
 

How to cite this article:
Samra T, Arya V K. Comparison of cardiac output estimation by FloTrac/Vigileo TM and intermittent pulmonary artery thermodilution in patient with Takayasu arteritis. Ann Card Anaesth 2011;14:163-4

How to cite this URL:
Samra T, Arya V K. Comparison of cardiac output estimation by FloTrac/Vigileo TM and intermittent pulmonary artery thermodilution in patient with Takayasu arteritis. Ann Card Anaesth [serial online] 2011 [cited 2019 Oct 13];14:163-4. Available from: http://www.annals.in/text.asp?2011/14/2/163/81579


The Editor,

Pulmonary artery catheters (PAC) measure cardiac output by thermodilution technique, but FloTrac sensor and Vigileo TM monitor calculate cardiac output (CO) by analyzing arterial pressure waveform. [1] Chronic inflammatory diseases of major arteries like Takayasu's arteritis (TA) alter arterial compliance, vascular resistance and characteristics of arterial pressure waveform. [2] Thus, we compared CO estimations using both the techniques in a patient with Takayasu arteritis.

A 40-year old, 65 kg male, with Takayasu arteritis and chronic renal failure, was admitted for renal transplant. Transthoracic echocardiography revealed left ventricle (LV) dysfunction with LV ejection fraction of 29%. CT angiogram showed 60% stenosis of right renal artery with involvement of celiac axis, superior mesenteric, and inferior mesenteric arteries.

General anesthesia with epidural analgesia was administered. Pulmonary artery catheterization and right radial artery catheterization was done. FloTrac/Vigileo TM was connected, patient data (age, gender, body weight, height) entered, the system zeroed and CO measurement initiated. CO measured by thermodilution technique was considered gold standard. Measurements were made at intervals of 45 min with three injections of 0.9% NaCl (10 ml, 4−6°C) using closed cold-injectate-delivery system and the mean value recorded. To compare the results and determine accuracy of estimation of cardiac output using FloTrac/Vigileo TM , we calculated "Percent Error" [Table 1].
Table 1: Measurements of cardiac output (CO) using FloTrac/VigileoTM [CO(FloTrac)] and pulmonary artery catheter [CO (PAC)]

Click here to view


Surgical duration was 9 h and the patient was hemodynamically stable at all points of measurements. He was extubated before transfer to renal intensive care unit and his postoperative course was uneventful.

There was an overestimation in measurement of CO with percentage error varying from 49% to 108% using FloTrac/Vigileo TM at all time intervals.

The FloTrac/Vigileo TM calculates cardiac output (CO) based on following equation:



where SV is dependent on two variables, i.e., pulse pressure and vascular resistance and compliance. Thus, Equation (1) can be expressed as CO = HR Χ σAP Χ χ, where σAP is the standard deviation of arterial pressure and χ is a measure of vascular tone.



where M is multivariate approximating function M, MAP is the mean arterial pressure, C(P) is a function of arterial compliance, μ3AP and μ4AP are skewness and kurtosis of arterial pressure data and BSA is body surface area calculated from weight and height. [3]

C(P) is further derived using method of Langewouters, which uses the aortic compliance data generated from cadaver studies. [4] Bank et al.[5] have described a technique to study the elastic properties of arteries in patients with vascular pathology and a model to estimate mechanical parameters of the human brachial artery in vivo. The pulse wave analysis algorithm does not incorporate the contributions of collagen, elastin, and smooth muscle to arterial mechanical properties in humans with vascular pathology, and thus needs a modification in its algorithm based on model proposed by Bank et al.[5]

Insertion of PAC requires floatation through right side of the heart. However, only catheterization of peripheral artery is needed for determination of CO using FloTrac/Vigileo TM . Being a minimally invasive technique, it is now being used preferentially for estimation of CO. However, findings from the above case show that validity of its results are questionable in patients with pathological lesions of vasculature. Further research is needed with the device in different clinical scenarios to develop a clear understanding of its limitations and devise new algorithms to analyze pulse waves.

 
   References Top

1.Manecke GR. Edwards FloTrac sensor and Vigileo monitor: Easy, accurate, reliable cardiac output assessment using the arterial pulse wave. Expert Rev Med Devices 2005;2:523-7.  Back to cited text no. 1
[PUBMED]  [FULLTEXT]  
2.Thorburn JR, James MF. Anaesthetic management of Takayasu's arteritis. Anaesthesia 1986;41:734-8.  Back to cited text no. 2
[PUBMED]    
3.Button D, Weibel L, Reuthebuch O, Genoni M, Zollinger A, Hofer CK. Clinical evaluation of the FloTrac/Vigileo system and two established continuous cardiac output monitoring devices in patients undergoing cardiac surgery. Br J Anaesth 2007;99:329-36.  Back to cited text no. 3
[PUBMED]  [FULLTEXT]  
4.Langewouters GJ, Wesseling KH, Goedhard WJ. The pressure dependent dynamic elasticity of 35 thoracic and 16 abdominal human aortas in vitro described by a five component model. J B iomech 1985;18:613-20.  Back to cited text no. 4
    
5.Bank AJ, Wang H, Holte JE, Mullen K, Shammas R, Kubo SH. Contribution of collagen, elastin, and smooth muscle to in vivo human brachial artery wall stress and elastic modulus. Circulation 1996;94:3263-70.  Back to cited text no. 5
[PUBMED]  [FULLTEXT]  

Top
Correspondence Address:
Tanvir Samra
Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9784.81579

Rights and Permissions



 
 
    Tables

  [Table 1]

This article has been cited by
1 Effect of lung protection strategy on stroke volume variation in patients undergoing open-chest operation
Lu, Z.-F., Ge, S.-J., Xue, Z.-G., Deng, X.-M.
Academic Journal of Second Military Medical University. 2012; 33(12): 1329-1334
[Pubmed]



 

Top