Abstract
IntroductionTranspulmonary thermodilution is used to measure cardiac output (CO), global end-diastolic volume (GEDV) and extravascular lung water (EVLW). A system has been introduced (VolumeView/EV1000™ system, Edwards Lifesciences, Irvine CA, USA) that employs a novel algorithm for the mathematical analysis of the thermodilution curve. Our aim was to evaluate the agreement of this method with the established PiCCO™ method (Pulsion Medical Systems SE, Munich, Germany, clinicaltrials.gov identifier: NCT01405040)MethodsSeventy-two critically ill patients with clinical indication for advanced hemodynamic monitoring were included in this prospective, multicenter, observational study. During a 72-hour observation period, 443 sets of thermodilution measurements were performed with the new system. These measurements were electronically recorded, converted into an analog resistance signal and then re-analyzed by a PiCCO2™ device (Pulsion Medical Systems SE).ResultsFor CO, GEDV, and EVLW, the systems showed a high correlation (r2 = 0.981, 0.926 and 0.971, respectively), minimal bias (0.2 L/minute, 29.4 ml and 36.8 ml), and a low percentage error (9.7%, 11.5% and 12.2%). Changes in CO, GEDV and EVLW were tracked with a high concordance between the two systems, with a traditional concordance for CO, GEDV, and EVLW of 98.5%, 95.1%, and 97.7% and a polar plot concordance of 100%, 99.8% and 99.8% for CO, GEDV, and EVLW, respectively. Radial limits of agreement for CO, GEDV and EVLW were 0.31 ml/minute, 81 ml and 40 ml, respectively. The precision of GEDV measurements was significantly better using the VolumeView™ algorithm compared to the PiCCO™ algorithm (0.033 (0.03) versus 0.040 (0.03; median (interquartile range), P = 0.000049).ConclusionsFor CO, GEDV, and EVLW, the agreement of both the individual measurements as well as measurements of change showed the interchangeability of the two methods. For the VolumeView method, the higher precision may indicate a more robust GEDV algorithm.Trial registrationclinicaltrials.gov NCT01405040.
Highlights
Transpulmonary thermodilution is used to measure cardiac output (CO), global end-diastolic volume (GEDV) and extravascular lung water (EVLW)
Precision did not differ between the algorithms for the calculation of EVLW (0.22 (0.02) versus. 0.24 (0.02), P = 0.27 for the VolumeViewTM/ EV1000TM and the PiCCO algorithms, respectively). This prospective, multi-center clinical study demonstrates that CO, GEDV and EVLW calculated by the newly introduced VolumeView/EV1000TM system are interchangeable with CO, GEDV and EVLW obtained using the PiCCO algorithms over a wide range of values and in various clinical situations, including low cardiac output syndrome, hyperdynamic state, hypo- and hypervolemia, and severe pulmonary edema
The results of the present study show that the systems can be used interchangeably in various clinical situations and over a wide range of clinically relevant conditions, such as low or high cardiac output, hypo- and hyper-volemia and presence or absence of pulmonary edema
Summary
Transpulmonary thermodilution is used to measure cardiac output (CO), global end-diastolic volume (GEDV) and extravascular lung water (EVLW). Measurement of cardiac output (CO) and other parameters that guide cardiovascular therapy is paramount for the hemodynamic management of critically ill patients. In addition to CO measurements, TPTD provides volumetric hemodynamic parameters, that is, global end-diastolic volume (GEDV) and extravascular lung water (EVLW). GEDV has been shown to be a more reliable parameter of intravascular volume status when compared with the standard pressure preload parameters [6,7,8]. TPTD can be reliably performed at bedside [11] and has been successfully implemented in algorithms for goal directed hemodynamic therapy [12]
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