Electrical bioimpedance cardiography: an old technology with new hopes for the future.

Abstract

THE POSITIVE IMPACT of early goal-directed hemodynamic therapy on postoperative outcome increasingly has been investigated over the last few years in high-risk patients undergoing noncardiac and cardiac surgeries. 1 Phan T.D. Ismail H. Herior A.G. et al. Improving perioperative outcomes: Fluid optimization with the esophageal Doppler monitor, a meta-analysis and review. J Am Coll Surg. 2008; 207: 935-941 Abstract Full Text Full Text PDF PubMed Scopus (87) Google Scholar , 2 Hamilton M. Cecconi M. Rhodes A. A systematic review and meta-analysis on the use of preemptive hemodynamic intervention to improve postoperative outcomes in moderate and high-risk surgical patients. Anesth Analg. 2011; 112: 1392-1402 Crossref PubMed Scopus (593) Google Scholar , 3 Aya H.D. Cecconi M. Hamilton M. et al. Goal-directed therapy in cardiac surgery: A systematic review and meta-analysis. Br J Anaesth. 2013; 110: 510-517 Crossref PubMed Scopus (156) Google Scholar , 4 Goepfert M.S. Richter H.P. Eulenburg C.Z. et al. Individually optimized hemodynamic therapy reduces complications and length of stay in the intensive care unit: A prospective, randomized controlled study. Anesthesiology. 2013; 119: 824-836 Crossref PubMed Scopus (120) Google Scholar However, these preemptive strategies require advanced hemodynamic monitoring to assess cardiac output and stroke volume. The classic available tools (intermittent pulmonary arterial or transpulmonary thermodilution or esophageal Doppler), either invasive or operator-dependent and necessitating a learning curve, are not convenient for routine practice. Therefore, they remain insufficiently used among North American and European anesthesiologists. 5 Cannesson M. Pestel G. Ricks C. et al. Hemodynamic monitoring and management in patients undergoing high risk surgery: A survey among North American and European anesthesiologists. Crit Care. 2011; 15: R197 Crossref PubMed Scopus (208) Google Scholar Besides, new mini-invasive cardiac output devices have been developed commercially over the last decade. 6 Marik P.E. Noninvasive cardiac output monitors: A state-of the-art review. J Cardiothorac Vasc Anesth. 2013; 27: 121-134 Abstract Full Text Full Text PDF PubMed Scopus (205) Google Scholar Less accurate but more convenient and easy to use, they potentially could help the practitioners in promoting advanced hemodynamic monitoring and early goal-directed therapy at the bedside in high-risk patients in an attempt to further improve postoperative outcome. Among these mini-invasive technologies, thoracic electrical bioimpedance (TEB) has major theoretical advantages and could be of great clinical utility in the settings of anesthesiology, cardiology, and perioperative medicine. Despite extensive literature published over the last 50 years, TEB remains scarcely used by practitioners.