Abstract
Pregnant patients undergoing minimally-invasive foetoscopic surgery for foetal spina bifida have a need to be subjected to advanced haemodynamic monitoring. This observational study compares cardiac output as measured by transpulmonary thermodilution monitoring with the results of non-invasive estimated continuous cardiac output monitoring. Transpulmonary thermodilution-based pulse contour analysis was performed for usual anaesthetic care, while non-invasive estimated continuous cardiac output monitoring data were additionally recorded. Thirty-five patients were enrolled, resulting in 199 measurement time points. Cardiac output measurements of the non-invasive estimated continuous cardiac output monitoring showed a weak correlation with the corresponding thermodilution measurements (correlation coefficient: 0.44, R2: 0.19; non-invasive estimated continuous cardiac output: 7.4 [6.2–8.1]; thermodilution cardiac output: 8.9 [7.8–9.8]; p ≤ 0.001), while cardiac index experienced no such correlation. Furthermore, neither stroke volume nor stroke volume index correlated with the corresponding thermodilution-based data. Even though non-invasive estimated continuous cardiac output monitoring consistently underestimated the corresponding thermodilution parameters, no trend analysis was achievable. Summarizing, we cannot suggest the use of non-invasive estimated continuous cardiac output monitoring as an alternative to transpulmonary thermodilution for cardiac output monitoring in pregnant patients undergoing minimally-invasive foetoscopic surgery for spina bifida.
Highlights
Pregnant patients undergoing minimally-invasive foetoscopic surgery for foetal spina bifida have a need to be subjected to advanced haemodynamic monitoring
24.2% of all cardiac output (CO) measurements were within the tolerance of the 10% deviation (−10% to 0% deviation of CO = 11.1% of cases and 0–10% deviation of CO = 13.1% of cases; Fig. 3), while 37.7% of all CO measurements differed more than 25% between both methods (>25% downward deviation of CO = 33.2% of cases and >25% upward deviation of CO = 4.5% of cases; Fig. 3)
This study evaluated the validity of the non-invasive esCCO monitoring for the assessment of CO and stroke volume (SV) as well as their indices in pregnant patients undergoing minimally-invasive foetoscopic surgery for spina bifida
Summary
Pregnant patients undergoing minimally-invasive foetoscopic surgery for foetal spina bifida have a need to be subjected to advanced haemodynamic monitoring. This observational study compares cardiac output as measured by transpulmonary thermodilution monitoring with the results of non-invasive estimated continuous cardiac output monitoring. Summarizing, we cannot suggest the use of non-invasive estimated continuous cardiac output monitoring as an alternative to transpulmonary thermodilution for cardiac output monitoring in pregnant patients undergoing minimally-invasive foetoscopic surgery for spina bifida. For pregnant patients undergoing major surgery, calibrated transpulmonary thermodilution (TPTD)-based haemodynamic monitoring offers two main advantages It represents a widely accepted method for CO measurement. EsCCO might be able to show a relative correlation of CO in a homogenous healthy patient cohort such as pregnant women
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