High cardiac output by a continuous cardiac output pulmonary artery catheter

Abstract

A 60-YEAR-OLD man with an orthotopic heart transplantation 7 months previously for congestive cardiomyopathy developed histologically proven acute transplant rejection and was admitted to the intensive care unit. Initially, he was hemodynamically stable while receiving dobutamine and nitroglycerin. After several days of reinforced immunosuppression, however, he developed pneumonia and septic shock. An intraaortic balloon pump was inserted by the cardiac surgeons to improve myocardial perfusion and function. In parallel, a continuous cardiac output (CO)–measuring pulmonary artery catheter was advanced via the internal right jugular vein. Continuous pressure recordings showed correct passage through the superior vena cava, right ventricle, and pulmonary artery. The pulmonary artery pressure curve was obtained after 60 cm, and the catheter was advanced further to 80 cm in an attempt to obtain a wedge pressure tracing, which, however, remained unsuccessful. A mixed venous blood sample was taken and revealed an oxygen saturation of 73%. During fixation of the catheter, measurement of continuous CO was started. Over the first sampling minutes, CO values of about 20 L/min were obtained (Fig 1). What is the diagnosis? From the Department of Anesthesiology and Intensive Care Medicine, Friedrich-Schiller-University of Jena, Jena, Federal Republic of Germany. Address reprint requests to Samir G. Sakka, MD, DEAA, Department of Anesthesiology and Intensive Care Medicine, Friedrich-SchillerUniversity of Jena, Bachstrasse 18, D-077433 Jena, Federal Republic of Germany. E-mail: Samir.Sakka@med.uni-jena.de Copyright 2002, Elsevier Science (USA). All rights reserved. 1053-0770/02/1606-0022$35.00/0 doi:10.1053/jcan.2002.128430