Abstract
Thoracic electrical bioimpedance cardiography is a non-invasive, continuous and low-cost method of estimation of cardiac output and other haemodynamic parameters. Though subject to continuous technological refinement controversial opinions exist on its validity in subsets of critically ill patients, patients with heart disease or after cardiac surgery. A comparison study between thermodilution (TD) and bioimpedance (TEB) was performed in 28 patients undergoing elective cardiac surgery (CABG, aortic or mitral valve replacement or combined procedures). 128 pairs of cardiac index estimates at specific time points during 20 hours at the postoperative ICU were evaluated. A poor correlation (r = 0.26, p < 0.05, bias -0.07 l.min-1.m2, precision + 1.1 l.min-1.m-2, 95% limits of agreement -2.27-2.13 l.min-1.m-2) between TD and TEB cannot support the routine use of TEB monitoring in early postoperative period after open-heart surgery. Possible reasons of lack of agreement in this population are discussed. Further studies with technically improved bioimpedance cardiographs will be needed.
Highlights
Knowledge of changes of central haemodynamics in patients after cardiac surgery is of crucial importance for optimal therapy
Transthoracic electrical bioimpedance though controversially accepted is an established method for non-invasive monitoring of central haemodynamics
The bioimpedance cardiographs have been subject to continuous refinement of calculation algorithm
Summary
Knowledge of changes of central haemodynamics in patients after cardiac surgery is of crucial importance for optimal therapy. Cardiac output and other derived parameters can be measured invasively by Fick method, dye dilution or thermodilution. Fick method and dye dilution are employed mostly in catheterization laboratories and are not suitable for clinical haemodynamic monitoring because of their technical difficulties. Thermodilution (TD) by means of right heart catheterization by Swan-Ganz pulmonary artery catheter is method most frequently used for routine and repeated bedside measurement of cardiac output despite its possible risks and costs. Cardiac output can be estimated non-invasively by Doppler echocardiography but the method is unsuitable for routine monitoring because it is timeconsuming and operator-depending
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