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Agreement between PiCCO pulse-contour analysis, pulmonal artery thermodilution and transthoracic thermodilution
P S Halvorsen1, A Espinoza, R Lundblad
1The Interventional Centre, Department of Anesthesiology at Rikshospitalet-Radiumhospitalet University Hospital, Osly, Norway.
Insights
Continuous cardiac index monitoring is crucial during off-pump coronary artery bypass surgery (OPCAB). Thermodilution methods show better agreement than pulse-contour analysis (PCCI) with thermodilution, suggesting PCCI recalibration is needed.
Area of Science:
- Cardiovascular Surgery
- Anesthesiology
- Critical Care Medicine
Background:
- Hemodynamic instability can rapidly occur during off-pump coronary artery bypass surgery (OPCAB).
- Continuous monitoring of cardiac index (CI) is advisable during OPCAB procedures.
- The PiCCO monitor offers continuous CI measurement via pulse-contour analysis and intermittent measurement via transthoracic thermodilution.
Purpose of the Study:
- To evaluate the agreement between pulmonary artery thermodilution CI (Tpa), transthoracic thermodilution CI (Tpc), and pulse-contour CI (PCCI) during OPCAB surgery.
- To determine the reliability of different CI monitoring methods in the context of OPCAB.
Main Methods:
- 30 patients undergoing OPCAB surgery were enrolled.
- Pulmonary artery and PiCCO catheters were inserted for simultaneous CI measurements.
- Tpa, Tpc, and PCCI were compared at multiple time points, including post-induction, post-pericardiothomy, after grafting, and post-chest closure.
- PCCI was recalibrated between T2 and T6.
Main Results:
- Limits of agreement (percentage error) between Tpa and Tpc were 22.0%.
- Limits of agreement between Tpa and PCCI were 33.5%.
- Limits of agreement between Tpc and PCCI were 35.5%.
- Analysis of changes in CI (DeltaCI) showed varying limits of agreement between the methods.
Conclusions:
- Thermodilution methods (Tpa and Tpc) demonstrated smaller limits of agreement compared to PCCI during OPCAB surgery.
- Pulse-contour analysis (PCCI) showed wider variability when compared to thermodilution methods.
- Recalibration of the PCCI is recommended to improve its accuracy during OPCAB procedures.
Background:
Haemodynamic instability during off-pump coronary artery bypass surgery (OPCAB) may appear rapidly, and continuous monitoring of the cardiac index (CI) during the procedure is advisable. With the PiCCO monitor, CI can be measured continuously and almost real time with pulse-contour analysis and intermittently with transthoracic thermodilution. The agreement between pulmonal artery thermodilution CI (Tpa), transthoracic thermodilution CI (Tpc) and pulse-contour CI (PCCI) during OPCAB surgery has not been evaluated sufficiently.
Methods:
In 30 patients scheduled for OPCAB surgery, a pulmonary artery catheter and a PiCCO catheter were inserted. At different time points during surgery, Tpa, Tpc and PCCI were compared. Measurements were performed after induction of anesthesia (T1), after pericardiothomy (T2), after grafting on the anterior (T3), posterior (T4) and lateral (T5) walls and after chest closure (T6). The PCCI was recalibrated at time point T2-T6.
Results:
Mean difference and the limits of agreements (percentage error) between Tpa and Tpc were: -0.14 +/- 0.60 (22.0%) l/min/m2, between Tpa and PCCI: -0.07 +/- 0.92 (33.5%) l/min/m2 and between Tpc and PCCI: 0.10 +/- 1.00 (35.5%) l/min/m2. For changes in CI from one time point to the next (DeltaCI), the limits of agreements between DeltaCI Tpa and DeltaCI Tpc were 0.04 +/- 0.90 l/min/m2, between DeltaCI Tpa and DeltaCI PCCI: -0.02 +/- 1.22 l/min/m2 and between DeltaCI Tpc and DeltaCI PCCI: -0.08 +/- 1.32 l/min/m2.
Conclusion:
In OPCAB surgery, limits of agreement comparing thermodilution methods were smaller than comparing PCCI with thermodilution. Recalibration of PCCI is therefore advisable.
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