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Updated: Apr 26, 2026
Noninvasive Determination of Vortex Formation Time Using Transesophageal Echocardiography During Cardiac Surgery
Published on: November 28, 2018
Oesophageal Doppler and calibrated pulse contour analysis are not interchangeable within a goal-directed haemodynamic
A Feldheiser1, O Hunsicker1, H Krebbel1
1Department of Anaesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-University Medicine Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
Insights
Oesophageal Doppler monitor (ODM) and calibrated pulse contour analysis (PCA) show similar precision in measuring stroke volume changes during surgery. However, they are not interchangeable for goal-directed hemodynamic management, especially with increasing norepinephrine levels.
Area of Science:
- Anesthesiology and Critical Care Medicine
- Hemodynamic Monitoring
- Surgical Oncology
Background:
- Goal-directed hemodynamic management is increasingly recognized for its benefits during surgery.
- Accurate assessment of stroke volume (SV) changes is crucial for effective hemodynamic management.
- Non-cardiac surgery, particularly cytoreductive procedures for ovarian cancer, presents unique monitoring challenges.
Purpose of the Study:
- To compare the oesophageal Doppler monitor (ODM) with calibrated pulse contour analysis (PCA) for assessing stroke volume (SV) changes.
- To evaluate the interchangeability of ODM and PCA within a goal-directed hemodynamic algorithm during non-cardiac surgery.
- To identify clinical factors influencing the trending agreement between ODM and PCA.
Main Methods:
- Prospective data collection in 41 patients undergoing cytoreductive surgery for metastatic ovarian carcinoma.
- Fluid challenges administered based on an ODM-guided hemodynamic algorithm.
- Comparison of ODM and PCA for precision and trending of SV changes using polar plot analysis and regression analysis.
Main Results:
- A total of 762 fluid challenges and 1524 paired measurements were analyzed.
- ODM and PCA demonstrated comparable precision (5.7% vs. 6.0%, P=0.80).
- Poor trending agreement was observed between ODM and PCA (angular concordance 67.8%), influenced by norepinephrine dosage and mean arterial pressure (MAP) changes.
Conclusions:
- Despite similar precision, ODM and PCA are not interchangeable for monitoring SV changes in goal-directed hemodynamic management.
- The degree of interchangeability decreases with higher norepinephrine levels and greater MAP fluctuations.
- Clinical decisions based on hemodynamic monitoring should consider the limitations of each device's trending capabilities.
Background:
Evidence for the benefit of an intraoperative use of a goal-directed haemodynamic management has grown. We compared the oesophageal Doppler monitor (ODM, CardioQ-ODM™) with a calibrated pulse contour analysis (PCA, PiCCO2™) with regard to assessment of stroke volume (SV) changes after volume administration within a goal-directed haemodynamic algorithm during non-cardiac surgery.
Methods:
The data were obtained prospectively in patients with metastatic ovarian carcinoma undergoing cytoreductive surgery. During surgery, fluid challenges were performed as indicated by the goal-directed haemodynamic algorithm guided by the ODM. Monitors were compared regarding precision and trending. Clinical characteristics associated with trending were studied by extended regression analysis.
Results:
A total of 762 fluid challenges were performed in 41 patients resulting in 1524 paired measurements. The precision of ODM and PCA was 5.7% and 6.0% (P=0.80), respectively. Polar plot analysis revealed a poor trending between ODM and PCA with an angular bias of -7.1°, radial limits of agreement of -58.1° to 43.8°, and an angular concordance rate of 67.8%. Dose of norepinephrine (NE) (scaled 0.1 µg kg(-1) min(-1)) [adjusted odds ratio (OR) 0.606 (95% confidence interval, CI: 0.404-0.910); P=0.016] and changes in mean arterial pressure (MAP) to a fluid challenge (scaled 10%) [adjusted OR 0.733 (95% CI: 0.635-0.845); P<0.001] were associated with trending between ODM and PCA, whereas there was no relation to type of i.v. solution.
Conclusions:
Despite a similar precision, ODM and PCA were not interchangeable with regard to measuring SV changes within a goal-directed haemodynamic algorithm. A decrease in interchangeability coincided with increasing NE levels and greater changes of MAP to a fluid challenge.
