Effect of injectate volume and temperature on thermodilution cardiac output determination

Six combinations of injectate volume (10, 5, and 3 ml) and temperature (0 degree C and room temperature [RT]) are recommended by the manufacturers of thermodilution cardiac output catheters and computers. We prospectively studied the accuracy and variability associated with these six combinations in critically ill patients requiring intermittent mandatory ventilation. The six methods were similar in their average estimation of cardiac output but differed markedly in their reproducibility. The 10 ml 0 degree C and 10 ml RT combinations produced the least variability. The 5 ml 0 degree C and 5 ml RT combinations produced more variability. Variability was much greater with the remaining two combinations. The 3 ml RT combination resulted in an average range of 1.71 1/min within each set of three repeat measurements and an average absolute difference of 1.51 1/min from the values obtained with 10 ml 0 degree C (each the mean of three injections). We recommend the use of 10 ml 0 degree C or 10 ml RT for cardiac output determinations in critically ill patients. If it is important to minimize volume administration, the use of 5 ml injectate is acceptable for an estimation of cardiac output. The use of 3 ml injectate volumes is rarely, if ever, justified because the small reduction in volume administration results in a large increase in variability.