[Continuous measurement of cardiac output with pulse contour analysis]

Pulse contour cardiac output (PCCO) is an easily applicable method for continuous measurement of cardiac output in critically ill patients. Calculation of stroke volume is possible by analysing the area under the systolic part of the arterial pulse pressure waveform together with an individual calibration factor (Zao) to account for the individually variable vascular impedance. Since vascular impedance is potentially affected by altered vascular tone, it was the aim of the present study to examine the validity of PCCO in ICU patients receiving various dosages of a variety of vasoactive drugs. PATIENTS AND METHODS. Continuous cardiac output was measured in 20 ICU patients for a total of 110 h using the pulse contour method. The precision of PCCO was determined in comparison with its calibration reference, the thermodilution method (TDCO): (1) during administration of vasoactive drugs at a constant rate and (2) during conditions with altered vascular tone and haemodynamics elicited by changes in vasoactive drug dosage. For this purpose, the patients received varying dosages of vasoactive drugs (dopamine, dobutamine, epinephrine, norepinephrine, nitroglycerin, prostacyclin and urapidil). RESULTS. A total of 165 data sets was obtained, each consisting of the average of four capnometrically triggered TDCO measurements and the corresponding PCCO values. The relative difference between methods (+/- 2 SD) was +/- 23.9% (SD 0.85 l.min-1; r = 0.93) if a single calibration at the beginning of measurement series was performed (Fig. 2). The bias of the mean cardiac output values of both methods was -0.09 l.min-1. The precision of PCCO improved to +/- 15.7% by additional calibrations (SD 0.56.min-1; r = 0.96; bias 0.003 l.min-1). Data of two patients showed that recalibration may be necessary after extreme haemodynamic changes due to septic shock or cooling. Alteration of vascular tone by clinically used dosage of vasoactive drugs, however, had no destabilizing effect on the pulse contour method. CONCLUSIONS. It could be demonstrated that PCCO provides a valuable method for continuous cardiac output measurement in the intensive care setting with a precision comparable to that of thermodilution.