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Schierbauer J, Ficher S, Zimmermann P, Wachsmuth NB, Schmidt WFJ. Cardiac stroke volume in females and its correlation to blood volume and cardiac dimensions. Front Physiol 2022; 13:895805. [PMID: 36237526 PMCID: PMC9551173 DOI: 10.3389/fphys.2022.895805] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 09/07/2022] [Indexed: 12/02/2022] Open
Abstract
We aimed to continuously determine the stroke volume (SV) and blood volume (BV) during incremental exercise to evaluate the individual SV course and to correlate both variables across different exercise intensities. Twenty-six females with heterogeneous endurance capacities performed an incremental cycle ergometer test to continuously determine the oxygen uptake (V̇O2), cardiac output (Q̇) and changes in BV. Q̇ was determined by impedance cardiography and resting cardiac dimensions by 2D echocardiography. Hemoglobin mass and BV were determined using a carbon monoxide-rebreathing method. V̇O2max ranged from 32 to 62 mL·kg−1·min−1. Q̇max and SVmax ranged from 16.4 to 31.6 L·min−1 and 90–170 mL, respectively. The SV significantly increased from rest to 40% and from 40% to 80% V̇O2max. Changes in SV from rest to 40% V̇O2max were negatively (r = −0.40, p = 0.05), between 40% and 80% positively correlated with BV (r = 0.45, p < 0.05). At each exercise intensity, the SV was significantly correlated with the BV and the cardiac dimensions, i.e., left ventricular muscle mass (LVMM) and end-diastolic diameter (LVEDD). The BV decreased by 280 ± 115 mL (5.7%, p = 0.001) until maximum exercise. We found no correlation between the changes in BV and the changes in SV between each exercise intensity. The hemoglobin concentration [Hb] increased by 0.8 ± 0.3 g·dL−1, the capillary oxygen saturation (ScO2) decreased by 4.0% (p < 0.001). As a result, the calculated arterial oxygen content significantly increased (18.5 ± 1.0 vs. 18.9 ± 1.0 mL·dL−1, p = 0.001). A 1 L higher BV at V̇O2max was associated with a higher SVmax of 16.2 mL (r = 0.63, p < 0.001) and Q̇max of 2.5 L·min−1 (r = 0.56, p < 0.01). In conclusion, the SV strongly correlates with the cardiac dimensions, which might be the result of adaptations to an increased volume load. The positive effect of a high BV on SV is particularly noticeable at high and severe intensity exercise. The theoretically expected reduction in V̇O2max due to lower SV as a consequence of reduced BV is apparently compensated by the increased arterial oxygen content due to a higher [Hb].
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Affiliation(s)
- Janis Schierbauer
- Division of Exercise Physiology and Metabolism, University of Bayreuth, Bayreuth, Germany
- Department of Sports Medicine/Sports Physiology, University of Bayreuth, Bayreuth, Germany
- *Correspondence: Janis Schierbauer,
| | - Sandra Ficher
- Department of Sports Medicine/Sports Physiology, University of Bayreuth, Bayreuth, Germany
| | - Paul Zimmermann
- Division of Exercise Physiology and Metabolism, University of Bayreuth, Bayreuth, Germany
- Department of Cardiology, Klinikum Bamberg, Bamberg, Germany
| | - Nadine B. Wachsmuth
- Division of Exercise Physiology and Metabolism, University of Bayreuth, Bayreuth, Germany
- Department of Sports Medicine/Sports Physiology, University of Bayreuth, Bayreuth, Germany
| | - Walter F. J. Schmidt
- Department of Sports Medicine/Sports Physiology, University of Bayreuth, Bayreuth, Germany
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Bawua LK, Miaskowski C, Suba S, Badilini F, Rodway GW, Hu X, Pelter MM. Thoracic Impedance Pneumography-Derived Respiratory Alarms and Associated Patient Characteristics. Am J Crit Care 2022; 31:355-365. [PMID: 36045046 DOI: 10.4037/ajcc2022295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Respiratory rate (RR) alarms alert clinicians to a change in a patient's condition. However, RR alarms are common occurrences. To date, no study has examined RR alarm types and associated patient characteristics, which could guide alarm management strategies. OBJECTIVES To characterize RR alarms by type, frequency, duration, and associated patient demographic and clinical characteristics. METHODS A secondary data analysis of alarms generated with impedance pneumography in 461 adult patients admitted to either a cardiac, a medical/surgical, or a neurological intensive care unit (ICU). The RR alarms included high parameter limit (≥30 breaths/min), low parameter limit (≤5 breaths/min), and apnea (no breathing ≥20 s). The ICU type; total time monitored; and alarm type, frequency, and duration were evaluated. RESULTS Of 159 771 RR alarms, parameter limit alarms (n = 140 975; 88.2%) were more frequent than apnea alarms (n = 18 796; 11.8%). High parameter limit alarms were most frequent (n = 131 827; 82.5%). After ICU monitoring time was controlled for, multivariate analysis showed that alarm rates were higher in patients in the cardiac and neurological ICUs (P = .001), patients undergoing mechanical ventilation (P = .005), and patients without a ventricular assist device or pacemaker (P = .02). Male sex was associated with low parameter limit (P = .01) and apnea (P = .005) alarms. CONCLUSION High parameter limit RR alarms were most frequent. Factors associated with RR alarms included monitoring time, ICU type, male sex, and mechanical ventilation. Although these factors are not modifiable, these data could be used to guide management strategies.
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Affiliation(s)
- Linda K Bawua
- Linda K. Bawua is a former PhD student, School of Nursing, University of California, San Francisco, California
| | - Christine Miaskowski
- Christine Miaskowski is a professor, School of Nursing, University of California, San Francisco, California
| | - Sukardi Suba
- Sukardi Suba is a postdoctoral associate, School of Nursing, University of Rochester Medical Center, Rochester, New York
| | - Fabio Badilini
- Fabio Badilini is director of the Center for Physiological Research, School of Nursing, University of California, San Francisco, California
| | - George W Rodway
- George W. Rodway is an assistant professor, School of Medicine, University of Nevada, Reno, Nevada
| | - Xiao Hu
- Xiao Hu is a professor, School of Nursing, Duke University, Durham, North Carolina
| | - Michele M Pelter
- Michele M. Pelter is an associate professor, School of Nursing, University of California, San Francisco, California
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Bawua LK, Miaskowski C, Suba S, Badilini F, Mortara D, Hu X, Rodway GW, Hoffmann TJ, Pelter MM. Agreement between respiratory rate measurement using a combined electrocardiographic derived method versus impedance from pneumography. J Electrocardiol 2021; 71:16-24. [PMID: 35007832 DOI: 10.1016/j.jelectrocard.2021.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 12/15/2021] [Accepted: 12/20/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Impedance pneumography (IP) is the current device-driven method used to measure respiratory rate (RR) in hospitalized patients. However, RR alarms are common and contribute to alarm fatigue. While RR derived from electrocardiographic (ECG) waveforms hold promise, they have not been compared to the IP method. PURPOSE Study examined the agreement between the IP and combined-ECG derived (EDR) for normal RR (≥12 or ≤20 breaths/minute [bpm]); low RR (≤5 bpm); and high RR (≥30 bpm). METHODOLOGY One-hundred intensive care unit patients were included by RR group: (1) normal RR (n = 50; 25 low RR and 25 high RR); (2) low RR (n = 50); and (3) high RR (n = 50). Bland-Altman analysis was used to evaluate agreement. RESULTS For normal RR, a significant bias difference of -1.00 + 2.11 (95% CI -1.60 to -0.40) and 95% limit of agreement (LOA) of -5.13 to 3.13 was found. For low RR, a significant bias difference of -16.54 + 6.02 (95% CI: -18.25 to -14.83) and a 95% LOA of -28.33 to - 4.75 was found. For high RR, a significant bias difference of 17.94 + 12.01 (95% CI: 14.53 to 21.35) and 95% LOA of -5.60 to 41.48 was found. CONCLUSION Combined-EDR method had good agreement with the IP method for normal RR. However, for the low RR, combined-EDR was consistently higher than the IP method and almost always lower for the high RR, which could reduce the number of RR alarms. However, replication in a larger sample including confirmation with visual assessment is warranted.
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Affiliation(s)
- Linda K Bawua
- School of Nursing, University of California, San Francisco, CA, USA.
| | | | - Sukardi Suba
- School of Nursing, University of Rochester, NY, USA.
| | - Fabio Badilini
- School of Nursing, University of California, San Francisco, CA, USA.
| | - David Mortara
- School of Nursing, University of California, San Francisco, CA, USA.
| | - Xiao Hu
- School of Nursing, Duke University Durham, NC, USA.
| | | | - Thomas J Hoffmann
- School of Nursing, University of California, San Francisco, CA, USA.
| | - Michele M Pelter
- School of Nursing, University of California, San Francisco, CA, USA.
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Sanders M, Servaas S, Slagt C. Accuracy and precision of non-invasive cardiac output monitoring by electrical cardiometry: a systematic review and meta-analysis. J Clin Monit Comput 2019; 34:433-460. [PMID: 31175501 PMCID: PMC7205855 DOI: 10.1007/s10877-019-00330-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 05/29/2019] [Indexed: 12/14/2022]
Abstract
Cardiac output monitoring is used in critically ill and high-risk surgical patients. Intermittent pulmonary artery thermodilution and transpulmonary thermodilution, considered the gold standard, are invasive and linked to complications. Therefore, many non-invasive cardiac output devices have been developed and studied. One of those is electrical cardiometry. The results of validation studies are conflicting, which emphasize the need for definitive validation of accuracy and precision. We performed a database search of PubMed, Embase, Web of Science and the Cochrane Library of Clinical Trials to identify studies comparing cardiac output measurement by electrical cardiometry and a reference method. Pooled bias, limits of agreement (LoA) and mean percentage error (MPE) were calculated using a random-effects model. A pooled MPE of less than 30% was considered clinically acceptable. A total of 13 studies in adults (620 patients) and 11 studies in pediatrics (603 patients) were included. For adults, pooled bias was 0.03 L min-1 [95% CI - 0.23; 0.29], LoA - 2.78 to 2.84 L min-1 and MPE 48.0%. For pediatrics, pooled bias was - 0.02 L min-1 [95% CI - 0.09; 0.05], LoA - 1.22 to 1.18 L min-1 and MPE 42.0%. Inter-study heterogeneity was high for both adults (I2 = 93%, p < 0.0001) and pediatrics (I2 = 86%, p < 0.0001). Despite the low bias for both adults and pediatrics, the MPE was not clinically acceptable. Electrical cardiometry cannot replace thermodilution and transthoracic echocardiography for the measurement of absolute cardiac output values. Future research should explore it's clinical use and indications.
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Affiliation(s)
- M Sanders
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6500 HB, Nijmegen, The Netherlands
| | - S Servaas
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6500 HB, Nijmegen, The Netherlands
| | - C Slagt
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6500 HB, Nijmegen, The Netherlands.
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Woolstenhulme JG, Guccione AA, Herrick JE, Collins JP, Nathan SD, Chan LE, Keyser RE. Left Ventricular Function Before and After Aerobic Exercise Training in Women With Pulmonary Arterial Hypertension. J Cardiopulm Rehabil Prev 2019; 39:118-126. [PMID: 30624371 PMCID: PMC6452473 DOI: 10.1097/hcr.0000000000000397] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pulmonary arterial hypertension (PAH) is a chronic debilitating illness. The effects of vigorous aerobic exercise training (AET) on heart function in PAH are poorly understood. METHODS Eighteen women with PAH (aged 56.2 ± 8.8 yr, body mass index: 28.8 ± 7.3 kg/m) underwent 10 wk of vigorous AET. Cardiac function was observed at rest and peak exercise using bioelectrical impedance cardiography before and after the AET. Cardiac function was observed in a small PAH subset (n = 7) for 10 wk before beginning the AET. A cohort of sedentary women (n = 19) served as healthy controls. RESULTS Left ventricular ejection fraction (48 ± 9.2 vs 61.5 ± 13.3%, P = .034) and the systemic vascular resistance index (2258 ± 419.1 vs 2939 ± 962.4 dyn·sec/cm·m, P = .008) were lower at supine rest in the baseline PAH group versus the healthy group, as were peak exercise heart rate (140 ± 13.3 vs 170 ± 13.8 beats/min, P < .001) and systemic vascular resistance index (828 ± 141.1 vs 824 ± 300.9 dyn·sec/cm·m, P = .050) after controlling for age and heart rate. Systemic vascular resistance index measured at peak exercise decreased in the PAH group after AET (828 ± 141.1 vs 766 ± 139.6 dyn·sec/cm·m, P = .020). Left ventricular early diastolic filling ratio worsened in the PAH subset prior to AET (95.9 ± 19.4 vs 76.2 ± 18.9%, P = .043) and remained unchanged after AET. CONCLUSION Vigorous AET was not associated with significant declines in left ventricular systolic or diastolic function in women with PAH. Aerobic exercise training may be beneficial for reducing afterload and may preserve left ventricular diastolic function.
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Affiliation(s)
- Joshua G. Woolstenhulme
- Department of Rehabilitation Science, George Mason University, Fairfax, VA
- Rehabilitation Medicine Department, Clinical Research Center, National Institutes of HealthBethesda, MD
- The Department of Physical Therapy and Health Care Sciences, The George Washington University, Washington, DC
| | - Andrew A. Guccione
- Department of Rehabilitation Science, George Mason University, Fairfax, VA
| | - Jeffrey E. Herrick
- Department of Rehabilitation Science, George Mason University, Fairfax, VA
| | - John P. Collins
- Department of Rehabilitation Science, George Mason University, Fairfax, VA
- Rehabilitation Medicine Department, Clinical Research Center, National Institutes of HealthBethesda, MD
| | - Steven D. Nathan
- Advanced Lung Disease and Transplant Program, Inova Fairfax Hospital, Falls Church, VA
| | - Leighton E. Chan
- Rehabilitation Medicine Department, Clinical Research Center, National Institutes of HealthBethesda, MD
| | - Randall E. Keyser
- Department of Rehabilitation Science, George Mason University, Fairfax, VA
- Rehabilitation Medicine Department, Clinical Research Center, National Institutes of HealthBethesda, MD
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Allegri D, Donida A, Malcovati P, Barrettino D. CMOS-Based Multifrequency Impedance Analyzer for Biomedical Applications. IEEE TRANSACTIONS ON BIOMEDICAL CIRCUITS AND SYSTEMS 2018; 12:1301-1312. [PMID: 30605084 DOI: 10.1109/tbcas.2018.2867172] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
In this paper, we present a monolithic microsystem, which can perform bioimpedance analysis and electroimpedance tomography measurements as well as record electrocardiogram signals. In contrast to a full analog lock-in approach, a mixed analog/digital solution is adopted. The proposed solution has been designed, implemented, and tested using a commercial 0.35-μm CMOS technology. The tuning range of the signal generator and the detector is from 10 kHz to 10 MHz in 1 kHz steps. The circuit ensures a CMRR of 81 dB@10 kHz, which increases to 84 dB@10 MHz. The measured equivalent input noise power spectral density is en = 2.57 nV/√Hz at 10 kHz in the worst case, close to the 1/f corner frequency. It decreases until en = 1.8 nV/√Hz at 1 MHz and en = 1.9 nV/√Hz at 10 MHz. Measurements of a reference RC network performed with the proposed monolithic solution and compared with a Keysight E4980A Precision LCR Meter shows a maximal relative error of 0.8% over the whole operating frequency range.
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Wu J, Wang Z, Wang T, Yu T, Yuan J, Zhang Q, Lu W, Zhang X. Evaluation of the fluid responsiveness in patients with septic shock by ultrasound plus the passive leg raising test. J Surg Res 2018; 224:207-214. [PMID: 29506842 DOI: 10.1016/j.jss.2017.12.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Revised: 11/14/2017] [Accepted: 12/13/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Prompt, accurate, and noninvasive prediction of fluid responsiveness is still lacking in intensive care unit. This study is to investigate the value of the Doppler ultrasound evaluation of variation in brachial artery peak velocity (VVpeakbrach) and passive leg raising (PLR)-induced changes in the brachial artery peak velocity (ΔVpeakPLR) in predicting the fluid responsiveness in mechanically ventilated patients with severe sepsis or septic shock. METHODS A prospective study was conducted involving 62 patients. Semirecumbent positioning, PLR, and a return to the semirecumbent position were performed with all patients before volume expansion. VVpeakbrach, ΔVpeakPLR, and stroke volume were observed by Doppler ultrasound. A patient with an increase of ≥15% in the stroke volume on volume expansion was defined as a responder. The predictive value was evaluated on the receiver operating characteristic curve analysis. RESULTS A total of 28 patients were classified as responders. The area under the receiver operating characteristic curve of ΔVpeakPLR and VVpeakbrach was 0.898 and 0.891, respectively. A ΔVpeakPLR value of more than 10.6% predicted the fluid responsiveness with a sensitivity of 82.1% and a specificity of 88.2%. A VVpeakbrach value of more than 10.95% predicted the fluid responsiveness with a sensitivity of 78.6% and a specificity of 91.2%. The positive predictive value was 94.4% when both were positive. In contrast, the negative predictive value was 96.6%. CONCLUSIONS Doppler ultrasound evaluation of VVpeakbrach and ΔVpeakPLR could be a feasible method for the noninvasive assessment of fluid responsiveness in mechanically ventilated patients with severe sepsis or septic shock. The combination of two indicators can improve the predictive value.
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Affiliation(s)
- Jingyi Wu
- Department of Intensive Care Unit, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui, China
| | - Zhen Wang
- Department of Intensive Care Unit, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui, China
| | - Tao Wang
- Department of Intensive Care Unit, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui, China
| | - Tao Yu
- Department of Intensive Care Unit, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui, China
| | - Jing Yuan
- Department of Intensive Care Unit, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui, China
| | - Qingling Zhang
- Department of Ultrasound, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui, China
| | - Weihua Lu
- Department of Intensive Care Unit, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui, China
| | - Xia Zhang
- Department of Ultrasound, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui, China.
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Bioreactance Is Not Interchangeable with Thermodilution for Measuring Cardiac Output during Adult Liver Transplantation. PLoS One 2015; 10:e0127981. [PMID: 26017364 PMCID: PMC4446098 DOI: 10.1371/journal.pone.0127981] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 04/21/2015] [Indexed: 11/19/2022] Open
Abstract
Background Thermodilution technique using a pulmonary artery catheter is widely used for the assessment of cardiac output (CO) in patients undergoing liver transplantation. However, the unclearness of the risk-benefit ratio of this method has led to an interest in less invasive modalities. Thus, we evaluated whether noninvasive bioreactance CO monitoring is interchangeable with thermodilution technique. Methods Nineteen recipients undergoing adult-to-adult living donor liver transplantation were enrolled in this prospective observational study. COs were recorded automatically by the two devices and compared simultaneously at 3-minute intervals. The Bland–Altman plot was used to evaluate the agreement between bioreactance and thermodilution. Clinically acceptable agreement was defined as a percentage error of limits of agreement <30%. The four quadrant plot was used to evaluate concordance between bioreactance and thermodilution. Clinically acceptable concordance was defined as a concordance rate >92%. Results A total of 2640 datasets were collected. The mean CO difference between the two techniques was 0.9 l/min, and the 95% limits of agreement were -3.5 l/min and 5.4 l/min with a percentage error of 53.9%. The percentage errors in the dissection, anhepatic, and reperfusion phase were 50.6%, 56.1%, and 53.5%, respectively. The concordance rate between the two techniques was 54.8%. Conclusion Bioreactance and thermodilution failed to show acceptable interchangeability in terms of both estimating CO and tracking CO changes in patients undergoing liver transplantation. Thus, the use of bioreactance as an alternative CO monitoring to thermodilution, in spite of its noninvasiveness, would be hard to recommend in these surgical patients.
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Bernstein DP, Henry IC, Lemmens HJ, Chaltas JL, DeMaria AN, Moon JB, Kahn AM. Validation of stroke volume and cardiac output by electrical interrogation of the brachial artery in normals: assessment of strengths, limitations, and sources of error. J Clin Monit Comput 2015; 29:789-800. [PMID: 25682204 PMCID: PMC4621712 DOI: 10.1007/s10877-015-9668-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 02/04/2015] [Indexed: 11/03/2022]
Abstract
The goal of this study is to validate a new, continuous, noninvasive stroke volume (SV) method, known as transbrachial electrical bioimpedance velocimetry (TBEV). TBEV SV was compared to SV obtained by cardiac magnetic resonance imaging (cMRI) in normal humans devoid of clinically apparent heart disease. Thirty-two (32) volunteers were enrolled in the study. Each subject was evaluated by echocardiography to assure that no aortic or mitral valve disease was present. Subsequently, each subject underwent electrical interrogation of the brachial artery by means of a high frequency, low amplitude alternating current. A first TBEV SV estimate was obtained. Immediately after the initial TBEV study, subjects underwent cMRI, using steady-state precession imaging to obtain a volumetric estimate of SV. Following cMRI, the TBEV SV study was repeated. Comparing the cMRI-derived SV to that of TBEV, the two TBEV estimates were averaged and compared to the cMRI standard. CO was computed as the product of SV and heart rate. Statistical methods consisted of Bland-Altman and linear regression analysis. TBEV SV and CO estimates were obtained in 30 of the 32 subjects enrolled. Bland-Altman analysis of pre- and post-cMRI TBEV SV showed a mean bias of 2.87 % (2.05 mL), precision of 13.59% (11.99 mL) and 95% limits of agreement (LOA) of +29.51% (25.55 mL) and -23.77% (-21.45 mL). Regression analysis for pre- and post-cMRI TBEV SV values yielded y = 0.76x + 25.1 and r(2) = 0.71 (r = 0.84). Bland-Altman analysis comparing cMRI SV with averaged TBEV SV showed a mean bias of -1.56% (-1.53 mL), precision of 13.47% (12.84 mL), 95% LOA of +24.85% (+23.64 mL) and -27.97% (-26.7 mL) and percent error = 26.2 %. For correlation analysis, the regression equation was y = 0.82x + 19.1 and correlation coefficient r(2) = 0.61 (r = 0.78). Bland-Altman analysis of averaged pre- and post-cMRI TBEV CO versus cMRI CO yielded a mean bias of 5.01% (0.32 L min(-1)), precision of 12.85% (0.77 L min(-1)), 95% LOA of +30.20 % (+0.1.83 L min(-1)) and -20.7% (-1.19 L min(-1)) and percent error = 24.8%. Regression analysis yielded y = 0.92x + 0.78, correlation coefficient r(2) = 0.74 (r = 0.86). TBEV is a novel, noninvasive method, which provides satisfactory estimates of SV and CO in normal humans.
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Affiliation(s)
- Donald P Bernstein
- Sotera Wireless, Inc., 10020 Huennekens Street, San Diego, CA, 92121, USA.
| | - Isaac C Henry
- Sotera Wireless, Inc., 10020 Huennekens Street, San Diego, CA, 92121, USA
| | - Harry J Lemmens
- Department of Anesthesia, Stanford University School of Medicine, Stanford, CA, 94305-5115, USA
| | - Janell L Chaltas
- Sotera Wireless, Inc., 10020 Huennekens Street, San Diego, CA, 92121, USA
| | - Anthony N DeMaria
- Department of Medicine, University of California San Diego School of Medicine, San Diego, CA, 92103, USA
| | - James B Moon
- Sotera Wireless, Inc., 10020 Huennekens Street, San Diego, CA, 92121, USA
| | - Andrew M Kahn
- Department of Medicine, University of California San Diego School of Medicine, San Diego, CA, 92103, USA
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Lorne E, Mahjoub Y, Diouf M, Sleghem J, Buchalet C, Guinot PG, Petiot S, Kessavane A, Dehedin B, Dupont H. Accuracy of impedance cardiography for evaluating trends in cardiac output: a comparison with oesophageal Doppler. Br J Anaesth 2014; 113:596-602. [PMID: 24871872 DOI: 10.1093/bja/aeu136] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Impedance cardiography (ICG) enables continuous, beat-by-beat, non-invasive, operator-independent, and inexpensive cardiac output (CO) monitoring. We compared CO values and variations obtained by ICG (Niccomo™, Medis) and oesophageal Doppler monitoring (ODM) (CardioQ™, Deltex Medical) in surgical patients. METHODS This prospective, observational, single-centre study included 32 subjects undergoing surgery with general anaesthesia. CO was measured simultaneously with ICG and ODM before and after events likely to modify CO (vasopressor administration and volume expansion). One hundred and twenty pairs of CO measurements and 94 pairs of CO variation measurements were recorded. RESULTS The CO variations measured by ICG correlated with those measured by ODM [r=0.88 (0.82-0.94), P<0.001]. Trending ability was good for a four-quadrant plot analysis with exclusion of the central zone (<10%) [95% confidence interval (CI) for concordance (0.86; 1.00)]. Moderate to good trending ability was observed with a polar plot analysis (angular bias: -7.2°; 95% CI -12.3°; -2.5°; with radial limits of agreement -38°; 24°). After excluding subjects with chronic obstructive pulmonary disease, a Bland-Altman plot showed a mean bias of 0.47 litre min(-1), limits of agreements between -1.24 and 2.11 litre min(-1), and a percentage error of 35%. CONCLUSION ICG appears to be a reliable method for the non-invasive monitoring of CO in patients undergoing general surgery.
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Affiliation(s)
- E Lorne
- Department of Anesthesiology and Critical Care Medicine and INSERM U1088, Jules Verne University of Picardy, Amiens, France
| | - Y Mahjoub
- Department of Anesthesiology and Critical Care Medicine and INSERM U1088, Jules Verne University of Picardy, Amiens, France
| | - M Diouf
- Biostatistics Department, Amiens University Medical Center, Amiens, France
| | - J Sleghem
- Department of Anesthesiology and Critical Care Medicine and
| | - C Buchalet
- Department of Anesthesiology and Critical Care Medicine and
| | - P-G Guinot
- Department of Anesthesiology and Critical Care Medicine and
| | - S Petiot
- Department of Anesthesiology and Critical Care Medicine and
| | - A Kessavane
- Department of Anesthesiology and Critical Care Medicine and
| | - B Dehedin
- Department of Anesthesiology and Critical Care Medicine and
| | - H Dupont
- Department of Anesthesiology and Critical Care Medicine and INSERM U1088, Jules Verne University of Picardy, Amiens, France
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Critchley LAH, Huang L, Zhang J. Continuous Cardiac Output Monitoring: What Do Validation Studies Tell Us? CURRENT ANESTHESIOLOGY REPORTS 2014. [DOI: 10.1007/s40140-014-0062-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Siebenmann C, Rasmussen P, Sørensen H, Zaar M, Hvidtfeldt M, Pichon A, Secher NH, Lundby C. Cardiac output during exercise: A comparison of four methods. Scand J Med Sci Sports 2014; 25:e20-7. [DOI: 10.1111/sms.12201] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2014] [Indexed: 12/21/2022]
Affiliation(s)
- C. Siebenmann
- Center for Integrative Human Physiology; Institute of Physiology; University of Zürich; Zürich Switzerland
| | - P. Rasmussen
- Center for Integrative Human Physiology; Institute of Physiology; University of Zürich; Zürich Switzerland
| | - H. Sørensen
- Department of Anesthesia; The Copenhagen Muscle Research Center; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - M. Zaar
- Department of Anesthesia; The Copenhagen Muscle Research Center; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - M. Hvidtfeldt
- Department of Anesthesia; The Copenhagen Muscle Research Center; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - A. Pichon
- Laboratoire Réponses Cellulaires et Fonctionnelles à l'Hypoxie; Université Paris 13; Bobigny France
| | - N. H. Secher
- Department of Anesthesia; The Copenhagen Muscle Research Center; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - C. Lundby
- Center for Integrative Human Physiology; Institute of Physiology; University of Zürich; Zürich Switzerland
- Food & Nutrition & Sport Science; Gothenburg University; Gothenburg Sweden
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Kupersztych-Hagege E, Teboul JL, Artigas A, Talbot A, Sabatier C, Richard C, Monnet X. Bioreactance is not reliable for estimating cardiac output and the effects of passive leg raising in critically ill patients. Br J Anaesth 2013; 111:961-6. [PMID: 23985531 DOI: 10.1093/bja/aet282] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Bioreactance estimates cardiac output in a non-invasive way. We evaluated the ability of a bioreactance device (NICOM®) to estimate cardiac index (CI) and to track relative changes induced by volume expansion. METHODS In 48 critically ill patients, we measured CI estimated by the NICOM® device (CINicom) and by transpulmonary thermodilution (CItd, PiCCO2™ device) before and after a 500 ml saline infusion. Before volume expansion, we performed a passive leg raising (PLR) test and measured the changes it induced in CINicom and in pulse contour analysis-derived CI. RESULTS Considering the values recorded before PLR and before and after volume expansion (n=144), the bias (lower and upper limits of agreement) between CItd and CINicom was 0.9 (-2.2 to 4.1) litre min(-1) m(-2). The percentage error was 82%. There was no significant correlation between the changes in CItd and CINicom induced by volume expansion (P=0.24). An increase in CI estimated by pulse contour analysis >9% during the PLR test predicted fluid responsiveness with a sensitivity of 84% (95% confidence interval 60-97%) and a specificity of 97% (95% confidence interval 82-100%). The area under the receiver operating characteristic curve constructed to test the ability of the PLR-induced changes in CINicom in predicting fluid responsiveness did not differ significantly from 0.5 (P=0.77). CONCLUSIONS The NICOM® device cannot accurately estimate the cardiac output in critically ill patients. Moreover, it could not predict fluid responsiveness through the PLR test.
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Affiliation(s)
- E Kupersztych-Hagege
- Hôpitaux universitaires Paris-Sud, Hôpital de Bicêtre, service de réanimation médicale, 78, rue du Général Leclerc, F-94270 Le Kremlin-Bicêtre, France
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Minimally- and non-invasive assessment of maternal cardiac output: go with the flow! Int J Obstet Anesth 2011; 20:330-40. [DOI: 10.1016/j.ijoa.2011.07.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Revised: 06/29/2011] [Accepted: 07/05/2011] [Indexed: 10/17/2022]
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Critchley LA, Lee A, Ho AMH. A Critical Review of the Ability of Continuous Cardiac Output Monitors to Measure Trends in Cardiac Output. Anesth Analg 2010; 111:1180-92. [DOI: 10.1213/ane.0b013e3181f08a5b] [Citation(s) in RCA: 380] [Impact Index Per Article: 27.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Petter H, Erik A, Björn E, Göran R. Measurement of cardiac output with non-invasive Aesculon® impedance versus thermodilution. Clin Physiol Funct Imaging 2010; 31:39-47. [DOI: 10.1111/j.1475-097x.2010.00977.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kemps HMC, Thijssen EJM, Schep G, Sleutjes BTHM, De Vries WR, Hoogeveen AR, Wijn PFF, Doevendans PAFM. Evaluation of two methods for continuous cardiac output assessment during exercise in chronic heart failure patients. J Appl Physiol (1985) 2008; 105:1822-9. [DOI: 10.1152/japplphysiol.90430.2008] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The purpose of this study was to evaluate the accuracy of two techniques for the continuous assessment of cardiac output in patients with chronic heart failure (CHF): a radial artery pulse contour analysis method that uses an indicator dilution method for calibration (LiDCO) and an impedance cardiography technique (Physioflow), using the Fick method as a reference. Ten male CHF patients (New York Heart Association class II–III) were included. At rest, cardiac output values obtained by LiDCO and Physioflow were compared with those of the direct Fick method. During exercise, the continuous Fick method was used as a reference. Exercise, performed on a cycle ergometer in upright position, consisted of two constant-load tests at 30% and 80% of the ventilatory threshold and a symptom-limited maximal test. Both at rest and during exercise LiDCO showed good agreement with reference values [bias ± limits of agreement (LOA), −1% ± 28% and 2% ± 28%, respectively]. In contrast, Physioflow overestimated reference values both at rest and during exercise (bias ± LOA, 48% ± 60% and 48% ± 52%, respectively). Exercise-related within-patient changes of cardiac output, expressed as a percent change, showed for both techniques clinically acceptable agreement with reference values (bias ± LOA: 2% ± 26% for LiDCO, and −2% ± 36% for Physioflow, respectively). In conclusion, although the limits of agreement with the Fick method are pretty broad, LiDCO provides accurate measurements of cardiac output during rest and exercise in CHF patients. Although Physioflow overestimates cardiac output, this method may still be useful to estimate relative changes during exercise.
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