Cardiac output monitoring in the critically ill patient is
standard practice in order to ensure tissue oxygenation
[1] and has been traditionally accomplished using the
pulmonary artery catheter (PAC) In recent years,
however, the value of PAC has been questioned with
some suggesting that its use might not only be unnecessary
but also potentially harmful [1] Th is notion,
together with the availability of new less invasive cardiac
output measuring devices, has markedly decreased the
widespread use of the PAC [2] Today, various devices are
available to measure or estimate cardiac output using
diff erent methods Some of these less invasive devices
track stroke volume (SV) continuously and provide
dynamic indices of fl uid responsiveness, others allow
assessment of volumetric preload variables, and some
also provide continuous measurement of central venous
saturation via the use of proprietary catheters that are
attached to the same monitor All these variables –
together with cardiac output – may result in an improved
hemodynamic assessment of the critically ill patient
However, it is important to appreciate that each device
has its inherent limitations and that no cardiac output
monitoring device can change patient outcome unless its
use is coupled with an intervention that by itself has been
associated with improved patient outcomes Th erefore,
the concept of hemodynamic optimization is increasingly
recognized as a cornerstone in the management of
critically ill patients and has been shown to be associated
with improved outcome in the perioperative [3] and in
the intensive care unit (ICU) [4] setting
Th e aim of this article is to provide a systematic update
of the currently available and most commonly used
cardiac output monitoring devices In addition, an integrated
approach for the use of these diff erent devices in
critically ill patients will be presented taking into considera
tion the devices’ technical characteristics, their
perfor mance and typical limitations, and also any additional
hemodynamic variables they may offer

Cardiac output monitoring: an integrative perspective

Objectives:Echocardiography and pulse contour methods allow, respectively, noninvasive and less invasive cardiac output estimation. The aim of the present study was to compare Doppler echocardiography with the pulse contour method MostCare for cardiac output estimation in a large and nonselected cri

Comparison Between Doppler-Echocardiography and Uncalibrated Pulse Contour Method for Cardiac Output Measurement: A Multicenter Observational Study.

Thermodilution vs pressure recording analytical method in hemodynamic stabilized patients.

FloTrac/Vigileo(TM) (third generation) and MostCare(®)/PRAM versus echocardiography for cardiac output estimation in vascular surgery

Summary
Background

Pulse pressure variation (PPV) is a dynamic index of fluid responsiveness. This parameter helps clinicians in improving haemodynamic status while avoiding potential fluid overload. Echocardiographic indices, such as E/E' ratio and left atrial (LA) strain by speckle tracking echocardiography (STE), are used to estimate left ventricular (LV) filling pressures. This study aimed at exploring the relationship between PPV and echocardiographic indices of LV filling pressures in critically ill patients.



Methods

Twenty-two patients (mean age of 50·9 ± 21·6, male/female = 15/7) admitted to intensive care unit, and requiring mechanical ventilation and invasive arterial pressure monitoring, were studied. In all patients, two independent operators assessed simultaneously PPV, using a pulse contour method, mean E/E' ratio and peak atrial longitudinal strain (PALS) by means of STE. PALS values were obtained by averaging LA segments measured in the 4-chamber and 2-chamber views (global PALS).



Results

A significant negative correlation was found between mean E/E' ratio and PPV (R2 = −0·76; P 15%.



Conclusion

In a group of mechanically ventilated patients PPV, derived from pulse contour analysis, and echocardiographic preload parameters were well correlated. Global PALS by STE provided better estimation of PPV than mean E/E' ratio. PALS seems a potential alternative to PPV in assessing fluid responsiveness in critically ill patients.

Relationship between pulse pressure variation and echocardiographic indices of left ventricular filling pressure in critically ill patients.

BACKGROUND Echocardiography is a valuable technique to assess cardiac output (CO) in trauma patients, but it does not allow a continuous bedside monitoring. Beat-to-beat CO assessment can be obtained by other techniques, including the pulse contour method MostCare. The aim of our study was to compare CO obtained with MostCare (MC-CO) with CO estimated by transthoracic echocardiography (TTE-CO) in trauma patients. METHODS Forty-nine patients with blunt trauma admitted to an intensive care unit and requiring hemodynamic optimization within 24 hours from admission were studied. TTE-CO and MC-CO were estimated simultaneously at baseline, after a fluid challenge and after the start of vasoactive drug therapy. RESULTS One hundred sixteen paired CO values were obtained. TTE-CO values ranged from 2.9 to 7.6 L·min(-1), and MC-CO ranged from 2.8 to 8.2 L·min(-1). The correlation between the two methods was 0.94 (95% confidence interval [CI]=0.89 to 0.97; P<0.001). The mean bias was -0.06 L·min(-1) with limits of agreements (LoA) of -0.94 to 0.82 L·min(-1) (lower 95% CI, -1.16 to -0.72; upper 95% CI, 0.60 to 1.04) and a percentage error of 18%. Changes in CO showed a correlation of 0.91 (95% CI=0.87 to 0.95; P<0.001), a mean bias of -0.01 L·min(-1) with LoA of -0.67 to 0.65 L·min(-1) (lower 95% CI, -0.83 to -0.51; upper 95% CI, 0.48 to 0.81). CONCLUSION CO measured by MostCare showed good agreement with CO obtained by transthoracic echocardiography. Pulse contour analysis can complement echocardiography in evaluating hemodynamics in trauma patients.

Echocardiography and pulse contour analysis to assess cardiac output in trauma patients.

Author reply to: can transthoracic echocardiography be used as a reference method for cardiac output measurement?

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Echocardiography and pulse contour analysis to assess cardiac output in trauma patients.

Author reply to: can transthoracic echocardiography be used as a reference method for cardiac output measurement?