Noninvasive monitoring of cardiac output in critically ill patients using transesophageal Doppler

• Published in: American journal of respiratory and critical care medicine Vol. 158; no. 1; pp. 77 - 83
• Main Authors: VALTIER, B, CHOLLEY, B. P, BELOT, J.-P, DE LA COUSSAYE, J.-E, MATEO, J, PAYEN, D. M
• Format: Journal Article
• Language: English
• Published: New York, NY American Lung Association 01-07-1998
• Subjects: Adult; Aged; Biological and medical sciences; Cardiac Output; Cardiovascular system; Critical Illness; Echocardiography, Transesophageal; Female; Humans; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Monitoring, Physiologic - methods; Oxygen Consumption; Prospective Studies; Reproducibility of Results; Respiration, Artificial; Thermodilution; Ultrasonic investigative techniques; Sonography; Heart; Doppler ultrasound study; Human; Intensive care; Critically ill; Artificial ventilation; Blood flow; Validity; Thermodilution; Surveillance; Measurement technique; Cardiac output; Mechanical ventilation; Comparative study
• ISSN: 1073-449X; 1535-4970
• DOI: 10.1164/ajrccm.158.1.9707031

Measurement of cardiac output using thermodilution technique in mechanically ventilated patients is associated with significant morbidity. The goal of the present study was to assess the validity of cardiac output measurement using transesophageal Doppler in critically ill patients. Forty-six patients from three different intensive care units underwent 136 paired cardiac output measurements using thermodilution (COTH) and transesophageal Doppler (COTED). In addition, simultaneous suprasternal Doppler and indirect calorimetry (Fick principle) were used to measure cardiac output in 26 patients from one center. A good correlation was found between COTH and COTED (r = 0.95), with a small systematic underestimation (bias = 0.24 L/min) using transesophageal Doppler. The limits of agreement between COTH and COTED were +2 L/min and -1.5 L/min. Variations in cardiac output between two consecutive measures using either transesophageal Doppler or thermodilution techniques were similar in direction and magnitude (bias = 0 L/min; limits of agreement = +/-1.7 L/min). Suprasternal Doppler and indirect calorimetry yielded similar correlations and agreements in the subset of patients in whom they were used. These results confirm that transesophageal Doppler can provide a noninvasive, clinically useful estimate of cardiac output and detect hemodynamic changes in mechanically ventilated, critically ill patients.