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Transesophageal Doppler reliably tracks changes in cardiac output in comparison with intermittent pulmonary artery thermodilution in cardiac surgery patients

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Abstract

In this study a comparison of cardiac output (CO) measurements obtained with CardioQ transesophageal Doppler (TED) and pulmonary artery catheter (PAC) thermodilution (TD) technique was done in a systematic set-up, with induced changes in preload, afterload and heart rate. Twenty-five patients completed the study. Each patient were placed in the following successive positions: (1) supine, (2) head-down tilt, (3) head-up tilt, (4) supine, (5) supine with phenylephrine administration, (6) pace heart rate 80 beats per minute (bpm), (7) pace heart rate 110 bpm. The agreement of compared data was investigated by Bland–Altman plots, and to assess trending ability a four quadrants plot and a polar plot were constructed. Both methods showed an acceptable precision 6.4 % (PAC TD) and 12.8 % (TED). In comparison with PAC TD, the TED was associated with a mean bias in supine position of −0.30 l min−1 (95 % CI −0.88; 0.27), wide limits of agreement, a percentage error of 69.5 %, and a trending ability with a concordance rate of 92 %, angular bias of 1.1° and a radial sector size of 40.0° corresponding to an acceptable trending ability. In comparison with PAC TD, the CardioQ TED showed a low mean bias, wide limits of agreement and a larger percentage error than should be expected from the precision of the two methods. However, an acceptable trending ability was found. Thus, the CardioQ TED should not replace CO measurements done by PAC TD, but could be a valuable tool in guiding therapy.

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Acknowledgments

This work was financially supported by the Department of Cardiothoracic Anesthesiology, Rigshospitalet, Denmark.

Authorship

All authors have approved to the submitted manuscript. hms: study design, data-analysis and interpretation, drafting the article; jc: patient recruitment, acquisition of data, revising article draft; klh: data-analysis and interpretation, revising article draft; mø: acquisition of data, revising article draft; jcn: data-interpretation, revising article draft.

Author information

Authors and Affiliations

  1. Department of Cardiothoracic Anesthesiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen OE, Denmark

    Hasse Møller-Sørensen, Joakim Cordtz, Morten Østergaard & Jens C. Nilsson

  2. Department of Radiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark

    Kristoffer L. Hansen

Authors
  1. Hasse Møller-Sørensen
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  2. Joakim Cordtz
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  3. Morten Østergaard
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  4. Jens C. Nilsson
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  5. Kristoffer L. Hansen
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Corresponding author

Correspondence to Hasse Møller-Sørensen.

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Conflicts of interest

None; Specifically no commercial funding was received. The CardioQ esophageal probes and the CardioQ-ODM were sponsored by NEOVITALIS ApS.

Take-home message

Transesophageal Doppler reliably tracks changes in cardiac output, but can not replace measurements of cardiac output obtained with PAC.

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Møller-Sørensen, H., Cordtz, J., Østergaard, M. et al. Transesophageal Doppler reliably tracks changes in cardiac output in comparison with intermittent pulmonary artery thermodilution in cardiac surgery patients. J Clin Monit Comput 31, 135–142 (2017). https://doi.org/10.1007/s10877-015-9806-4

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  • DOI: https://doi.org/10.1007/s10877-015-9806-4

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