Intensive Care Medicine

, Volume 30, Issue 1, pp 82–87

A comparative evaluation of thermodilution and partial CO2 rebreathing techniques for cardiac output assessment in critically ill patients during assisted ventilation

  • Monica Rocco
  • Gustavo Spadetta
  • Andrea Morelli
  • Donatella Dell’Utri
  • Patrizia Porzi
  • Giorgio Conti
  • Paolo Pietropaoli
Original

DOI: 10.1007/s00134-003-2069-4

Cite this article as:
Rocco, M., Spadetta, G., Morelli, A. et al. Intensive Care Med (2004) 30: 82. doi:10.1007/s00134-003-2069-4

Abstract

Objective

To evaluate the reliability and clinical value of partial noninvasive CO2 (NICO2) rebreathing technique for measuring cardiac output compared with standard thermodilution in a group of intensive care nonpostoperative patients.

Design and setting

Clinical investigation in a university hospital ICU.

Patients

Twelve mechanically ventilated patients with high ( n =6) and low ( n =6) pulmonary shunt fractions.

Measurements and results

Thirty-six paired measurements of cardiac output were carried out with NICO2 and thermodilution in patients ventilated in pressure-support mode and sedated with a sufentanil continuous infusion to obtain a Ramsay score value of 2. The mean cardiac output was: thermodilution 7.27±2.42 l/min; NICO2 6.10±1.66 l/min; r 2 was 0.62 and bias −1.2 l/min±1.5. Mean values of cardiac output were similar in the low shunt group (\( {\dot{\text {Q}}} {\text {s}} /\ {\dot{\text {Q}}} {\text {t}} < 20 \)), with r2=0.90 and a bias of 0.01 l/min±0.4; conversely, in the high pulmonary shunt group (\( {\dot{\text {Q}}} {\text {s}} /\ {\dot{\text {Q}}} > 35\% \)) the mean was 9.32±1.23 l/min with thermodilution and a mean NICO2CO value was 6.97±1.53 l/min, with r2 of 0.38 and a bias of −2.3 l±1.2 min.

Conclusions

The partial CO2 rebreathing technique is reliable in measuring cardiac output in nonpostoperative critically ill patients affected by diseases causing low levels of pulmonary shunt, but underestimates it in patients with shunt higher than 35%.

Keywords

Noninvasive CO2 rebreathing technique Thermodilution Cardiac output Hemodynamic evaluation Pulmonary shunt 

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • Monica Rocco
    • 1
  • Gustavo Spadetta
    • 1
  • Andrea Morelli
    • 1
  • Donatella Dell’Utri
    • 1
  • Patrizia Porzi
    • 1
  • Giorgio Conti
    • 2
  • Paolo Pietropaoli
    • 1
  1. 1.Department of Anesthesiology and Intensive CareUniversity of Rome La SapienzaRomeItaly
  2. 2.Department of Anesthesiology and Intensive CareCatholic University of RomeRomeItaly

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