Intensive Care Medicine

, Volume 30, Issue 11, pp 2060–2066 | Cite as

The validity of trans-esophageal Doppler ultrasonography as a measure of cardiac output in critically ill adults

Original

Abstract

Objective

To determine the validity of the esophageal Doppler monitor (EDM) and echo-esophageal Doppler (Echo-ED) in measuring cardiac output in the critically ill.

Design

Systematic search of relevant international literature and data synthesis.

Search strategy

Literature search (1989–2003) using Ovid interface to Medline, Embase and Cochrane databases aimed at finding studies comparing EDM or Echo-ED cardiac output with that derived from simultaneous pulmonary artery thermodilution (PACTD) with Bland Altman measures of validity.

Patients

Critically ill adults in operating departments or intensive care units.

Data synthesis

Summary validity measures synthesized from Bland Altman analyses included pooled median bias and the median percentage of clinical agreement (PCA) derived from the limits of agreement.

Main results

Eleven validation papers for EDM (21 studies) involving 314 patients and 2,400 paired measurements. The pooled median bias for PACTD versus EDM was 0.19 l/min (range −0.69 to 2.00 l/min) for cardiac output (16 studies), and 0.6% (range 0–2.3%) for changes in cardiac output (5 studies). The pooled median percentage of clinical agreement for PACTD versus EDM was 52% (interquartile range 42–69%) for cardiac output and 86% (interquartile range 55–93%) for changes in cardiac output. These differences in PCA were significant (p=0.03 Mann-Whitney) for bolus PACTD as the clinical “gold standard”. We found an insufficient number of studies (2 papers) to assess the validity of Echo-ED.

Conclusions

The esophageal Doppler monitor has high validity (no bias and high clinical agreement with pulmonary artery thermodilution) for monitoring changes in cardiac output.

Keywords

Cardiac output Trans-esophageal Doppler ultrasonography Esophageal Doppler monitoring 

References

  1. 1.
    Pulmonary Artery Catheter Consensus Conference participants (1997) Pulmonary artery catheter consensus conference: consensus statement. Crit Care Med 25:910–924PubMedGoogle Scholar
  2. 2.
    Chaney JC, Derdak S (2002) Minimally invasive hemodynamic monitoring for the intensivist: current and emerging technology. Crit Care Med 30:2338–2345CrossRefPubMedGoogle Scholar
  3. 3.
    Side C, Gosling R (1971) Non-surgical assessment of cardiac function. Nature 232:335–336PubMedGoogle Scholar
  4. 4.
    Singer M, Clarke J, Bennett ED (1989) Continuous hemodynamic monitoring by esophageal Doppler. Crit Care Med 17:447–452PubMedGoogle Scholar
  5. 5.
    Venn R, Rhodes A, Bennett ED (1999) The esophageal Doppler. In: Vincent JL (ed) Yearbook of Intensive Care and Emergency Medicine. Springer Verlag, Berlin, pp 482–493Google Scholar
  6. 6.
    Laupland KB, Bands CJ (2002) Utility of esophageal Doppler as a minimally invasive hemodynamic monitor: a review. Can J Anesth 49:393–401Google Scholar
  7. 7.
    Schmid ER, Spahn DR, Tornic M (1993) Reliability of a new generation transesophageal Doppler device for cardiac output monitoring. Anesth Analg 77:971–979PubMedGoogle Scholar
  8. 8.
    Bland MJ, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet I: 307–310Google Scholar
  9. 9.
    Colbert S, O’Hanlon DM, Duranteau J, Ecoffey C (1998) Cardiac output during liver transplantation. Can J Anesth 45:133–138Google Scholar
  10. 10.
    Valtier B, Cholley BP, Belot JP, de la Coussaye JE, Mateo J, Payen DM (1998) Noninvasive monitoring of cardiac output in critically ill patients using transesophageal Doppler. Am J Respir Crit Care Med 158:77–83PubMedGoogle Scholar
  11. 11.
    Nuan-Yen S, Chun-Jen H, Peishan T, Yung-Wei H, Yu-Chun H, Ching-Rong C (2002) Cardiac output measurement during cardiac surgery: esophageal Doppler versus pulmonary artery catheter. Acta Anaesthesiol Sin 40:127–123PubMedGoogle Scholar
  12. 12.
    Singer M, Bennett ED (1991) Noninvasive optimization of left ventricular filling using esophageal Doppler. Crit Care Med 19:1132–1137PubMedGoogle Scholar
  13. 13.
    Klotz KF, Klingsiek S, Singer M, Wenk H, Eleftheriadis S, Kuppe H, Schmucker P (1995) Continuous measurement of cardiac output during aortic cross-clamping by the oesophageal Doppler monitor ODM 1. Br J Anaesth 74:655–660PubMedGoogle Scholar
  14. 14.
    Keyl C, Rodig G, Lemberger P, Hobbhahn J (1996) A comparison of the use of transoesophageal Doppler and thermodilution techniques for cardiac output determination. Eur J Anaesth 13:136–142CrossRefGoogle Scholar
  15. 15.
    Krishnamurthy B, McMurray TJ, McClean E (1997) The peri-operative use of oesophageal Doppler monitor in patients undergoing coronary artery revascularisation. A comparison with the continuous cardiac output monitor. Anaesth 52:624–629CrossRefGoogle Scholar
  16. 16.
    Lefrant JY, Bruelle P, Aya AG, Saissi G, Dauzat M, de la Coussaye JE, Eledjam JJ (1998) Training is required to improve the reliability of esophageal Doppler to measure cardiac output in critically ill patients. Intensive Care Med 24:347–352CrossRefPubMedGoogle Scholar
  17. 17.
    Baillard C, Cohen Y, Fosse JP, Karoubi P, Hoang P, Cupa M (1999) Haemodynamic measurements in critically ill patients: transoesophageal versus continuous thermodilution. Anaesth Intensive Care 27:33–37PubMedGoogle Scholar
  18. 18.
    Penny JA, Anthony J, Shennan AH, De Swiet M, Singer M (2000) A comparison of hemodynamic data derived by pulmonary artery flotation catheter and the esophageal Doppler monitor in pre-eclampsia. Am J Obstet Gynecol 183:658–661CrossRefPubMedGoogle Scholar
  19. 19.
    Leather HA, Wouters PF (2001) Oesophageal Doppler monitoring overestimates cardiac output during lumbar epidural anaesthesia. Br J Anaesth 86:794–797CrossRefPubMedGoogle Scholar
  20. 20.
    Jaeggi P, Hofer CK, Klaghofer R, Fodor P, Genoni M, Zollinger A (2003) Measurement of cardiac output after cardiac surgery by a new transesophageal Doppler device. J Cardiothorac Vasc Anesth 17:217–220CrossRefPubMedGoogle Scholar
  21. 21.
    Le Tulzo Y, Belghith M, Seguin P, Dall’Ava J, Monchi M, Thomas R, Dhainaut JF (1996) Reproducibility of thermodilution cardiac output determination in critically ill patients: comparison between bolus and continuous method. J Clin Monit 12:379–385PubMedGoogle Scholar
  22. 22.
    Medin DL, Brown DT, Wesley R, Cunnion RE, Ognilbene FP (1998) Validation of continuous thermodilution cardiac output in critically ill patients with analysis of systematic errors. J Crit Care 13:184–189CrossRefPubMedGoogle Scholar
  23. 23.
    Zollner C, Goetz AE, Weis M, Morstedt K, Pichler B, Lamm P, Kilger E, Haller M (2001) Continuous cardiac output measurements do not agree with conventional bolus thermodilution cardiac output determination. Can J Anesth 48:1143–1147Google Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  1. 1.Department of Intensive Care Medicine, Injury, Repair and Rehabilitation Research Group, Hope Hospital University of ManchesterGreater ManchesterUK
  2. 2.Department of Medicine and Wolfson Institute of Biomedical ResearchUniversity College LondonLondonUK

Personalised recommendations