Intensive Care Medicine

, Volume 33, Issue 7, pp 1191–1194 | Cite as

Noninvasive cardiac output monitoring (NICOM): a clinical validation

  • Pierre Squara
  • Dominique Denjean
  • Philippe Estagnasie
  • Alain Brusset
  • Jean Claude Dib
  • Claude Dubois
Brief Report



To evaluate the clinical utility of a new device for continuous noninvasive cardiac output monitoring (NICOM) based on chest bio-reactance compared with cardiac output measured semi-continuously by thermodilution using a pulmonary artery catheter (PAC-CCO).


Prospective, single-center study.


Intensive care unit.


Consecutive adult patients immediately after cardiac surgery.


Cardiac output measurements obtained from NICOM and thermodilution were simultaneously recorded minute by minute and compared in 110 patients. We evaluated the accuracy, precision, responsiveness, and reliability of NICOM for detecting cardiac output changes. Tolerance for each of these parameters was specified prospectively.

Measurements and results

A total of 65,888 pairs of cardiac output measurements were collected. Mean reference values for cardiac output ranged from 2.79 to 9.27 l/min. During periods of stable PAC-CCO (slope < ± 10%, 2SD/mean < 20%), the correlation between NICOM and thermodilution was R = 0.82; bias was +0.16 ± 0.52 l/min (+4.0 ± 11.3%), and relative error was 9.1% ± 7.8%. In 85% of patients the relative error was < 20%. During periods of increasing output, slopes were similar with the two methods in 96% of patients and intra-class correlation was positive in 96%. Corresponding values during periods of decreasing output were 90% and 84%, respectively. Precision was always better with NICOM than with thermodilution. During hemodynamic challenges, changes were 3.1 ± 3.8 min faster with NICOM (p < 0.01) and amplitude of changes did not differ significantly. Finally, sensitivity of the NICOM for detecting significant directional changes was 93% and specificity was 93%.


Cardiac output measured by NICOM had most often acceptable accuracy, precision, and responsiveness in a wide range of circulatory situations.


Chronic Obstructive Pulmonary Disease Cardiac Output Tricuspid Regurgitation Cardiac Output Measurement High Peep 

Supplementary material

134_2007_640_MOESM1_ESM.doc (554 kb)
Electronic Supplementary Material (DOC 554K)


  1. 1.
    Boldt J, Menges T, Wollbruck M, Hammermann H, Hempelmann G (1994) Is continuous cardiac output measurement using thermodilution reliable in the critically ill patient? Crit Care Med 22:1913–1918CrossRefPubMedGoogle Scholar
  2. 2.
    Gratz I, Kraidin J, Jacobi AG, deCastro NG, Spagna P, Larijani GE (1992) Continuous noninvasive cardiac output as estimated from the pulse contour curve. J Clin Monit 8:20–27CrossRefPubMedGoogle Scholar
  3. 3.
    Combes A, Berneau JB, Luyt CE, Trouillet JL (2004) Estimation of left ventricular systolic function by single transpulmonary thermodilution. Intensive Care Med 30:1377–1383PubMedGoogle Scholar
  4. 4.
    Rocco M, Spadetta G, Morelli A, Dell'Utri D, Porzi P, Conti G, Pietropaoli P (2004) A comparative evaluation of thermodilution and partial CO2 rebreathing techniques for cardiac output assessment in critically ill patients during assisted ventilation. Intensive Care Med 30:82–87CrossRefPubMedGoogle Scholar
  5. 5.
    Su NY, Huang CJ, Tsai P, Hsu YW, Hung YC, Cheng CR (2002) Cardiac output measurement during cardiac surgery: esophageal Doppler versus pulmonary artery catheter. Acta Anaesthesiol Sin 40:127–133PubMedGoogle Scholar
  6. 6.
    Dark PM, Singer M (2004) The validity of trans-esophageal Doppler ultrasonography as a measure of cardiac output in critically ill adults. Intensive Care Med 30:2060–2066CrossRefPubMedGoogle Scholar
  7. 7.
    Barin E, Haryadi D, Schookin S, Westenskow D, Zubenko V, Beliaev K, Morozov A (2000) Evaluation of a thoracic bioimpedance cardiac output monitor during cardiac catheterization. Crit Care Med 28:698–702CrossRefPubMedGoogle Scholar
  8. 8.
    Bernstein DP (1986) Continuous noninvasive real-time monitoring of stroke volume and cardiac output by thoracic electrical bioimpedance. Crit Care Med 14:898–901CrossRefPubMedGoogle Scholar
  9. 9.
    Spiess B, Patel M, Soltow L, Wright I (2001) Comparison of bioimpedance versus thermodilution cardiac output during cardiac surgery: evaluation of a second-generation bioimpedance device. J Cardiothorac Vasc Anesth 15:567–573CrossRefPubMedGoogle Scholar
  10. 10.
    Leslien S, McKee S, Newby D, Webb D, Denvir M (2004) Non-invasive measurement of cardiac output in patients with chronic heart failure. Blood Press Monit 9:277–280CrossRefGoogle Scholar
  11. 11.
    Engoren M, Barbee D (2005) Comparison of cardiac output determined by bioimpedance, thermodilution, and the Fick method. Am J Crit Care 14:40–45PubMedGoogle Scholar
  12. 12.
    Squara P, Estagnasie P, Denjean D, Brusset A, Dib J, Dubois C (2006) NICOM (Non Invasive Cardiac Output Monitoring) Clinical Evaluation. Proc Am Thorac Soc 3:A295Google Scholar
  13. 13.
    Haller M, Zollner C, Briegel J, Forst H (1995) Evaluation of a new continuous thermodilution cardiac output monitor in critically ill patients: a prospective criterion standard study. Crit Care Med 23:860–866CrossRefPubMedGoogle Scholar
  14. 14.
    Nelson LD (1997) The new pulmonary artery catheters: continuous venous oximetry, right ventricular ejection fraction, and continuous cardiac output. New Horiz 5:251–258PubMedGoogle Scholar
  15. 15.
    Mihm FG, Gettinger A, Hanson CW 3rd, Gilbert HC, Stover EP, Vender JS, Beerle B, Haddow G (1998) A multicenter evaluation of a new continuous cardiac output pulmonary artery catheter system. Crit Care Med 26:1346–1350CrossRefPubMedGoogle Scholar
  16. 16.
    Stetz CW, Miller RG, Kelly GE, Raffin TA (1982) Reliability of the thermodilution method in the determination of cardiac output in clinical practice. Am Rev Respir Dis 126:1001–1004PubMedGoogle Scholar
  17. 17.
    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 12:379–385CrossRefPubMedGoogle Scholar
  18. 18.
    Critchley LA, Critchley JA (1999) A meta-analysis of studies using bias and precision statistics to compare cardiac output measurement techniques. J Clin Monit Comput 15:85–91CrossRefPubMedGoogle Scholar
  19. 19.
    Hillis LD, Firth BG, Winniford MD (1985) Analysis of factors affecting the variability of Fick versus indicator dilution measurements of cardiac output. Am J Cardiol 56:764–768CrossRefPubMedGoogle Scholar
  20. 20.
    Rubini A, Del Monte D, Catena V, Attar I, Cesaro M, Soranzo D, Rattazzi G, Alati GL (1995) Cardiac output measurement by the thermodilution method: an in vitro test of accuracy of three commercially available automatic cardiac output computers. Intensive Care Med 21:154–158CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Pierre Squara
    • 1
  • Dominique Denjean
    • 1
  • Philippe Estagnasie
    • 1
  • Alain Brusset
    • 1
  • Jean Claude Dib
    • 1
  • Claude Dubois
    • 1
  1. 1.CERICClinique Ambroise ParéNeuilly-sur-SeineFrance

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