Abstract
Objective. A semi-continuous thermodilution method (CCO) was recently developed to measure cardiac output with less risk of bacterial contamination, fluid overload, and user-induced errors than the classical bolus technique (BCO). Previous comparison between these two methods showed negligible bias. However, large limits of agreement suggest that the two methods are not interchangeable. We hypothesized that this poor agreement may be due to differences in reproducibility.Methods. In 23 critically ill patients, 369 paired measurements of CCO and BCO were compared (range of cardiac outputs: 2.8 to 16 L/min). The reproducibility of BCO and CCO methods was evaluated on a sample of 205 and 209 determinations, respectively.Results. The comparison between the CCO and the BCO methods confirmed previous results: i.e., small bias (−0.39 L/min) and large limits of agreement ⊂-2.06 to +1.28 L/min). Reproducibility showed no bias for either the CCO or the BCO method. Limits of reproducibility agreement between repeated determinations were approximately 50% less for CCO than for BCO method: respectively −0.87 to +0.82 L/min for the CCO method and −1.56 to +1.37 L/min for the BCO method. Consequently, the threshold necessary to ascertain that the difference between two measurements was not due to the internal variability of the method (3 x SEM) was 0.39 for the CCO method and 0.75 L/min for the BCO method.Conclusion. Differences in reproducibility may explain the poor agreement between the CCO and BCO methods. The better reproducibility of the CCO method allows the detection of smaller variations in cardiac output and suggests the superiority of this new method.
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Matthay MA, Chatterjee K. Bedside catheterization of the pulmonary artery: Risk compared with benefits. Ann Int Med 1988; 103: 445–449
Myers ML, Austin TW, Sibbald WJ. Pulmonary artery catheter infections. Ann Surg 1985; 201: 237–241
Yelderman ML. Continuous measurement of cardiac output with the use of stochastic system identification techniques. J Clin Monit 1990; 6: 322–332
Yelderman ML, Ramsay MA, Quinn MD, Paulsen AW, MacKown RC, Gillman PH. Continuous thermodilution cardiac output measurement in intensive care unit patients. J Cardiothorac Vasc Anesth 1992; 6: 270–274
Yelderman ML, Quinn MD, McKown RC. Thermal safety of a filamented pulmonary artery catheter. J Clin Monit 1992; 8: 147–149
Lichtenthal PR, Wade LD. Clinical evaluation of a continuous cardiac output system in post operative cardiac surgical patients. Crit Care Med 1993; 21: S214
Spackman TN, Abenstein JF. Continuous cardiac output may be more accurate than bolus thermodilution output during the use of an upper-body warming blanket. Anesthesiology 1993; 79 (3A): A473
Glorieux D, Jacquet L, Matte P, Goenen M. Comparison of cardiac output measurement by continuous thermodilution, bolus thermodilution and Fick principle [abstract]. Intensive Care Med 1994; 20 (supp 2): S109
Schmid ER, Tornic R. Accuracy of continuous cardiac output monitoring by thermodilution [abstract]. Anesthesiology 1994; 81 (3A): A519
Lichrenthal PR, Wade LD. Clinical evaluation of theVigilance continuous cardiac output/Sv02 monitoring system in cardiac surgical patients [abstract]. Anesthesiology 1994; 81 (3A): A517
Böttiger BW, Soder M, Rauch H, Böhrer H, Morsch J, Martin E. Accuracy of continuous cardiac output monitoring in the intensive care unit [abstract]. Intensive Care Med 1994; 20 (supp 2): S129
Haller M, Zöllner C, Briegel J, Polasek J, Forst H. Evaluation of a new continuous thermodilution cardiac output monitor in critically ill patients [abstract]. Anesthesiology 1994; 81 (3A): A51
Munro HM, Wood CE, Taylor BL, Smirh GB. Continuous invasive cardiac output monitoring: The Baxter/Edwards Critical Care, Swan Ganz® Intellicath ™, and Vigilance™ system. Clin Intensive Care 1994; 5: 52–55
Boldt J, Menges T, Wollbrïck M, Hammermann H, Hempelmann G. Is continuous cardiac output measurement using thermodilution reliable in the critically ill patients. Crit Care Med 1994; 22: 1913–1918
Altman DG, Bland JM. Measurement in medicine: The analysis of method comparison studies. Statistician 1983; 32: 307–317
Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986; 1: 307–310
Stetz CW, Miller RG, Kelly GE, Raffin TA. Reliability of the thermodilution method in the determination of cardiac output in clinical practice. Am Rev Respir Dis 1982; 126: 1001–1004
Le Gall JR, Loirar P, Alperovitch A, et al. A simplified acute physiology score for ICU patients. Crit Care Med 1984; 12: 975–977
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Le Tulzo, Y., Belghith, M., Seguin, P. et al. Reproducibility of thermodilution cardiac output determination in critically ill patients: Comparison between bolus and continuous method. J Clin Monitor Comput 12, 379–385 (1996). https://doi.org/10.1007/BF02077635
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DOI: https://doi.org/10.1007/BF02077635