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Errors in the measurement of cardiac output by thermodilution

Abstract

Cardiac output (CO) determination by thermodilution, which was introduced by Fegler in 1954, has gained wide acceptance in clinical medicine and animal experiments because it has several advantages over other methods with respect to simplicity, accuracy, reproducibility, repeated measurements at short intervals, and because there is no need for blood withdrawal. However, errors in determination of CO by thermodilution may be introduced by technical factors and the patients’ pathological conditions. The current review summarizes these issues and provides our recommendations, based on the medical literature published between 1954–1992. To obtain more reproducible and accurate CO values by thermodilution, one should make several determinations (1) by using 10 ml injectate at room temperature for adults and 0.15 ml · kg−1 injectate for infants and children; (2) at evenly spaced intervals of the ventilation cycle; (3) when rapid intravenous fluid administration is discontinued; (4) by observing thermodilution curves so that baseline pulmonary artery temperature drift or the existence of intra- and extra-cardiac shunts are noticed. Finally, CO determination by thermodilution may be unreliable or impossible in patients with low CO slates and tricuspid or pulmonary regurgitation. Since non-invasive CO monitoring has not replaced CO determination by thermodilution, intimate knowledge of this method is crucial for anaesthetists to prevent errors in the management of patients.

Résumé

La mesure du débit cardiaque par thermodilution introduite par Fegler en 1954 est largement répandue en clinique et en recherche animale grâce à ses nombreux avantages sur les autres méthodes: simplicité, précision, reproductiblé, répétivité à courts intervalles, absence de prélèvement sanguin. Cependant, dans son application il peut facilement s’introduire des erreurs d’origine technique ou pathologique. La présente revue résume ces questions et propose certaines recommandations, basées sur la littérature médicale publiée entre 1954 et 1992. Pour obtenir des mesures fiables et précises du débit cardiaque par thermodilution, il faut répéter les mesures: 1) avec 10 ml d’injectat maintenu à température de la pièce chez le adulte, 0,15 ml · kg− 1 chez l’enfant; 2) à des moments identiques du cycle respiratoire; 3) après l’arret d’une perfusion rapide de liquide intraveineux; 4) en observant les courbes de thermodilution pour pouvoir tenir compte de la dérive de la température initiale de l’artère pulmonaire et de la présence de shunts intraou extracardiaques. Finalement, le débit cardiaque par hémodilution peut manquer de fiabilité et peut même devenir impossible à mesurer chez les malades dont le débit est bas ou qui souffrent de régurgitation tricuspidienne ou pulmonaire. Comme le monitorage du débit cardiaque non invasif n’a pas encore remplacé la thermodilution, les anesthésistes doivent posséder une connaissance approfondie de cette méthode pour éviter des erreurs thérapeutiques graves.

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Nishikawa, T., Dohi, S. Errors in the measurement of cardiac output by thermodilution. Can J Anaesth 40, 142–153 (1993). https://doi.org/10.1007/BF03011312

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Key words

  • heart: cardiac output
  • measurement techniques: Cardiac Output, thermodilution