Journal of Clinical Monitoring and Computing

, Volume 15, Issue 6, pp 387–401 | Cite as

Partial CO2 Rebreathing Cardiac Output – Operating Principles of the NICO™ System

  • Michael B. Jaffe
Article

Abstract

The partial rebreathing method of cardiac output estimation is reviewed with a particular focus on its application for continuous monitoring, rebreathing and implementations and from both a historical and technical perspective. The assumptions of the method are discussed as well as the various implementations. The NICO monitor and rebreathing valve are described from a functional view. The clinical data including (a) comparisons between bolus thermodilution and continuous thermodilution in patients in the OR setting, (b) comparisons to continuous thermodilution with both the Baxter and Abbott continuous cardiac output devices and (c) comparison between different means of shunt correction are presented. Compared to conventional cardiac output methods, the partial CO2 rebreathing technique is non-invasive, can easily be automated and can provide real-time and continuous cardiac output monitoring. Taking advantage of modern sophisticated sensor and signal processing technology and integrating multiple monitored physiological variables the NICO monitor is the first commercially available cardiac output system making use of the partial rebreathing of CO2.

Cardiac output pulmonary capillary blood flow Fick equation partial rebreathing carbon dioxide elimination non-invasive 

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REFERENCES

  1. 1.
    Fick A. Ueber die Messung des Blutquantums in den Herzventrikeln. Sitzungsberichte der Physiologisch-Medizinosche Gesellschaft zuWuerzburg 1870; 2: 16Google Scholar
  2. 2.
    Connors AF Jr, Speroff T, Dawson NV, Thomas C, Harrell FE Jr, Wagner D et al. The effectiveness of right heart catheterization in the initial care of critically ill patients. JAMA1996; 276: 889–897PubMedGoogle Scholar
  3. 3.
    Sackner MA. Measurement of cardiac output by alveolar gas exchange. In: Field J (ed). Handbook of physiology-the respiratory system IV. Washington, DC: American Physiological Society, 1977: 233–255Google Scholar
  4. 4.
    Gedeon A, Forslund L, Hedenstierna G, Romano E. A new method for noninvasive bedside determination of pulmonary blood flow. Med Bio Eng Comput 1980; 18: 411–418Google Scholar
  5. 5.
    Gedeon A. Noninvasive pulmonary blood flow for opti-mal PEEP. Clin Physiol 1985; 5 (Suppl 3): 49–58Google Scholar
  6. 6.
    Roy RJ, Capek JM. Noninvasive cardiac output monitoring using partial CO2 rebreathing [Abstract]. Anesthesiology 1985; 63: A172Google Scholar
  7. 7.
    Capek JM, Roy RJ. Noninvasive measurement of cardiac output using partial CO2 rebreathing. IEEE Trans Bi-omed Eng 1988; 35: 653–661Google Scholar
  8. 8.
    Gama de Abreu M, Quintel M, Albrecht M. Reliability of the partial CO2 Rebreathing technique for measure-ment of cardiac output. Proc RC IEEE-EMBS 1995; 4.15–4.16Google Scholar
  9. 9.
    McIlroy MB. Pulmonary Shunts. In: John Field (ed.). Handbook of Physiology.Washington, DC: Am Physi-olog Soc 1977: 1519–1524Google Scholar
  10. 10.
    Kück K, Haryadi DG, Orr JA, Jaffe MB. Arterial blood gas measurements improve noninvasive cardiac output estimates from partial CO2 rebreathing Fick technique [Abstract]. Crit CareMed 1999; 27 (1, Suppl): A109.Google Scholar
  11. 11.
    Sapsford DJ, Jones JG. The PIO2 vs. SpO2 diagram: A non-invasive measure of pulmonary oxygen exchange. Eur J Anaesth 1995; 12: 375–386Google Scholar
  12. 12.
    Nunn JF. Applied Respiratory Physiology. 4th Ed. Oxford, England: Butterworth Ltd, 1993.Google Scholar
  13. 13.
    Taylor SH. Measurement of cardiac output in man. Proc Royal SocMed 1966; 59 (Suppl): 35–53Google Scholar
  14. 14.
    Haryadi DG, Kück K, Orr JA, Westenskow DR. Reli-ability of invasive versus noninvasive indices in reflecting intrapulmonary shunt [Abstract]. Crit CareMed 1999; 27 (1, Suppl): A116.Google Scholar
  15. 15.
    Gama de Abreu M, Quintel M, Ragaller M, Albrecht M. Partial carbon dioxide rebreathing: A reliable tech-nique for noninvasive measurement of nonshunted pul-monary capillary blood flow. Crit Care Med 1997; 25: 675–683PubMedGoogle Scholar
  16. 16.
    Jaffe MB. Performance of a new rebreathing valve for non-invasive cardiac output estimation. Annual Meeting of the Society for Technology in Anesthesia, 20–23 January 1999, San Diego, California.Google Scholar
  17. 17.
    Latson TW, Whitten CW, O'Flaherty DO. Ventilation, thermal noise, and errors in cardiac output measurements after cardiopulmonary bypass. Anesthesiology 1993; 79: 1233–1243PubMedGoogle Scholar
  18. 18.
    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: 1001–1004PubMedGoogle Scholar
  19. 19.
    Gedeon A, Krill P, Kristensen J, Gottlieb I. Noninvasive cardiac output determined with a new method based on gas exchange measurements and carbon dioxide rebreath-ing: A study in animals/pigs. J Clin Monit 1992; 8: 267–278PubMedGoogle Scholar
  20. 20.
    Capek JM. Noninvasive measurement of cardiac output using partial CO2 rebreathing. 1998 Ph.D. Dissertation, Rensselaer Polytechnic Institute, Troy, New York, U.S.A.Google Scholar
  21. 21.
    Gama de Abreu M. Prediction of ARDS and MOF in critically ill patients and Reliability of the partial CO2 rebreathing technique for measurement of cardiac output. 1996 Ph.D. Dissertation, Technical University Dresden, Dresden, GermanyGoogle Scholar
  22. 22.
    Gama de Abreu M, Geiger S, Ragaller M, Winkler T, Rasche S, vonWaldenfels A, Albrecht DM. Is the partial CO2 rebreathing method a useful tool for trending pulmonary capillary blood flow during adjustmens of PEEP? Crit CareMed1998; 26, 1 (Suppl):A106Google Scholar
  23. 23.
    Orr J, Kofoed S, Westenskow DR. Evaluation of partial rebreathing cardiac output measurement in animals [Ab-stract]. Crit CareMed 1999; 27 (Suppl): A114Google Scholar
  24. 24.
    Guzzi L, Jaffe MB, Orr JA. Clinical evaluation of a new noninvasive method of cardiac output measurement-preliminary results in CABG patients [Abstract]. Anes-thesiologyv 1998; 89: A543Google Scholar
  25. 25.
    Blomqvist H, Frostell C, Hedenstrierna G. A non-inva-sive technique for measurement of lung perfusion. Intens CareMed 1986; 12: 172–178Google Scholar
  26. 26.
    Bosman RJ, Stountenbeek CP, Zandstra DF. Non-inva-sive pulmonary blood flow measurement by means of CO2 analysis of expiratory gases. Intens Care Med 1991; 17: 98–102Google Scholar
  27. 27.
    Oësterlund B, Gedeon A, Krill P, Johansson G, Reiz S. A new method of using gas exchange measurements for the noninvasive determination of cardiac output: Clinical experiences in adults following cardiac surgery. Acta Anaesthesiol Scand 1995; 39: 727–732PubMedGoogle Scholar
  28. 28.
    Orr JA, Westenskow DR, Kofoed S, Turner R. A non-invasive cardiac output system using the partial rebreath-ing Fick method [Abstract]. J Clin Monit 1996; 12: 464–465Google Scholar
  29. 29.
    Orr JA, Westenskow DR, Haryadi DG, Kofoed S. Evalu-ation of partial re-breathing cardiac output measurement in animals. Joint Meeting of Society for Technology in Anesthesia & Rochester Simulator Symposium, 14–17 January 1998,Tucson, Arizona.Google Scholar
  30. 30.
    Bailey PL, Haryadi DG, Orr JA, Westenskow DR. Partial CO2 rebreathing Fick technique for noninvasive meas-urement of cardiac output [Abstract]. Anesth Analg 1998; 86,SCA53.Google Scholar
  31. 31.
    Haryadi,DG, Orr JA, Kück K, McJames S, Westenskow DR. Evaluation of a partial CO2 rebreathing Fick tech-nique for measurement of cardiac output [Abstract]. Anesthesiology 1998; 89: A534.Google Scholar
  32. 32.
    Johnson KB, Haryadi DG, Orr JA, McJames S, Kück K, Westenskow DR. Influence of pulmonary edema on noninvasivemeasurements of cardiac output using partial CO2 rebreathing in a canine model [Abstract]. Anesthesi-ology 1998; 89: A535.Google Scholar
  33. 33.
    Watt RC, Loeb RG, Orr JA. Comparison of a new non-invasive cardiac output technique with invasive bolus and continuous thermodilution [Abstract]. Anesthesiology 1998; 89: A536.Google Scholar
  34. 34.
    Kück K, Haryadi DG, Orr JA, Bailey PL. Evaluation of partial re-breathing cardiac output measurement during surgery [Abstract]. Anesthesiology 1998; 89: A542.Google Scholar
  35. 35.
    Jopling MW. Noninvasive cardiac output determination utilizing the method of partial CO2 re-breathing. A comparison with continuous and bolus thermodilution cardiac output [Abstract]. Anesthesiology 1998; 89: A544.Google Scholar
  36. 36.
    Orr JA, Kück K, Haryadi DG, Jaffe MB. Clinical validation of a new non-invasive breath to breath Fick method for cardiac output estimation. Annual Meeting of the Society for Technology in Anesthesia, 20–23 January 1999, San Diego, CA.Google Scholar
  37. 37.
    Haryadi DG, Bailey PL, Kück K, Orr vJA, Westenskow DR. Clinical evaluation of partial CO2 rebreathing Fick technique for noninvasive measurement of cardiac out-put. Annual Meeting of the Society for Technology in Anesthesia, 20–23 January 1999, San Diego, CA.Google Scholar
  38. 38.
    Loeb RG, Watt RC, DiNardo JA, Orr JA. Comparison of noninvasive, partial rebreathing cardiac output with invasive bolus and continuous thermodilution. Annual Meeting of the Society for Technology in Anesthesia, 20–23 January 1999, San Diego, CA.Google Scholar
  39. 39.
    Haryadi DG. Partial CO2 Rebreathing indirect Fick technique for noninvasive measurement of cardiac out-put. 1999 Ph.D. Dissertation, University of Utah, Salt Lake City, Utah, U.S.A.Google Scholar

Copyright information

© Kluwer Academic Publishers 1999

Authors and Affiliations

  • Michael B. Jaffe
    • 1
  1. 1.Novametrix Medical SystemsInc., 5 Technology DriveWallingfordU.S.A

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