Partial CO2 Rebreathing Indirect Fick Technique for Non-Invasive Measurement of Cardiac Output

  • Dinesh G. Haryadi
  • Joseph A. Orr
  • Kai Kuck
  • Scott McJames
  • Dwayne R. Westenskow


Objective.Evaluation in animals of a non-invasive and continuous cardiac output monitoring system based on partial carbon-dioxide (CO2) rebreathing indirect Fick technique. Methods.We have developed a non-invasive cardiac output (NICO) monitoring system, based on the partial rebreathing method. The partial rebreathing technique employs a differential form of the Fick equation for calculating cardiac output (QT) using non-invasive measurements. Changes in CO2 elimination (ΔVCO2) and partial pressure of end-tidal CO2 (Δ PETCO2) in response to a brief period of partial rebreathing are used to measure pulmonary capillary blood flow (QPCBF). A non-invasive estimate of anatomic and intrapulmonary shunt fraction (QS/QT), based on oxygen saturation from pulse oximetry (SpO2) and inspired oxygen concentration (FIO2), is added to compute total cardiac output [QT=QPCBF/(1−QS/QT)]. The performance of the NICO was compared with iced 5% dextrose bolus thermodilution cardiac output (TDco) measurements in 6 dogs. Cardiac output was varied using dobutamine, and halothane, and by clamping of the inferior vena cava. Two hundred and forty-six (n = 246) paired measurements of TDco and NICO over a range of cardiac outputs (TDco range = 0.60–8.87 l/min) were compared using Bland-Altman analysis and weighted correlation coefficient. Results.The Bland–Altman technique yielded a NICO precision of ±  0.70 l/min (13.8%) with a mean bias of −0.07 l/min (−1.4%) compared to TDco. The weighted correlation coefficient between TDco and NICO values was: r= 0.93 (n= 246). Conclusion.The partial CO2 rebreathing technique for measurement of cardiac output is non-invasive, automated, and based on the well accepted Fick principle. The limits of agreement between NICO and TDco is within the recommended value for NICO to be a clinically acceptable method for cardiac output measurement. The results of this canine study show that NICO performed as well, and in some cases better, than other currently available non-invasive cardiac output techniques over a wide range of cardiac outputs.

Cardiac output partial rebreathing NICO carbon dioxide non-invasive monitoring thermodilution cardiac output 


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Copyright information

© Kluwer Academic Publishers 2000

Authors and Affiliations

  • Dinesh G. Haryadi
    • 1
  • Joseph A. Orr
    • 1
  • Kai Kuck
    • 1
  • Scott McJames
    • 1
  • Dwayne R. Westenskow
    • 1
  1. 1.Departments of Anesthesiology and BioengineeringUniversity of UtahSalt Lake CityU.S.A.

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