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.
Article PDF
Similar content being viewed by others
References
Fegler G. Measurement of cardiac output in anaesthetized animals by a thermo-dilution method. Quarterly Journal of Experimental Physiology 1954; 39: 153–64.
Fegler G. The reliability of the thermodilution method for determination of the cardiac output and the blood flow in central veins. Quarterly Journal of Experimental Physiology 1957; 42: 254–66.
Goodyer AVN, Huvos A, Eckhardt WF, Ostberg RH. Thermal dilution curves in the intact animal. Circ Res 1959; 7: 432–41.
Froněk A, Gam V. Measurement of flow in single blood vessels including cardiac output by local thermodilution. Circ Res 1960; 8: 175–82.
Evonuk E, Imig CJ, Greenfield W, Eckstein JW. Cardiac output measured by thermal dilution of room temperature injectate. J Appl Physiol 1961; 16: 271–5.
Pávek K, Boska D, Selecký FV. Measurement of cardiac output by thermodilution with constant rate injection of indicator. Circ Res 1964; 15: 311–9.
Lüthy E, Galletti PM. In vivo evaluation of the thermo-dilution technique for measuring cardiac output. Helv Physiol Acta 1966; 24: 15–23.
Branthwaite MA, Bradley RD. Measurement of cardiac output by thermal dilution in man. J Appl Physiol 1968; 24: 434–8.
Solomon HA, San Marco MA, Ellis RJ, Lillehei CW. Cardiac output determination: superiority of thermal dilution. Surg Forum 1969; 20: 28–30.
Olsson B, Pool J, Vandermoten P, Varnauskas E, Wassén R. Validity and reproducibility of determination of cardiac output by thermodilution in man. Cardiology 1970; 55: 136–48.
Enghoff E, Michaëlsson M, Pavek K, Sjögren S. A comparison between the thermal dilution method and the direct Fick and the dye dilution methods for cardiac output measurements in man. Acta Societatis Medicorum Upsaliensis 1970; 75: 157–70.
Lin Y-C, Dawson CA, Nadel ER, Horvath SM. Reliability of cardiac output measured by thermodilution method in small animals. Comp Biochem Physiol 1970; 34: 245–50.
Sanmarco ME, Philips CM, Marquez LA, Hall C, Davila JC. Measurement of cardiac output by thermal dilution. Am J Cardiol 1971; 28: 54–8.
Silove ED, Cantez T, Wells BG. Thermodilution measurement of left and right ventricular outputs. Cardiovasc Res 1971; 5: 174–7.
Hanwell A, Linzell JL. Validation of the thermodilution technique for the estimation of cardiac output in the rat. Comp Biochem Physiol 1972; 41A: 647–57.
Wilson EM, Ranieri AJ Jr, Updike OL, Dammann JF Jr. An evaluation of thermal dilution for obtaining serial measurements of cardiac output. Med Biol Eng Comput 1972; 10: 179–91.
Ganz W, Donoso R, Marcus HS, Forrester JS, Swan HJC. A new technique for measurement of cardiac output by thermodilution in man. Am J Cardiol 1971; 27: 392–6.
Ganz W, Swan HJC. Measurement of blood flow by ther-modilution. Am J Cardiol 1972; 29: 241–6.
Forrester JS, Ganz W, Diamond G, McHugh T, Chonette DW, Swan HJC. Thermodilution cardiac output determination with a single flow-directed catheter. Am Heart J 1972; 83: 306–11.
Ellis RJ, Gold J, Rees JR, Lillehei CW. Computerized monitoring of cardiac output by thermal dilution. JAMA 1972; 220: 507–11.
Silove ED, Tynan MJ, Simcha AJ. Thermal dilution measurement of pulmonary and systemic blood flow in secundum atrial septal defect, and transposition of great arteries with intact interventricular septum. Br Heart J 1972; 34: 1142–6.
Andreen M. Computerized measurement of cardiac output by thermodilution: methodological aspects. Acta Anaesthesiol Scand 1974; 18: 297–305.
Weisel RD, Vito L, Dennis RC, Berger RL, Hechtman HB. Clinical applications of thermodilution cardiac output determinations. Am J Surg 1975; 129: 449–54.
Weisel RD, Berger RL, Hechtman HB. Measurement of cardiac output by thermodilution. N Engl J Med 1975; 292: 682–4.
Berger RL, Weisel RD, Vito L, Dennis RC, Hechtman HB. Cardiac output measurement by thermodilution during cardiac operations. Ann Thorac Surg 1976; 21: 43–7.
Swan HJC, Ganz W. Use of balloon flotation catheters in critically ill patients. Surg Clin North Am 1975; 55: 501–20.
Tietjen GW, Gump FE, Kinney JM. Cardiac output determinations in surgical patients. Surg Clin North Am 1975; 55: 521–9.
Hodges M, Downs JB, Mitchell LA. Thermodilution and Fick cardiac index determinations following cardiac surgery. Crit Care Med 1975; 3: 182–4.
Alfieri O, Agosti J, Subramanian S. Thermodilution cardiac output measurement in infants and small children following intracardiac surgery. J Pediatr Surg 1975; 10: 649–55.
Wyse SD, Pfitzner J, Rees A, Lincoln JCR, Branthwaite MA. Measurement of cardiac output by thermal dilution in infants and children. Thorax 1975; 30: 262–5.
Mathur M, Harris EA, Yarrow S, Barratt-Boyes BG. Measurement of cardiac output by thermodilution in infants and children after open-heart operations. J Thorac Cardiovasc Surg 1976; 72: 221–5.
Callaghan ML, Weintraub WH, Coran AG. Assessment of thermodilution cardiac output in small subjects. J Pediatr Surg 1976; 11: 629–33.
Buchbinder N, Ganz W. Hemodynamic monitoring: invasive techniques. Anesthesiology 1976; 45: 146–55.
Venkataraman K, DeGuzman MF, Hafeezkhan A, Haywood LJ. Cardiac output measurement: a comparison of direct Fick, dye dilution and thermodilution methods in stable and acutely ill patients. J Natl Med Assoc 1976; 68: 281–4.
Saadjian A, Quercy JE, Torresani J. Cardiac output measurement by thermodilution. Methodologic problems. Med Prog Technol 1976; 3: 161–7.
Weil MH. Measurement of cardiac output (Editorial). Crit Care Med 1977; 5: 117–9.
Kohanna FH, Cunningham JN Jr. Monitoring of cardiac output by thermodilution after open-heart surgery. J Thorac Cardiovasc Surg 1977; 73: 451–7.
Aikawa N, Martyn JAJ, Burke JF. Pulmonary artery catheterization and thermodilution cardiac output determination in the management of critically burned patients. Am J Surg 1978; 135: 811–7.
Hoel BL. Some aspects of the clinical use of thermodilution in measuring cardiac output. Scand J Clin Lab Invest 1978; 38: 383–8.
Fischer AP, Benis AM, Jurado RA, Seely E, Teirstein P, Litwak RS. Analysis of errors in measurement of cardiac output by simultaneous dye and thermal dilution in cardithoracic surgical patients. Cardiovasc Res 1978; 12: 190–9.
Forrester JS, Diamond GA, Swan HJC. Correlative classification of clinical and hemodynamic function after acute myocardial infarction. Am J Cardiol 1977; 39: 137–45.
Connors AF Jr, McCaffree DR, Gray BA. Evaluation of right-heart catheterization in the critically ill patient without acute myocardial infarction. N Engl J Med 1983; 308: 263–7.
Sharkey SW. Beyond the wedge: clinical physiology and the Swan-Ganz catheter. Am J Med 1987; 83: 111–22.
Warren DJ, Ledingham JGG. Cardiac output in the conscious rabbit: an analysis of the thermodilution technique. J Appl Physiol 1974; 36: 246–51.
Merjavy JP, Hahn JW, Barner HB. Comparison of thermodilution cardiac output and electromagnetic flowmeter. Surg Forum 1974; 25: 145–7.
Hendriks FFA, Schipperheyn JJ, Quanjer PH. Thermal dilution measurement of cardiac output in dogs using an analog computer. Basic Res Cardiol 1978; 73: 459–68.
Levine BA, Sirinek KR. Cardiac output determination by thermodilution technique: the method of choice in low flow states. Proc Soc Exp Biol Med 1981; 167: 279–83.
Hosie KF. Thermal-dilution technics. Circ Res 1962; 5: 491–504.
Levett JM, Replogle RL. Thermodilution cardiac output: a critical analysis and review of the literature. J Surg Res 1979; 27: 392–404.
Arfors K-E, Malmberg P, Pavek K. Conservation of thermal indicator in lung circulation. Cardiovasc Res 1971; 5: 530–4.
Vliers ACAP, Oeseburg B, Visser KR, Zijlstra WG. Choice of detection site for the determination of cardiac output by thermal dilution: the injection-thermistor-catheter. Cardiovasc Res 1973; 7: 133–8.
Vliers ACAP, Visser KR, Zijlstra WG. Analysis of indicator distribution in the determination of cardiac output by thermal dilution. Cardiovasc Res 1973; 7: 125–32.
Nadeau S, Noble WH. Limitations of cardiac output measurements by thermodilution. Can Anaesth Soc J 1986; 33: 780–4.
Zierler KL. Theoretical basis of indicator-dilution methods for measuring flow and volume. Circ Res 1962; 5: 393–407.
Phillips CM, Davila JC, Sanmarco ME. Measurement of cardiac output by thermal dilution II. A new computer for rapid convenient determinations. Medical Research in Engineering 1970; 9: 25–9.
Olsson SB, Wassén R, Vamauskas ED, Wallman H. A simple analogue computer for cardiac output determination by thermodilution. Cardiovasc Res 1972; 6: 303–8.
Korner PI, Hilder RG. Measurement of cardiac output and regional blood flow by thermodilution. Clin Exp Pharmacol Physiol 1974; Suppl 1: 47–66.
Kay JC, Noble WH. A comparison of thermal and dye dilution methods of determining cardiac output. Can Anaesth Soc J 1973; 20: 347–56.
Hedvall G, Kjellmer I, Olsson T. An experimental evaluation of the thermodilution method for determination of cardiac output and of intracardiac right-to-left shunts. Scand J Clin Lab Invest 1973; 31: 61–8.
Meisner H, Hagl S, Heimisch W, et al. Evaluation of the thermodilution method for measurement of cardiac output after open-heart surgery. Ann Thorac Surg 1974; 18: 504–15
Sørensen MB, Bille-Brahe NE, Engell HC. Cardiac output measurement by thermal dilution: Reproducibility and comparison with the dye-dilution technique. Ann Surg 1976; 183: 67–72.
Colgan FJ, Stewart S. An assessment of cardiac output by thermodilution in infants and children following cardiac surgery. Crit Care Med 1977; 5: 220–5.
Freed MD, Keane JF. Cardiac output measured by ther-modilution in infants and children. J Pediatr 1978; 92: 39–42.
Stawicki JJ, Holford FD, Michelson EL, Josephson ME. Multiple cardiac output measurements in man. Evaluation of a new closed-system thermodilution method. Chest 1979; 76: 193–7.
Pelletier C. Cardiac output measurement by thermodilution. Can J Surg 1979; 22: 347–50.
Rogers MC, Nugent SK, Pickard LR, Roland J-M, Shermeta DW. Experimental evaluation of 2F transthoracic thermodilution cardiac outputs in small animals. Crit Care Med 1979; 7: 171–3.
Runciman WB, Ilsley AH, Roberts JG. Thermodilution cardiac output — a system error. Anaesth Intensive Care 1981; 9: 135–9.
Elkayam U, Berkley R, Azen S, Weber L, Geva B, Henry WL. Cardiac output by thermodilution technique. Effect of injectate’s volume and temperature on accuracy and reproducibility in the critically ill patient. Chest 1983; 84: 418–22.
Pearl RG, Rosenthal MH, Nielson L, Ashton JPA, Brown BW Jr. Effect of injectate volume and temperature on thermodilution cardiac output determination. Anesthesiology 1986; 64: 798–801.
Bilfinger TV, Lin C-Y, Anagnostopoulos CE. In vitro determination of accuracy of cardiac output measurements by thermal dilution. J Surg Res 1982; 33: 409–14.
Stetz CW, Miller RG, Kelly GE, Rqffin TA. Reliability of the thermodilution method in the determination of cardiac output in clinical practice. Am Rev Respir Dis 1982; 126: 1001–4.
Shellock FG, Riedinger MS. Reproducibility and accuracy of using room-temperature vs. ice-temperature injectate for thermodilution cardiac output determination. Heart Lung 1983; 12: 175–6.
Vennix CV, Nelson DH, Pierpont GL. Thermodilution cardiac output in critically ill patients: comparison of room-temperature and iced injectate. Heart Lung 1984; 13: 574–8.
Nelson LD, Anderson HB. Patient selection for iced versus room temperature injectate for thermodilution cardiac output determinations. Crit Care Med 1985; 13: 182–4.
Runciman WB, Ilsley AH, Roberts JG. An evaluation of thermodilution cardiac output measurement using the Swan-Ganz catheter. Anaesth Intensive Care 1981; 9: 208–20
Woog RH, Mc William DB. A comparison of methods of cardiac output measurement. Anesth Intensive Care 1983; 11: 141–6.
Nishikawa T, Dohi S. Slowing of heart rate during cardiac output measurement by thermodilution. Anesthesiology 1982; 57: 538–9.
Harris AP, Miller CF, Beattie C, Rosenfeld GI, Rogers MC. The slowing of sinus rhythm during thermodilution cardiac output determination and the effect of altering injectate temperature. Anesthesiology 1985; 63: 540–1.
Nishikawa T, Dohi S. Hemodynamic status susceptible to slowing of heart rate during thermodilution cardiac output determination in anesthetized patients. Crit Care Med 1990; 18: 841–4.
Nishikawa T, Namiki A. Mechanism for slowing of heart rate and associated changes in pulmonary circulation elicited by cold injectate during thermodilution cardiac output determination in dogs. Anesthesiology 1988; 68: 221–5.
Nishikawa T, Dohi S. Haemodynamic changes associated with thermodilution cardiac output determination during myocardial ischaemia or pulmonary oedema in dogs. Acta Anaesthesio Scand 1992; 36: 679–83.
Reininger EJ, Troy BL. Error in thermodilution cardiac output measurement caused by variation in syringe volume. Cathet Cardiovasc Diagn 1976; 2: 415–7.
Hammermeister KE, VanDamme J. A simple, new system for maintaining measured quantities of saline cold and sterile for thermodilution cardiac output measurement. Cathet Cardiovasc Diagn 1979; 5: 95–9.
Powner DJ. Thermodilution technic for cardiac output (Correspondence). N Engl J Med 1975; 293: 1210–1.
Meisner H, Glanert S, Steckmeier B, et al. Indicator loss during injection in the thermodilution system. Res Exp Med 1973; 159: 183–96.
Kim ME, Lin YC. Determination of catheter wall heat transfer in cardiac output measurement by thermodilution. Clin Exp Pharmacol Physiol 1980; 7: 383–9.
Singh R, Ranieri AJ Jr,Vest HR Jr,Bowers DL, Dammann JF Jr. Simultaneous determinations of cardiac output by thermal dilution, fiberoptic and dye-dilution methods. Am J Cardiol 1970; 25: 579–87.
Woods M, Scott RN, Harken AH. Practical considerations for the use of a pulmonary artery thermistor catheter. Surgery 1976; 79: 469–75.
Wessel HU, Paul MH, James GW, Grahn AR. Limitations of thermal dilution curves for cardiac output determinations. J Appl Physiol 1971; 30: 643–52.
Afonso S, Herrick JF, Youmans WB, Rowe GG, Crumpton CW. Temperature variations in the venous system of dogs. Am J Physiol 1962; 203: 278–82.
Wessel HU, James GW, Paul MH. Effects of respiration and circulation on central blood temperature of the dog. Am J Physiol 1966; 211: 1403–12.
Riedinger MS, Shellock FG. Technical aspects of the thermodilution method for measuring cardiac output. Heart Lung 1984; 13: 215–21.
Guyton AC. Regulation of cardiac output. N Engl J Med 1967; 277: 805–12.
Whittenberger JL, McGregor M, Berglund E, Borst HG. Influence of state of inflation of the lung on pulmonary vascular resistance. J Appl Physiol 1960; 15: 878–82.
Snyder JV, Powner DJ. Effects of mechanical ventilation on the measurement of cardiac output by thermodilution. Crit Care Med 1982; 10: 677–82.
Armengol J, Man GCW, Balsys AJ, Wells AL. Effects of the respiratory cycle on cardiac output measurements: reproducibility of data enhanced by timing the thermodilution injections in dogs. Crit Care Med 1981; 9: 852–4.
Jansen JRC, Schreuder JJ, Bogaard JM, Van Rooyen W, Versprille A. Thermodilution technique for measurement of cardiac output during artificial ventilation. J Appl Physiol 1981; 50: 584–91.
Tajiri J, Katsuya H, Okamoto K, Urata K, Sato T. The effects of the respiratory cycle by mechanical ventilation on cardiac output measured using the thermodilution method. Jpn Circ J 1984; 48: 328–30.
Stevens JH, Rqffin TA, Mihm FG, Rosenthal MH, Stetz CW Thermodilution cardiac output measurement. Effects of the respiratory cycle on its reproducibility. JAMA 1985; 253: 2240–2.
Okamoto K, Komatsu T, Kumar V, et al. Effects of intermittent positive-pressure ventilation on cardiac output measurements by thermodilution. Crit Care Med 1986; 14: 977–80.
Versprille A. Thermodilution in mechanically ventilated patients (Editorial). Intensive Care Med 1984; 10: 213–5.
Jansen JRC, Versprille A. Improvement of cardiac output estimation by the thermodilution method during mechanical ventilation. Intensive Care Med 1986; 12: 71–9.
Sherry KM, Feneck RO, Normandale J. Thermodilution cardiac output measurements during conventional and high-frequency ventilation. J Cardiothorac Vase Anesth 1988; 2: 320–5.
Thrush DN, Varlotta D. Thermodilution cardiac output: comparison between automated and manual injection of indicator. J Cardiothorac Vase Anesth 1992; 6: 17–9.
Enghoff E, Sjögren S. Thermal dilution for measurement of cardiac output in the pulmonary artery in man in relation to choice of indicator volume and injection time. Ups J Med Sci 1973; 78: 33–7.
Dizon CT, Gezari WA, Barash PG, Crittenden JF. Hand held thermodilution cardiac output injector. Crit Care Med 1977; 5: 210–2.
Nelson LD, Houtchens BA. Automatic vs manual injections for thermodilution cardiac output determinations. Crit Care Med 1982; 10: 190–2.
Wetzel RC, Latson TW. Major errors in thermodilution cardiac output measurement during rapid volume infusion. Anesthesiology 1985; 62: 684–7.
Shellock FG, Riedinger MS. Hemodynamic measurement errors caused by catheter introducers (Correspondence). Cathet Cardiovasc Diagn 1982; 8: 319.
Merrick SH, Hessel EA II, Dillard DH. Determination of cardiac output by thermodilution during hypothermia. Am J Cardiol 1980; 46: 419–22.
Shellock FG, Riedinger MS, Bateman TM, Gray RJ. Thermodilution cardiac output determination in hypothermic postcardiac surgery patients: room vs ice temperature injectate. Crit Care Med 1983; 11: 668–70.
Bazaral MG, Petre J, Novoa R. Errors in thermodilution cardiac output measurements caused by rapid pulmonary artery temperature decreases after cardiopulmonary bypass. Anesthesiology 1992; 77: 31–7.
Moodie DS, Feldt RH, Kaye MP, Strelow DA, van der Hagen LJ. Measurement of cardiac output by thermodilution: development of accurate measurements at flows applicable to the pediatric patient. J Surg Res 1978; 25: 305–11.
Norris SL, King EG, Grace M, Weir B. Thermodilution cardiac output — an in vitro model of low flow states. Crit Care Med 1986; 14: 57–9.
Hillis LD, Firth BG, Winniford MD. Analysis of factors affecting the variability of Fick versus indicator dilution measurements of cardiac output. Am J Cardiol 1985; 56: 764–8.
While SW, MeRitchie RJ, Porges WL. A comparison between thermodilution, electromagnetic and Doppler methods for cardiac output measurement in the rabbit. Clin Exp Pharmacol Physiol 1974; 1: 175–82.
van Grondelle A, Ditchey RV, Groves BM, Wagner WW Jr,Reeves JT. Thermodilution method overestimates low cardiac output in humans. Am J Physiol 1983; 245: H690–2.
Bjoraker DG, Ketcham TR. Catheter thrombus artifactually decreases thermodilution cardiac output measurements. Anesth Analg 1983; 62: 1031–4.
Martin C., Saux P, Auffray JP, Fulachier V, Setbon F, Gouin F. Thermodilution cardiac output measurements by injection in pulmonary artery vs CVP catheter. Crit Care Med 1983; 11: 460–1.
Pesola GR, Carlon GC. Thermodilution cardiac output: proximal lumen versus right ventricular port. Crit Care Med 1991; 19: 563–5.
Bearss MG, Yonutas DN, Allen WT. A complication with thermodilution cardiac output in centrally-placed pulmonary artery catheters (Correspondence). Chest 1982; 81: 527.
Curley J, Harte F, Sheikh F. Erroneous cardiac output determination due to pulmonary artery catheter proximal port dysfunction (Correspondence). Anesthesiology 1986; 64: 662.
Stoller JK, Herbst TJ, Hurford W, Rie MA. Spuriously high cardiac output from injecting thermal indicator through an ensheathed port. Crit Care Med 1986; 14: 1064–5.
Landais A, Morin JP, Roche A, Cornec C, Sansoy N. Measurement of cardiac output by the thermodilution method during left thoracotomy in the lateral position in the dog. Acta Anaesthesiol Scand 1990; 34: 158–61.
Hasan FM, Malanga A, Corrao WM, Braman SS. Effect of catheter position on thermodilution cardiac output during continuous positive-pressure ventilation. Crit Care Med 1984; 12: 387–90.
Boucek C, Klain M, Obuchowski N, Molner R. Pulmonary artery catheter monitoring during single-lung ventilation in dogs. J Clin Monit 1992; 8: 209–15.
Morady F, Brundage BH, Gelberg HJ. Rapid method for determination of shunt ratio using a thermodilution technique. Am Heart J 1983; 106: 369–73.
Hedvall G. The applicability of the thermodilution method for determination of pulmonary blood flow and pulmonary vascular resistance in infants and children with ventricular septal defects. Scand J Clin Lab Invest 1978; 38: 581–5.
Jögi P, Werner O. Left-to-right shunt assessed by thermo-dilution during surgery for congenital heart disease. Scand J Thorac Cardiovasc Surg 1987; 21: 203–6.
Burchman CA, Lappas DG. Thermodilution cardiac output provides unanticipated intraoperative diagnosis (Correspondence). J Cardiothorac Vase Anesth 1988; 4: 584–5.
McGuirk SM, Welker FH, Muir WW, Hull BL. Thermodilution curves for diagnosis of ventricular septal defect in cattle. J Am Vet Med Assoc 1984; 184: 1141–5.
Kahan F, Profeta J, Thys D. High cardiac output measurements in a patient with congestive heart failure. J Cardiothorac Vase Anesth 1987; 3: 234–6.
Pearl RG, Siegel LC. Thermodilution cardiac output measurement with a large left-to-right shunt. J Clin Monit 1991; 7: 146–53.
Swan HJC, Zapata-Diaz J, Wood EH. Dye dilution curves in cyanotic congenital heart disease. Circulation 1953; 8: 70–81.
Beyer J, Lamberti JJ, Replogle RL. Validity of thermodilution cardiac output determination: experimental studies with and without pulmonary insufficiency. J Surg Res 1976; 21: 313–7
Ohteki H, Nagara H, Wada J, Inoue Y, Kimata S. Measurement of cardiac output by thermodilution and Fick methods in man — problems in case of tricuspid re-gurgitation. Kokyu to Junkan 1981; 29: 433–7.
Kashtan HI, Maitland A, Salerno TA, Lichtenstein SV, Byrick RJ. Effects of tricuspid regurgitation on thermodilution cardiac output: studies in an animal model. Can J Anaesth 1987; 34: 246–51.
Rahimtoola SH, Swan HJC. Calculation of cardiac output from indicator-dilution curves in the presence of mitral regurgitation. Circulation 1965; 31: 711–8.
Samet P, Bernstein WH, Castillo C. Validity of indicator-dilution determinations of cardiac output in patients with mitral regurgitation. Circulation 1966; 33: 410–6.
Samet P, Castillo C, Bernstein WH. Validity of indicator-dilution determination of cardiac output by in patients with aortic regurgitation. Circulation 1966; 34: 609–10.
Alfieri O, Subramanian S. Cardiac output determination in infants and small children after open intracardiac operations. Ann Thorac Surg 1975; 19: 322–6.
Maruschak GF, Potter AM, Schauble JF, Rogers MC. Overestimation of pediatric cardiac output by thermal indicator loss. Circulation 1982; 65: 380–3.
Baskoff JD, Maruschak GF. Correction factor for ther-modilution determination of cardiac output in children. Crit Care Med 1981; 9: 870–2.
Pavek K, Lindquist O, Arfors K-E. Validity of thermodilution method for measurement of cardiac output in pulmonary oedema. Cardiovasc Res 1973; 7: 419–22.
Nishikawa T, Dohi S. Haemodynamic changes associated with thermodilution cardiac output determination during metabolic acidosis or hypoxic hypoxia in dogs. Eur J Anaesthesiol (in press).
Mendlowitz M. The specific heat of human blood. Science 1948; 107: 97–8.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
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
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF03011312