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Ability of pulse contour and esophageal Doppler to estimate rapid changes in stroke volume

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Abstract

Objective

Two technologies to acquire beat-to-beat stroke volume values exist, pulse contour analysis and esophageal Doppler monitoring. Pulse contour analysis assumes fixed aortic impedance. Esophageal Doppler assumes a constant proportional descending aortic flow and diameter. These assumptions may not be correct as arterial tone or myocardial contractility vary. We tested these relationships in the setting of rapidly changing stroke volumes and different cardiovascular states over a period of 10–15 cardiac cycles.

Design and setting

In a university research facility we compared beat-to-beat changes in stroke volume as measure by aortic root flow probe or conductance catheter to pulse contour analysis and stroke distance as measured by esophageal Doppler.

Subjects

Five purpose-bred research hounds.

Interventions

To obtain a wide range of rapidly changing stroke volumes measurements were made during transient inferior vena cava occlusion. Data were gathered under baseline conditions and during norepinephrine, nitroprusside, and dobutamine infusions.

Measurements and results

The pulse contour stroke volumes and esophageal Doppler stroke distance paralleled flow probe stroke volumes under all conditions (R 2 = 0.89 for all measures). However, the absolute changes and proportional changes and the absolute values for both surrogate measures differed from absolute stroke volumes. Bland-Altman analysis showed no consistent bias or degree of precision across all animals under any given cardiovascular state.

Conclusions

Both pulse contour stroke volumes and esophageal Doppler derived stroke distance estimates yield significant correlations with aortic root flow probe. However, the absolute values, absolute changes, or proportional changes may not reflect actual stroke volumes as cardiovascular state varies, making their use in estimating absolute changes in stroke volume potentially inaccurate.

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Acknowledgements

We thank Linda Santelices for her expert assistance with MATLAB.

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Authors and Affiliations

  1. Department of Critical Care Medicine, Medical Center, University of Pittsburgh, 3550 Terrace Street, PA 15261, Pittsburgh, USA

    Scott R. Gunn, Hyung Kook Kim & Michael R. Pinsky

  2. Department of Anaesthesia, Intensive Care, and Pain Management, John Hunter Hospital, Hunter Regional Mail Centre, NSW 2310, Newcastle, Australia

    Peter W. J. Harrigan

Authors
  1. Scott R. Gunn
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  2. Hyung Kook Kim
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  3. Peter W. J. Harrigan
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  4. Michael R. Pinsky
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Corresponding author

Correspondence to Scott R. Gunn.

Additional information

M.R.P. has the following potential conflicts of interest regarding this study: (a) He received unrestricted funding from both Deltex Inc. and Pulsion Ltd. to perform the clinical trial reported in this manuscript. Both companies received copies of their own data from trial prior to its submission for their critique of the technical aspects of the data collection and analysis. Neither company's input changed any of the data presented or its interpretation. (b) Following this study M.R.P. became a consultant to Arrow International, Edwards LifeSciences, and Lido Ltd., none of which companies' equipment was used in this study, but all these companies compete with Deltex and Pulsion for market share. (c) M.R.P. has received honoraria for lectures on hemodynamic monitoring from Edward LifeSciences and Arrow International. (d) M.R.P. is the inventor of a University of Pittsburgh patented hemodynamic monitoring protocol that uses dynamic changes in aortic pressure and flow to diagnose cardiovascular insufficiency. Thus the limitations of the devices reported in this study will impact on the utility of these approaches. M.R.P. also received a royalty from Arrow International for the use of his patented approach.

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Gunn, S.R., Kim, H.K., Harrigan, P.W.J. et al. Ability of pulse contour and esophageal Doppler to estimate rapid changes in stroke volume. Intensive Care Med 32, 1537–1546 (2006). https://doi.org/10.1007/s00134-006-0284-5

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  • DOI: https://doi.org/10.1007/s00134-006-0284-5

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