Luke E Hodgson1, Lui G Forni2, Richard Venn1, Theophilus L Samuels2, Howard G Wakeling1. 1. Anaesthetics & Intensive Care Department, Western Sussex NHS Foundation Trust, Worthing, UK. 2. Intensive Care Department, The Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK; Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK.
Abstract
BACKGROUND: Perioperative interventions, targeted to increase global blood flow defined by explicit measured goals, reduce postoperative complications. Consequently, reliable non-invasive estimation of the cardiac output could have far-reaching benefit. METHODS: This study compared a non-invasive Doppler device - the ultrasonic cardiac output monitor (USCOM) - with the oesophageal Doppler monitor (ODM), on 25 patients during major abdominal surgery. Stroke volume was determined by USCOM (SVUSCOM) and ODM (SVODM) pre and post fluid challenges. RESULTS: A ≥ 10% change (Δ) SVUSCOM had a sensitivity of 94% and specificity of 88% to detect a ≥ 10% Δ SVODM; the area under the receiver operating curve was 0.94 (95% CI 0.90-0.99). Concordance was 98%, using an exclusion zone of <10% Δ SVODM. 135 measurements gave median SVUSCOM 80 ml (interquartile range 65-93 ml) and SVODM 86 ml (69-100 ml); mean bias was 5.9 ml (limits of agreement -20 to +30 ml) and percentage error 30%. CONCLUSIONS: Following fluid challenges SVUSCOM showed good concordance and accurately discriminated a change ≥10% in SVODM.
BACKGROUND: Perioperative interventions, targeted to increase global blood flow defined by explicit measured goals, reduce postoperative complications. Consequently, reliable non-invasive estimation of the cardiac output could have far-reaching benefit. METHODS: This study compared a non-invasive Doppler device - the ultrasonic cardiac output monitor (USCOM) - with the oesophageal Doppler monitor (ODM), on 25 patients during major abdominal surgery. Stroke volume was determined by USCOM (SVUSCOM) and ODM (SVODM) pre and post fluid challenges. RESULTS: A ≥ 10% change (Δ) SVUSCOM had a sensitivity of 94% and specificity of 88% to detect a ≥ 10% Δ SVODM; the area under the receiver operating curve was 0.94 (95% CI 0.90-0.99). Concordance was 98%, using an exclusion zone of <10% Δ SVODM. 135 measurements gave median SVUSCOM 80 ml (interquartile range 65-93 ml) and SVODM 86 ml (69-100 ml); mean bias was 5.9 ml (limits of agreement -20 to +30 ml) and percentage error 30%. CONCLUSIONS: Following fluid challenges SVUSCOM showed good concordance and accurately discriminated a change ≥10% in SVODM.
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