The Science Journal of the American Association for Respiratory Care

1996 OPEN FORUM Abstracts

COMPARISON OF CONTINUOUS CARDIAC OUTPUT VERSES INTERMITTENT THERMAL BOLUS IN THE TRAUMA POPULATION.

Shari L. Bailey, RRT., Ronald E. Dechert, MS., RRT., Beth Callan, RRT., Jorge Rodriquez, MD.

Background: Continuous cardiac output (CCO) is achieved through the use of a modified pulmonary artery (PA) catheter. This PA catheter contains an external thermal filament located near the distal tip of the catheter, and when activated, will intermittently heat the surface of the catheter. The blood temperature changes are detected by the thermistor located at the distal tip of the catheter. These temperature changes are then processed by the CCO computer and CO values are calculated, displayed continuously, and updated every 30 seconds. Previous studies have indicated that this technology is consistent with intermittent thermal bolus (TBCO) measurement in postoperative patients. However, few studies have been performed in the hemodynamically challenged trauma population. Method: All patients admitted to the Trauma Burn Emergency Service who required PA catheterization were considered for inclusion in this comparative study. Patients with a known tricuspid valve dysfunction or prosthesis were excluded. Once the need for invasive hemodynamic monitoring was confirmed, the Baxter Edwards Swan-Ganz CCO/SvO2/VIP TD catheter (models 7468F and 746H8F, Baxter Healthcare Corporation, Edwards Critical Care Division, Irvine CA.), was inserted and comparison data points were collected. Each data point consisted of a continuous and TBCO value obtained through the Edwards Critical Care Vigilance Monitoring System. Simultaneous data collection is not possible with this technology, therefore, documentation of the CCO was made, the thermal filament was deactivated, and the TBCO value was then determined. Thermal dilution bolus was performed in triplicate and the average was the resultant TBCO. Comparison data points were collected at least once daily. Results: Thirty-three patients were included in this comparative study. A total of 183 data points were collected. We observed significant correlation (r^{2}=0.778, p < 0.001) between the CCO and TBCO values obtained. The bias for the entire population was 0.63% difference. The confidence interval (95%) for the total population comparison was +32.23 to -30.97% difference. Experience: The Vigilance Monitoring System provided valuable information regarding the patients hemodynamic status by supplying continuous display of SvO2, CCO, cardiac index, and patient core temperature. All patient parameters responded appropriately to changes in various patient conditions, such as sepsis, fluid overload, DO2/VO2 mismatch, and to titration of cardiac drugs. Conclusion: The association between the two techniques indicates that CCO and TBCO will trend appropriately with each other in this population. However, there is a potential significant error when comparing the absolute values obtained from the two techniques. This error prevents the interchangeability between the two CO values.

Reference: OF-96-097

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