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. 2008 Nov;36(11):3001-7.
doi: 10.1097/CCM.0b013e31818b31f0.

Ability of pulse power, esophageal Doppler, and arterial pulse pressure to estimate rapid changes in stroke volume in humans

José Marquez  1 , Kenneth McCurry, Donald A Severyn, Michael R Pinsky
Affiliations

Ability of pulse power, esophageal Doppler, and arterial pulse pressure to estimate rapid changes in stroke volume in humans

José Marquez et al. Crit Care Med. 2008 Nov.

Abstract

Introduction: Measures of arterial pulse pressure variation and left ventricular stroke volume variation induced by positive-pressure breathing vary in proportion to preload responsiveness. However, the accuracy of commercially available devices to report dynamic left ventricular stroke volume variation has never been validated.

Methods: We compared the accuracy of measured arterial pulse pressure and estimated left ventricular stroke volume reported from two Food and Drug Administration-approved aortic flow monitoring devices, one using arterial pulse power (LiDCOplus) and the other esophageal Doppler monitor (HemoSonic). We compared estimated left ventricular stroke volume and their changes during a venous occlusion and release maneuver to a calibrated aortic flow probe placed around the aortic root on a beat-to-beat basis in seven anesthetized open-chested cardiac surgery patients.

Results: Dynamic changes in arterial pulse pressure closely tracked left ventricular stroke volume changes (mean r .96). Both devices showed good agreement with steady-state apneic left ventricular stroke volume values and moderate agreement with dynamic changes in left ventricular stroke volume (esophageal Doppler monitor -1 +/- 22 mL, and pulse power -7 +/- 12 mL, bias +/- 2 sd). In general, the pulse power signals tended to underestimate left ventricular stroke volume at higher left ventricular stroke volume values.

Conclusion: Arterial pulse pressure, as well as, left ventricular stroke volume estimated from esophageal Doppler monitor and pulse power reflects short-term steady-state left ventricular stroke volume values and tract dynamic changes in left ventricular stroke volume moderately well in humans.

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Conflict of interest statement

Potential Conflicts of Interest: Michael R. Pinsky, MD is a member of the medical advisory board for LiDCO Ltd and was a medical advisory board for Arrow International. He has stock options with LiDCO Ltd. The remaining authors have not declared any conflicts of interest.

Figures

Figure 1
Figure 1
Trend display from one subject of radial arterial pressure, Cineflo™ aortic flow probe and HemoSonic™ esophageal Doppler monitor changes over a 20 second interval starting from apneic baseline and during inferior vena caval obstruction.
Figure 1
Figure 1
Trend display from one subject of radial arterial pressure, Cineflo™ aortic flow probe and HemoSonic™ esophageal Doppler monitor changes over a 20 second interval starting from apneic baseline and during inferior vena caval obstruction.
Figure 1
Figure 1
Trend display from one subject of radial arterial pressure, Cineflo™ aortic flow probe and HemoSonic™ esophageal Doppler monitor changes over a 20 second interval starting from apneic baseline and during inferior vena caval obstruction.
Figure 1
Figure 1
Trend display from one subject of radial arterial pressure, Cineflo™ aortic flow probe and HemoSonic™ esophageal Doppler monitor changes over a 20 second interval starting from apneic baseline and during inferior vena caval obstruction.
Figure 1
Figure 1
Trend display from one subject of radial arterial pressure, Cineflo™ aortic flow probe and HemoSonic™ esophageal Doppler monitor changes over a 20 second interval starting from apneic baseline and during inferior vena caval obstruction.
Figure 1
Figure 1
Trend display from one subject of radial arterial pressure, Cineflo™ aortic flow probe and HemoSonic™ esophageal Doppler monitor changes over a 20 second interval starting from apneic baseline and during inferior vena caval obstruction.
Figure 1
Figure 1
Trend display from one subject of radial arterial pressure, Cineflo™ aortic flow probe and HemoSonic™ esophageal Doppler monitor changes over a 20 second interval starting from apneic baseline and during inferior vena caval obstruction.
Figure 1
Figure 1
Trend display from one subject of radial arterial pressure, Cineflo™ aortic flow probe and HemoSonic™ esophageal Doppler monitor changes over a 20 second interval starting from apneic baseline and during inferior vena caval obstruction.
Figure 2
Figure 2
Regression analysis for arterial pulse pressure versus aortic flow probe-derived stroke volume (Cineflo™ stroke volume) for all subjects.
Figure 3
Figure 3
Regression analysis for arterial pulse power-derived stroke volume (LiDCO™) versus aortic flow probe-derived stroke volume (Cineflo™ stroke volume) for all subjects.
Figure 4
Figure 4
Regression analysis for esophageal Doppler monitor-derived stroke volume versus aortic flow probe-derived stroke volume (Cineflo™ stroke volume) for all subjects.
Figure 5
Figure 5
Bland-Altman Analysis for all subjects comparing pulse power-derived stroke volumes (LiDCO™) with aortic flow probe-derived stroke volumes during venous occlusion.
Figure 6
Figure 6
Bland-Altman Analysis for all subjects comparing esophageal Doppler monitor-derived (HemoSonic™) stroke volumes with aortic flow probe-derived stroke volumes during venous occlusion.
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