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Comparative Study
. 2009;13(4):R133.
doi: 10.1186/cc7994. Epub 2009 Aug 11.

Transpulmonary thermodilution-derived cardiac function index identifies cardiac dysfunction in acute heart failure and septic patients: an observational study

Simon Ritter  1 , Alain Rudiger, Marco Maggiorini
Affiliations
Comparative Study

Transpulmonary thermodilution-derived cardiac function index identifies cardiac dysfunction in acute heart failure and septic patients: an observational study

Simon Ritter et al. Crit Care. 2009.

Abstract

Introduction: There is limited clinical experience with the single-indicator transpulmonary thermodilution (pulse contour cardiac output, or PiCCO) technique in critically ill medical patients, particularly in those with acute heart failure (AHF). Therefore, we compared the cardiac function of patients with AHF or sepsis using the pulmonary artery catheter (PAC) and the PiCCO technology.

Methods: This retrospective observational study was conducted in the medical intensive care unit of a university hospital. Twelve patients with AHF and nine patients with severe sepsis or septic shock had four simultaneous hemodynamic measurements by PAC and PiCCO during a 24-hour observation period. Comparisons between groups were made with the use of the Mann-Whitney U test. Including all measurements, correlations between data pairs were established using linear regression analysis and are expressed as the square of Pearson's correlation coefficients (r2).

Results: Compared to septic patients, AHF patients had a significantly lower cardiac index, cardiac function index (CFI), global ejection fraction, mixed venous oxygen saturation (SmvO2) and pulmonary vascular permeability index, but higher pulmonary artery occlusion pressure. All patients with a CFI less than 4.5 per minute had an SmvO2 not greater than 70%. In both groups, the CFI correlated with the left ventricular stroke work index (sepsis: r2 = 0.30, P < 0.05; AHF: r2 = 0.23, P < 0.05) and cardiac power (sepsis: r2 = 0.39, P < 0.05; AHF: r2 = 0.45, P < 0.05).

Conclusions: In critically ill medical patients, assessment of cardiac function using transpulmonary thermodilution technique is an alternative to the PAC. A low CFI identifies cardiac dysfunction in both AHF and septic patients.

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Figures

Figure 1
Figure 1
The relation between CFI, LVSWI and CP. (a) The relationship between cardiac function index (CFI) and left ventricular stroke work index (LVSWI) in patients with sepsis and those with acute heart failure. Significant correlations between the two variables exist in patients with sepsis (r2 = 0.30, P = 0.001) and those with acute heart failure (r2 = 0.23, P = 0.002). (b) The significant relationship between CFI and cardiac power (CP) in both patient groups (sepsis: r2 = 0.39, P < 0.001; acute heart failure: r2 = 0.45, P < 0.001). Dashed lines indicate CFI of 4.5 per minute, LVSWI of 40 g-m/m2, and CP of 1.3 W.
Figure 2
Figure 2
The relation between GEF, LVSWI and CP. (a) The relationship between global ejection fraction (GEF) and left ventricular stroke work index (LVSWI) in patients with sepsis and those with acute heart failure. Significant correlations between the two variables exist in patients with sepsis (r2 = 0.26, P = 0.001) and those with acute heart failure (r2 = 0.18, P = 0.006). (b) The significant relationship between GEF and cardiac power (CP) in both patient groups (sepsis: r2 = 0.22, P = 0.004; acute heart failure: r2 = 0.13, P = 0.01). Dashed lines indicate GEF of 20%, LVSWI of 40 g-m/m2, and CP of 1.3 W.
Figure 3
Figure 3
The relation between CFI, PAOP and SmvO2. (a) The relationship between cardiac function index (CFI) and pulmonary artery occlusion pressure (PAOP) in patients with sepsis and acute heart failure. In patients with acute heart failure, CFI is negatively correlated with PAOP (r2 = -0.18, P = 0.006), whereas there is no significant correlation in septic patients (r2 = 0.0006, P = 0.89). (b) CFI is significantly correlated with mixed venous oxygen saturation (SmvO2) in patients with sepsis (r2 = 0.22, P = 0.004) but not in patients with acute heart failure (r2 = 0.03, P = 0.26). Dashed lines indicate CFI of 4.5 per minute, PAOP of 18 mm Hg, and SmvO2 of 70%.
Figure 4
Figure 4
The relation between PAOP, ELWI and PVPI. (a) The relationship between pulmonary artery occlusion pressure (PAOP) and extravascular lung water index (ELWI) in patients with sepsis and patients with acute heart failure. (b) The relationship between PAOP and pulmonary vascular permeability index (PVPI) in patients with sepsis and patients with acute heart failure. No significant correlation exists between PAOP and the other two variables in either group of patients. Dashed lines indicate PAOP of 18 mm Hg, ELWI of 10 mL/kg, and PVPI of 3.0.
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