Transgastric, pulsed Doppler echocardiographic determination of cardiac output

Abstract

Objective: The aim of this study was to evaluate the accuracy of cardiac output measurement with transesophageal echocardiography (TEE) using a transgastric, pulsed Doppler method in acutely ill patients.

Design: Cardiac output was simultaneously measured by thermodilution (TD) and a transgastric, pulsed Doppler method.

Setting: The study was carried out in a surgical intensive care unit as part of the management protocol of the patients.

Patients: Thirty consecutive acutely ill patients with a Swan-Ganz catheter, mechanically ventilated, sedated and with a stable hemodynamic condition were included.

Measurements: Pulsed Doppler TEE was performed using a transgastric approach in order to obtain a long axis view of the left ventricle. Cardiac output was calculated from the left ventricular outflow tract diameter, the velocity time integral of the blood flow profile and heart rate.

Results: One patient was excluded because of the presence of aortic regurgitation and another, because of the impossibility of obtaining a transgastric view. Twenty-eight simultaneous measurements were performed in 28 patients. A clinically acceptable correlation and agreement were found between the two methods (Doppler cardiac output = 0.889 thermodilution cardiac output +0.74 l/min, r = 0.975, p <0.0001).

Conclusion: Transgastric pulsed Doppler measurement across the left ventricular outflow tract with TEE is a very feasible and clinically acceptable method for cardiac output measurement in acutely ill patients.