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KMID : 0356920080550010057
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Korean Journal of Anesthesiology
2008 Volume.55 No. 1 p.57 ~ p.65
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Modelflow method versus continuous thermodilution technique for cardiac output measurement in liver transplant patients
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Huh In-Young
Hwang Gyu-Sam
Park Soon-Eun
Yang Hyun-Suk
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Abstract
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Background: In critically ill patients, cardiac output (CO) is used as a parameter for assessing hemodynamic status and efficacy of treatment. Continuous CO (CCO) could facilitate this assessment during general anesthesia. A new method of arterial pulse wave analysis has been introduced, which estimates beat to beat CO from arterial pressure via Modelflow. It remains uncertain how well this method performs in high output states. We analyzed the relationship between CCO and Modelflow computed from radial and femoral pressures (MFCORA, MFCOFA) during liver transplantation (LT).
Methods: Measurements were performed in 100 liver transplant patients. Groups A had 36 patients, and group C had 64 patients with both groups composed of Child-Turcotte A, B and C patients Eighty patients had CCO ＜ 10 L/min (group D), and 20 patients had CCO ＞ 10 L/min (group E) during anhepatic phase.
Results: CCO ranged from 5.0 to 15.4 L/min (MFCORA 3.2 to 10.7 L/min, MFCOFA 4.3 to 11.8 L/min). Bland-Altman analyses showed the limit of agreement of MFCORA (?1.5 to 5.2, bias = 1.9 L/min) and of MFCOFA (?2.6 to 4.4, bias = 0.9 L/min). CO measured by the two methods was significantly different in groups, except for MFCOFA in group C. In group D, bias was 1.5 L/min (SD 1.3 L/min) for MFCORA and 0.9 L/min for MFCOFA (SD 1.4 L/min). In group E, biases of 3.5 L/min and 2.4 L/min were obtained for MFCORA and MFCOFA, respectively.
Conclusions: These results suggest that the group-average value of MFCO is not an accurate parameter for estimating CO during LT, with the exception of MFCOFA in groups C and D. (Korean J Anesthesiol 2008; 55: 57∼65)
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KEYWORD
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cardiac output, liver transplantation, Modelflow, thermodilution
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