Abstract

Objective

In the management of haemodynamically unstable patients, cardiac output (CO) measurement provides clinicians with important data on organ tissue perfusion. This measurement can be performed by pulse-induced contour cardiac output (PiCCO) using thermodilution method, which is a less invasive method, and ultrasonic cardiac output monitoring (USCOM), which is completely non-invasive. The aim of this study was to investigate the clinical relevance of CO and cardiac index measurements obtained by USCOM in patient’s with sepsis and septic shock by comparing them with the PiCCO technique, which has been used as a reference measurement method in recent years.

Materials and Methods

In this prospective study, 36 patient’s with sepsis and septic shock ventilated with 8-10 mL/kg tidal volume without respiratory effort were included. Patient’s with arrhythmia, known heart failure or pulmonary embolism were excluded.

Results

After averaging the PiCCO and USCOM measurements performed by different clinicians, the heart rate was found to be 3.23 L/min/m2 with PiCCO and 2.24 L/min/m2 with USCOM. When the two results were compared, the difference was statistically significant (p=0.01). Stroke volume variation was 15.80% with PiCCO and 52.89% with USCOM. When the two results were compared, the difference was statistically significant (p=0.01).

Conclusion

There was no agreement between USCOM and PiCCO measurements in sepsis patient’s. In our opinion, more studies are needed for USCOM reliability.

Keywords: PiCCO, USCOM, cardiac output

References

  1. Beltramo F, Menteer J, Razavi A, Khemani RG, Szmuszkovicz J, Newth CJ, et al. Validation of an Ultrasound Cardiac Output Monitor as a Bedside Tool for Pediatric Patients. Pediatr Cardiol. 2016;37:177-83.
  2. Nidorf SM, Picard MH, Triulzi MO, Thomas JD, Newell J, King ME, et al. New perspectives in the assessment of cardiac chamber dimensions during development and adulthood. J Am Coll Cardiol. 1992;19:983-8.
  3. Hofkens PJ, Verrijcken A, Merveille K, Neirynck S, Van Regenmortel N, De Laet I, et al. Common pitfalls and tips and tricks to get the most out of your transpulmonary thermodilution device: results of a survey and state-of-the-art review. Anaesthesiol Intensive Ther. 2015;47:89-116.
  4. Oren-Grinberg A. The PiCCO Monitor. Int Anesthesiol Clin. 2010;48:57-85.
  5. Tibby S. Transpulmonary thermodilution: finally, a gold standard for pediatric cardiac output measurement. Pediatr Crit Care Med. 2008;9:341-2.
  6. Monnet X, Persichini R, Ktari M, Jozwiak M, Richard C, Teboul JL. Precision of the transpulmonary thermodilution measurements. Crit Care. 2011;15:R204.
  7. Pinsky MR, Payen D. Functional hemodynamic monitoring. Crit Care. 2005;9:566-72.
  8. Stemmler HJ, Weigert O, Grüner N, Tschop K, Lange V, Parhofer KG. Nicht-invasives hämodynamisches Monitoring bei Intensivpatienten. Intensivmed. 2007;44:366-71.
  9. Horster S, Stemmler HJ, Strecker N, Brettner F, Hausmann A, Cnossen J, et al. Cardiac Output Measurements in Septic Patients: Comparing the Accuracy of USCOM to PiCCO. Crit Care Res Pract. 2012;2012:270631.
  10. Chong SW, Peyton PJ. A meta-analysis of the accuracy and precision of the ultrasonic cardiac output monitor (USCOM). Anaesthesia. 2012;67:1266-71.
  11. Tan HL, Pinder M, Parsons R, Roberts B, van Heerden PV. Clinical evaluation of USCOM ultrasonic cardiac output monitor in cardiac surgical patients in intensive care unit. Br J Anaesth. 2005;94:287-91.
  12. Phillips RA, Smith BE, Madigan VM, Boyle M, Steel L, Flynn GM, et al. Assessment of the clinical utility of an ultrasonic monitor of cardiac output (the USCOM) and agreement with thermodilution measurement. Crit Care Resusc. 2010;12:209-13.
  13. Jain S, Allins A, Salim A, Vafa A, Wilson MT, Margulies DR. Noninvasive Doppler ultrasonography for assessing cardiac function: can it replace the Swan-Ganz catheter? Am J Surg. 2008;196:961-7.
  14. Phillips RA, Hood SG, Jacobson BM, West MJ, Wan L, May CN. Pulmonary Artery Catheter (PAC) Accuracy and Efficacy Compared with Flow Probe and Transcutaneous Doppler (USCOM): An Ovine Cardiac Output Validation. Crit Care Res Pract. 2012;2012:621496.
  15. Vandenbogaerde JF, Scheldewaert RG, Rijckaert DL, Clement DL, Colardyn FA. Comparison between ultrasonic and thermodilution cardiac output measurements in intensive care patients. Crit Care Med. 1986;14:294-7.
  16. Pinsky MR, Cecconi M, Chew MS, De Backer D, Douglas I, Edwards M, et al. Effective hemodynamic monitoring. Crit Care. 2022;26:294.
  17. Ait-Oufella H, Bige N, Boelle PY, Pichereau C, Alves M, Bertinchamp R, et al. Capillary refill time exploration during septic shock. Intensive Care Med. 2014;40:958-64.
  18. Jansen TC, van Bommel J, Schoonderbeek FJ, Sleeswijk Visser SJ, van der Klooster JM, Lima AP, et al. Early lactate-guided therapy in intensive care unit patients: a multicenter, open-label, randomized controlled trial. Am J Respir Crit Care Med. 2010;182:752-61.
  19. Cecconi M, De Backer D, Antonelli M, Beale R, Bakker J, Hofer C, et al. Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine. Intensive Care Med. 2014;40:1795-815.
  20. De Backer D, Cecconi M, Chew MS, Hajjar L, Monnet X, Ospina-Tascón GA, et al. A plea for personalization of the hemodynamic management of septic shock. Crit Care. 2022;26:372.
  21. De Backer D, Vincent JL. Should we measure the central venous pressure to guide fluid management? Ten answers to 10 questions. Crit Care. 2018;22:43.
  22. De Backer D, Aissaoui N, Cecconi M, Chew MS, Denault A, Hajjar L, et al. How can assessing hemodynamics help to assess volume status? Intensive Care Med. 2022;48:1482-94.
  23. Teboul JL, Saugel B, Cecconi M, De Backer D, Hofer CK, Monnet X, et al. Less invasive hemodynamic monitoring in critically ill patients. Intensive Care Med. 2016;42:1350-9.

Copyright and license

Copyright © 2024 The Author(s). This is an open access article distributed under the Creative Commons Attribution License (CC BY), which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is properly cited.

How to cite?

1.
Çakın Ö, Harmandar O, Parlak H, Cengiz M, Yılmaz M, Ramazanoğlu A. Comparison of USCOM and PiCCO Cardiac Output Measurements in Intensive Care Unit. Turk J Intensive Care. 2024;22(3):212-217. https://doi.org/10.4274/tybd.galenos.2024.63644