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Critical Care

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Open Access 01-08-2011 | Research

Precision of the transpulmonary thermodilution measurements

Authors: Xavier Monnet, Romain Persichini, Mariem Ktari, Mathieu Jozwiak, Christian Richard, Jean-Louis Teboul

Published in: Critical Care | Issue 4/2011

Abstract

Introduction

We wanted to determine the number of cold bolus injections that are necessary for achieving an acceptable level of precision for measuring cardiac index (CI), indexed global end-diastolic volume (GEDVi) and indexed extravascular lung water (EVLWi) by transpulmonary thermodilution.

Methods

We included 91 hemodynamically stable patients (age 59 (25% to 75% interquartile range: 39 to 79) years, simplified acute physiologic score (SAPS)II 59 (53 to 65), 56% under norepinephrine) who were monitored by a PiCCO2 device. We performed five successive cold saline (15 mL, 6°C) injections and recorded the measurements of CI, GEDVi and EVLWi.

Results

Considering five boluses, the coefficient of variation (CV, calculated as standard deviation divided by the mean of the five measurements) was 7 (5 to 11)%, 7 (5 to 12)% and 7 (6 to 12)% for CI, GEDVi and EVLWi, respectively. If the results of two bolus injections were averaged, the precision (2 × CV/√ number of boluses) was 10 (7 to 15)%, 10 (7 to 17)% and 8 (7 to 14)% for CI, GEDVi and EVLWi, respectively. If the results of three bolus injections were averaged, the precision dropped below 10%, that is, the cut-off that is generally considered as acceptable (8 (6 to 12)%, 8 (6 to 14)% and 8 (7 to 14)% for CI, GEDVi and EVLWi, respectively). If two injections were performed, the least significant change, that is, the minimal change in value that could be trusted to be significant, was 14 (10 to 21)%, 14 (10 to 24)% and 14 (11 to 23)% for CI, GEDVi and EVLWi, respectively. If three injections were performed, the least significant change was 12 (8 to 17)%, 12 (8 to 19)% and 12 (9 to 19)% for CI, GEDVi and EVLWi, respectively, that is, below the 15% cut-off that is usually considered as clinically relevant.

Conclusions

These results support the injection of at least three cold boluses for obtaining an acceptable precision when transpulmonary thermodilution is used for measuring CI, GEDVi and EVLWi.

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Title: Precision of the transpulmonary thermodilution measurements
Authors: Xavier Monnet
Romain Persichini
Mariem Ktari
Mathieu Jozwiak
Christian Richard
Jean-Louis Teboul
Publication date: 01-08-2011
Publisher: BioMed Central
Published in: Critical Care / Issue 4/2011
Electronic ISSN: 1364-8535
DOI: https://doi.org/10.1186/cc10421

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Precision of the transpulmonary thermodilution measurements

Abstract

Introduction

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

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