Abstract
Purpose
The current bedside “gold standard” for cardiac output (CO) monitoring is thermodilution using a pulmonary artery catheter (PAC) but there is a number of risks associated with its use. The primary objective of this review was to evaluate the utility of esophageal Doppler (ED) as a minimally invasive monitor of CO.
Source
Medline literature search from 1966 to 2001 with citation review for studies comparing ED to PAC thermodilution for CO in perioperative and critically ill patients.
Principal findings
Twenty-five publications were identifed comparing ED and PAC measurement of CO in a broad range of patients. There was a good overall correlation between CO determined by ED and thermodilution (n = 18 studies, median R = 0.89, range 0.52 to 0.98) and minimal bias (n = 13, median −0.01, range 1.38 to 2 L·min−1). The precision of ED was only fair overall as assessed by limits of agreement. The ED technique was found to be responsive in detecting changes in thermodilution CO and was reliable demonstrating both low intra- and inter-observer variation. ED was reportedly easy to insert after minimal training and was safe, with no significant complications identified.
Conclusion
ED is a practical, reliable, and valid device for measuring CO in perioperative and critically ill patients. Further studies with larger numbers of patients are needed to determine if the limited precision observed is inherent to the technique, the diagnoses of patients studied, or the small sample sizes.
Résumé
Objectif
La thermodilution avec un cathéter artériel pulmonaire (CAP) représente la référence actuelle en monitorage de chevet du débit cardiaque (DC), mais elle comporte certains risques. L’objectif principal de la présente revue était d’évaluer l’utilité du Doppler œsophagien (DO) comme moniteur du DC à effraction minimale.
Source
Nous avons procédé à une recherche dans Medline, pour la période de 1966 à 2001, et à une revue des citations pour les études comparant l’usage périopératoire du DO et de la thermodilution avec CAP pour le DC chez des patients gravement malades.
Constatations principales
Vingt-cinq articles traitaient de la comparaison des mesures du DC avec DO et CAP chez une grande diversité de patients. Une bonne corrélation globale a été notée entre le DC déterminé par le DO et la thermodilution (n = 18 études, R médian = 0,89, étendue de 0,52 à 0,98) et biais minimal (n = 13, médiane −0,01, étendue de 1,38 à 2 L·min−1). La précision du DO n’a été que bonne dans l’ensemble comme l’ont montré les limites de la concordance. La technique du DO a été trouvée efficace, car elle détecte les modifications du DC noté par thermodilution, et fiable, puisqu’elle peut démontrer une faible variation intra-observateur et interobservateur. Les articles révèlent que le DO est facile à insérer, ne requérant qu’une formation minimale, et sans risque, ne présentant pas de complications significatives connues.
Conclusion
Le DO est un appareil de mesure périopératoire du DC pratique, fiable et valide pour des patients gravement malades. D’autres études auprès d’un plus grand nombre de patients demeurent nécessaires pour déterminer si la précision limitée qui a été observée est inhérente à la technique, aux diagnostics des patients étudiés ou aux échantillonnages de faible effectif.
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Dr. Laupland was supported by the 2000 Bayer Healthcare/Canadian Institutes of Health Research/Canadian Infectious Diseases Society Research Fellowship and a clinical fellowship award from the Alberta Heritage Foundation for Medical Research.
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Laupland, K.B., Bands, C.J. Utility of esophageal Doppler as a minimally invasive hemodynamic monitor: a review. Can J Anesth 49, 393–401 (2002). https://doi.org/10.1007/BF03017329
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DOI: https://doi.org/10.1007/BF03017329