Cardiac output measurements during high‐risk Cesarean section using electrical bioreactance or arterial waveform analysis: assessment of agreement.

  1. Gutierrez, J. 3
  2. Perry, H. 34
  3. Columb, M. 1
  4. Bampoe, S. 2
  5. Thilaganathan, B. 34
  6. Khalil, A. 34
  1. 1 Manchester University Hospitals NHS Foundation Trust, Wythenshawe Hospital Manchester UK
  2. 2 Centre for Anaesthesia and Perioperative Medicine University College London London UK
  3. 3 Fetal Medicine Unit St George's University Hospitals NHS Foundation Trust, University of London London UK
  4. 4 Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute St George's University of London London UK
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Revista:
Ultrasound in Obstetrics & Amp; Gynecology

ISSN: 0960-7692,  1469-0705

Año de publicación: 2019

Volumen: 54

Número: 2

Páginas: 232-238

Tipo: Artículo

DOI: 10.1002/UOG.20142 GOOGLE SCHOLAR lock_openAcceso abierto editor

Otras publicaciones en: Ultrasound in Obstetrics & Amp; Gynecology

Resumen

Maternal hemodynamics can change significantly during Cesarean section, due to the effects of neuraxial sympathetic blockade, vasodilatory general anesthetic agents and changes in aortocaval compression, on supine positioning or at the time of delivery of the fetus, and also in response to massive hemorrhage1, 2. In routine practice, maternal heart rate and blood pressure (BP) are measured to monitor these changes. However, measurements of stroke volume, cardiac output (CO) and systemic vascular resistance provide a more nuanced assessment of hemodynamic changes and are desirable, particularly in cases of massive hemorrhage or hypertensive disease, in order to guide targeted hemodynamic therapy.Pulmonary artery catheterization is considered the gold standard of CO monitoring and has been performed in obstetric populations3-5. However, in practice, this invasive procedure is not practical perioperatively and carries significant risk to the pregnant woman. Several less invasive and non-invasive methods have been developed as alternatives6-9. For cases in which CO monitoring is required, this is commonly performed using a radial arterial line to give continuous BP recording via waveform analysis. LiDCOrapid™ (LiDCO, Cambridge, UK) is a CO monitor that converts the arterial pressure waveform into volume measurements using an algorithm (PulseCO™) to estimate CO, which has been validated against lithium indicator dilution assessment. However, LiDCOrapid has not been validated in pregnancy. NICOM® (Cheetah Medical, Boston, MA, USA) is a non-invasive device which uses thoracic bioreactance technology to estimate hemodynamic indices. We have shown previously good agreement of NICOM readings with echocardiography in the third trimester of pregnancy.The aim of this study was to record hemodynamic changes during Cesarean section in pregnancies at high risk of hemodynamic instability, using invasive (LiDCOrapid) and non-invasive (NICOM) monitors, and to assess the agreement between the two devices in measuring CO.

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Referencias bibliográficas

  • 10.1016/S0002-9378(15)33636-X
  • 10.1111/j.1471-0528.1989.tb03277.x
  • 10.1016/0002-9378(80)90396-8
  • 10.1016/0002-9378(89)90900-9
  • Ackerman W, (1991), Anesthesiol Rev, 17, pp. 37
  • 10.1016/j.ijoa.2013.11.001
  • 10.1016/j.ijoa.2011.07.006
  • 10.1159/000446650
  • 10.1002/uog.15915
  • 10.1177/0962280211402548
  • 10.1007/s001340050431
  • 10.1002/uog.17504
  • 10.1136/heartjnl-2015-308476
  • 10.1016/j.cacc.2008.07.001
  • 10.1023/A:1009982611386
  • 10.1053/j.jvca.2011.01.003
  • 10.1213/ANE.0000000000000725
  • 10.1097/ALN.0b013e3181b437e0
  • 10.1111/jog.12769
  • 10.4103/0366-6999.160546
  • 10.1038/jp.2017.53
  • 10.1016/j.ijoa.2016.08.005
  • 10.1213/ANE.0000000000001174
  • 10.1007/s10877-016-9896-7
  • 10.1093/bja/aex045
  • 10.1007/s00134-007-0640-0
  • 10.1159/000365278
  • 10.1213/ANE.0000000000000182
  • 10.1111/pan.12492
  • 10.1016/S0034-7094(11)70038-1
  • 10.1002/uog.18835
  • 10.1002/uog.17311
  • 10.1007/s00540-014-1938-z
  • 10.1016/j.resuscitation.2011.06.039
  • 10.1016/j.medin.2012.05.003
  • 10.1007/s40140-017-0239-0
  • 10.1016/S0140-6736(86)90837-8
  • Ueland K, Gills R, Hansen J. Maternal cardiovascular dynamics: I. Cesarean section under subarachnoid block anesthesia. Am J Obstet Gynecol 1968; 100: 42–54.
  • Robson S, Dunlop W, Hunter S, Boys R, Bryson M. Haemodynamic changes associated with caesarean section under epidural anaesthesia. Br J Obstet Gynaecol 1989; 96: 642–647.
  • Berkowitz R, Rafferty T. Invasive hemodynamic monitoring in critically ill pregnant patients: role of Swan-Ganz catheterization. Am J Obstet Gynecol 1980; 137: 127–134.
  • Clark S, Cotton D, Lee W, Bishop C, Hill T, Southwick J, Pivarnik J, Spillman T, DeVore G, Phelan J, Hankins G, Benedetti T, Tolley D. Central hemodynamic assessment of normal term pregnancy. Am J Obstet Gynecol 1989; 161: 1439–1442.
  • Ackerman W, Porembka D, Juneja M, Kaczorowski D. Use of a pulmonary artery catheter in the management of the severe pre-eclamptic patient. Anesthesiol Rev 1991; 17: 37–40.
  • Dennis AT, Dyer RA. Cardiac output monitoring in obstetric anaesthesia. Int J Obstet Anesth 2014; 23: 1–3.
  • Armstrong S, Fernando R, Columb M. Minimally- and non-invasive assessment of maternal cardiac output: Go with the flow! Int J Obstet Anesth 2011; 20: 330–340.
  • Vinayagam D, Bowe S, Sheehan E, Thilaganathan B, Khalil A. Non-Invasive Haemodynamic Monitoring in Pregnancy: A Comparative Study Using Ultrasound and Bioreactance. Fetal Diagn Ther 2017; 41: 273–282.
  • Vinayagam D, Patey O, Thilaganathan B, Khalil A. Cardiac output assessment in pregnancy: comparison of two automated monitors with echocardiography. Ultrasound Obstet Gynecol 2017; 49: 32–38.
  • Zou GY. Confidence interval estimation for the Bland–Altman limits of agreement with multiple observations per individual. Stat Methods Med Res 2013; 22: 630–642.
  • Brandi LS, Bertolini R, Pieri M, Giunta F, Calafà M. Comparison between cardiac output measured by thermodilution technique and calculated by O2 and modified CO2 Fick methods using a new metabolic monitor. Intensive Care Med 1997; 23: 908–915.
  • Vinayagam D, Thilaganathan B, Stirrup O, Mantovani E, Khalil A. Maternal hemodynamics in normal pregnancies: reference ranges and the role of maternal characteristics. Ultrasound Obstet Gynecol 2018; 51: 665–671.
  • Meah VL, Cockcroft JR, Backx K, Shave R, Stöhr EJ. Cardiac output and related haemodynamics during pregnancy: a series of meta-analyses. Heart 2016; 102: 518–526.
  • Columb MO. Clinical measurement and assessing agreement. Curr Anaesth Crit Care 2008; 19: 328–329.
  • Critchley LA, Critchley JA. A meta-analysis of studies using bias and precision statistics to compare cardiac output measurement techniques. J Clin Monit Comput 1999; 15: 85–91.
  • Critchley LA, Yang XX, Lee A. Assessment of trending ability of cardiac output monitors by polar plot methodology. J Cardiothorac Vasc Anesth 2011; 25: 536–546.
  • Saugel B, Grothe O, Wagner JY. Tracking Changes in Cardiac Output: Statistical Considerations on the 4-Quadrant Plot and the Polar Plot Methodology. Anesth Analg 2015; 121: 514–524.
  • Dyer RA, Reed AR, Dyk D Van, James MF, Ph D. Hemodynamic Effects of Ephedrine, Phenylephrine, and the Coadministration of Phenylephrine with Oxytocin during Spinal Anesthesia for Elective Cesarean Delivery. Anesthesiology 2009; 111: 753–766.
  • Xiao W, Duan Q, Zhao L, Chi X, Wang F, Ma D, Wang T. Goal-directed fluid therapy may improve hemodynamic stability in parturient women under combined spinal epidural anesthesia for cesarean section and newborn well-being. J Obstet Gynaecol Res 2015; 41: 1547–1555.
  • Xiao W, Duan QF, Fu WY, Chi XZ, Wang FY, Ma DQ, Wang TL, Zhao L. Goal-directed fluid therapy may improve hemodynamic stability of parturient with hypertensive disorders of pregnancy under combined spinal epidural anesthesia for Cesarean delivery and the well-being of newborns. Chin Med J (Engl) 2015; 128: 1922–1931.
  • Ram M, Lavie A, Lev S, Blecher Y, Amikam U, Shulman Y, Avnon T, Weiner E, Many A. Cardiac hemodynamics before, during and after elective Cesarean section under spinal anesthesia in low-risk women. J Perinatol 2017; 37: 793–799.
  • Vallejo MC, Attaallah AF, Elzamzamy OM, Cifarelli DT, Phelps AL, Hobbs GR, Shapiro RE, Ranganathan P. An open-label randomized controlled clinical trial for comparison of continuous phenylephrine versus norepinephrine infusion in prevention of spinal hypotension during Cesarean delivery. Int J Obstet Anesth 2017; 29: 18–25.
  • Kuhn JC, Hauge TH, Rosseland LA, Dahl V, Langesæter E. Hemodynamics of Phenylephrine Infusion Versus Lower Extremity Compression During Spinal Anesthesia for Cesarean Delivery. Anesth Analg 2016; 122: 1120–1129.
  • Asamoto M, Orii R, Otsuji M, Bougaki M, Imai Y, Yamada Y. Reliability of cardiac output measurements using LiDCOrapid™ and FloTrac/Vigileo™ across broad ranges of cardiac output values. J Clin Monit Comput 2017; 31: 709–716.
  • Doherty A, EL-Khuffash A, Monteith C, McSweeney L, Breatnach C, Kent E, Tully E, Malone F, Thornton P. Comparison of bioreactance and echocardiographic non-invasive cardiac output monitoring and myocardial function assessment in primigravida women. Br J Anaesth 2017; 118: 527–532.
  • Squara P, Denjean D, Estagnasie P, Brusset A, Dib JC, Dubois C. Non-invasive cardiac output monitoring (NICOM): a clinical validation. Intensive Care Med 2007; 33: 1191–1194.
  • Weisz DE, Jain A, Ting J, McNamara PJ, EL-Khuffash A. Non-Invasive Cardiac Output Monitoring in Preterm Infants Undergoing Patent Ductus Arteriosus Ligation: A Comparison with Echocardiography. Neonatology 2014; 106: 330–336.
  • Waldron NH, Miller TE, Thacker JK, Manchester AK, White WD, Nardiello J, Elgasim MA, Moon RE, Gan TJ. A Prospective Comparison of a Non-invasive Cardiac Output Monitor Versus Esophageal Doppler Monitor for Goal-Directed Fluid Therapy in Colorectal Surgery Patients. Anesth Analg 2014; 118: 966–975.
  • Sun Y, Wu C, Wu J-Z, Wang S-S, Bai J, Zhu M, Zhang Y-Q, Zhang M-Z. Noninvasive cardiac output monitoring using bioreactance-based technique in pediatric patients with or without ventricular septal defect during anesthesia: in comparison with echocardiography. Hammer G, ed. Paediatr Anesth 2015; 25: 167–173.
  • Doherty A, Ohashi Y, Downey K, Carvalho JC. Non-Invasive Monitoring Based on Bioreactance Reveals Significant Hemodynamic Instability during Elective Cesarean Delivery under Spinal Anesthesia. Rev Bras Anestesiol 2011; 61: 320–332.
  • Stott D, Nzelu O, Nicolaides KH, Kametas NA. Maternal hemodynamics in normal pregnancies and in pregnancies affected by pre-eclampsia. Ultrasound Obstet Gynecol 2018; 52: 359–364.
  • Cheung H, Dong Q, Dong R, Yu B. Correlation of cardiac output measured by non-invasive continuous cardiac output monitoring (NICOM) and thermodilution in patients undergoing off-pump coronary artery bypass surgery. J Anesth 2015; 29: 416–420.
  • Ballestero Y, Urbano J, López-Herce J, Solana MJ, Botrán M, Vinciguerra D, Bellón JM. Pulmonary arterial thermodilution, femoral arterial thermodilution and bioreactance cardiac output monitoring in a pediatric hemorrhagic hypovolemic shock model. Resuscitation 2012; 83: 125–129.
  • Mateu Campos ML, Ferrándiz Sellés A, Gruartmoner de Vera G, Mesquida Febrer J, Sabatier Cloarec C, Poveda Hernández Y, García Nogales X. Techniques available for hemodynamic monitoring. Advantages and limitations. Med Intensiva 2012; 36: 434–444.
  • Odor PM, Bampoe S, Cecconi M. Cardiac Output Monitoring: Validation Studies–how Results Should be Presented. Curr Anesthesiol Rep 2017; 7: 410–415.
  • Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986; 1: 307–310.