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

Any de publicació: 2019

Volum: 54

Número: 2

Pàgines: 232-238

Tipus: Article

DOI: 10.1002/UOG.20142 GOOGLE SCHOLAR lock_openAccés obert editor

Altres publicacions en: Ultrasound in Obstetrics & Amp; Gynecology

Resum

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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