RESUMEN
INTRODUCTION: Evaluation of accuracy, precision, and trending ability of cardiac index (CI) measurements using the Aesculon™ bioimpedance electrical cardiometry (Aesc) compared to the continuous pulmonary artery thermodilution catheter (PAC) technique before, during, and after cardiac surgery. METHODS: A prospective observational study with fifty patients with ASA 3-4. At six time points (T), measurements of CI simultaneously by continuous cardiac output pulmonary thermodilution and thoracic bioimpedance and standard hemodynamics were performed. Analysis was performed using Bland-Altman, four-quadrant plot, and polar plot methodology. RESULTS: CI obtained with pulmonary artery thermodilution and thoracic bioimpedance ranged from 1.00 to 6.75 L min-1 and 0.93 to 7.25 L min-1, respectively. Bland-Altman analysis showed a bias between CIBIO and CIPAC of 0.52 liters min-1 m-2, with LOA of [-2.2; 1.1] liters min-1 m-2. Percentage error between the two techniques was above 30% at every time point. Polar plot methodology and 4-quadrant analysis showed poor trending ability. Skin incision had no effect on the results. CONCLUSION: CI obtained by continuous PAC and CI obtained by Aesculon bioimpedance are not interchangeable in cardiac surgical patients. No effects of skin incision were found. International clinical trial registration number is ISRCTN26732484.
Asunto(s)
Fenómenos Electrofisiológicos , Arteria Pulmonar/fisiología , Termodilución/métodos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Hemodinámica , Humanos , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
A multidisciplinary approach for patients who will undergo colonic resection was introduced in 2006 and 2007 in 26 Dutch hospitals, following several other European centres. This approach aims to place the patient in an optimal metabolic state before operation, with subsequent rapid mobilisation and resumption of oral intake of liquids and solid food. The surgeon, anaesthetist, and nursing staff collaborate in this approach, each taking responsibility for specific tasks. The anaesthesiological tasks consist of withholding preoperative intake of drink and food, appropriate pain reduction, perioperative fluid balance management, use of inotropic and vasopressor drugs, prevention of post-operative nausea and vomiting, and addressing possible immunological consequences of surgery.