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Significant changes in haemodynamics occur after brain stem death (BSD) and there is evidence that yield of transplantable organs may be decreased in donors who remain preload responsive prior to donation [1], suggesting that optimisation of the cardiac output (CO) may be beneficial in potential organ donors. We describe current UK practice with regard to CO monitoring in this group.

Patient's height and weight measurements are used regularly within the critical care setting whether for calculation of drug doses, nutritional intake, ventilator settings or calibration of cardiac output monitoring [1]. In sedated patients these parameters are often obtained via estimation by critical care staff. Errors in these estimations have the potential to cause harm either from errors in drug calculations [2], inappropriate ventilatory settings or underfeeding or overfeeding.

The EV1000 platform, a new calibrated device for intermittent and continuous cardiac output monitoring, has recently been introduced into clinical practice [1]. This study aims to assess the level of agreement between intermittent and continuous cardiac output obtained from VolumeView (ICOvv and CCOvv) connected to the EV1000 platform (Edwards Lifesciences, Irvine, CA, USA) and intermittent (ICOvig) and continuous cardiac output (CCOvig) obtained using an advanced pulmonary artery catheter (PAC) connected to the Vigilance System (Edwards Lifesciences) in cirrhotic patients undergoing liver transplantation.

Haemodynamic monitoring is essential for the management of critically ill patients. Currently there are various techniques available in clinical practice to measure cardiac output (CO) in ICUs including pulmonary artery catheter (PAC), oesophageal Doppler, lithium dilution cardiac output (LiDCO) and pulse-induced contour cardiac output (PiCCO) studies. In recent times PAC has been used less with less invasive methods becoming more popular. We conducted a telephone survey of the current CO monitoring practices in adult ICUs in the United Kingdom.

The aim of this work is to verify that low incidence of hemodynamic interventions in hemodynamically monitored patients in our postoperative ICU is not caused by insufficient attention being paid to the drop of noncalibrated cardiac index (nCI). In the last 2 years there was a need for hemodynamic intervention in 92% of patients with perioperative cardiac output monitoring, while only 31% of these patients needed at least one hemodynamic intervention postoperatively in the ICU.

Abdominal aortic surgery is a high-risk procedure. Cardiac output monitoring allowing haemodynamic optimisation may reduce the complication rate. Minimally invasive, continuous techniques are preferable. Cardiac output using oesophageal Doppler has been validated in several studies, showing good agreement with the gold standard. The aim of this study was to assess the degree of correlation and agreement between cardiac output measured by oesophageal Doppler and bioimpedance obtained from an endotracheal tube.

The aim of this study was to validate impedance cardiography (electrical velocimetry (EV)) as a continuous noninvasive cardiac output monitoring in neonates and infants. As the reference method, discontinuous transthoracic echocardiography (TTE) was used.

Intermittent cardiac output measurement using the transpulmonary thermodilution (TPTD) method is considered to be the gold standard in young children but a validated continuous cardiac output technique is not available in these patients. We compared the continuous pulse contour cardiac output (PCCO) measurements with the TPTD method in critically ill children.

Introduction Acute hemodynamic instability increases morbidity and mortality. We investigated whether early non-invasive cardiac output monitoring enhances hemodynamic stabilization and improves outcome. Methods A multicenter, randomized controlled trial was conducted in three European university hospital intensive care units in 2006 and 2007. A total of 388 hemodynamically unstable patients identified during their first six hours in the intensive care unit (ICU) were randomized to receive either non-invasive cardiac output monitoring for 24 hrs (minimally invasive cardiac output/MICO group; n = 201) or usual care (control group; n = 187). The main outcome measure was the proportion of patients achieving hemodynamic stability within six hours of starting the study. Results The number of hemodynamic instability criteria at baseline (MICO group mean 2.0 (SD 1.0), control group 1.8 (1.0); P = .06) and severity of illness (SAPS II score; MICO group 48 (18), control group 48 (15); P = .86)) were similar. At 6 hrs, 45 patients (22%) in the MICO group and 52 patients (28%) in the control group were hemodynamically stable (mean difference 5%; 95% confidence interval of the difference -3 to 14%; P = .24). Hemodynamic support with fluids and vasoactive drugs, and pulmonary artery catheter use (MICO group: 19%, control group: 26%; P = .11) were similar in the two groups. The median length of ICU stay was 2.0 (interquartile range 1.2 to 4.6) days in the MICO group and 2.5 (1.1 to 5.0) days in the control group (P = .38). The hospital mortality was 26% in the MICO group and 21% in the control group (P = .34). Conclusions Minimally-invasive cardiac output monitoring added to usual care does not facilitate early hemodynamic stabilization in the ICU, nor does it alter the hemodynamic support or outcome. Our results emphasize the need to evaluate technologies used to measure stroke volume and cardiac output--especially their impact on the process of care--before any large-scale outcome studies are attempted. Trial Registration The study was registered at ClinicalTrials.gov (Clinical Trials identifier NCT00354211)

Several studies have demonstrated that perioperative hemodynamic optimization has the ability to improve postoperative outcome in high-risk surgical patients. All of these studies aimed at optimizing cardiac output and/or oxygen delivery in the perioperative period. We conducted a survey with the American Society of Anesthesiologists (ASA) and the European Society of Anaesthesiology (ESA) to assess current hemodynamic management practices in patients undergoing high-risk surgery in Europe and in the United States.A survey including 33 specific questions was emailed to 2,500 randomly selected active members of the ASA and to active ESA members.Overall, 368 questionnaires were completed, 57.1% from ASA and 42.9% from ESA members. Cardiac output is monitored by only 34% of ASA and ESA respondents (P = 0.49) while central venous pressure is monitored by 73% of ASA respondents and 84% of ESA respondents (P0.01). Specifically, the pulmonary artery catheter is being used much more frequently in the US than in Europe in the setup of high-risk surgery (85.1% vs. 55.3% respectively, P0.001). Clinical experience, blood pressure, central venous pressure, and urine output are the most widely indicators of volume expansion. Finally, 86.5% of ASA respondents and 98.1% of ESA respondents believe that their current hemodynamic management could be improved.In conclusion, these results point to a considerable gap between the accumulating evidence about the benefits of perioperative hemodynamic optimization and the available technologies that may facilitate its clinical implementation, and clinical practices in both Europe and the United States.

Continuous noninvasive cardiac output (CO) provides valuable information for patient management. Non-invasive cardiac output monitoring (NICOM) measures CO based on chest bioreactance and is validated in adults [1]. Validated data in children are lacking. Our objective was to evaluate NICOM in children with pulmonary artery catheter thermodilution (PAC) as reference.

This study was designed to compare the clinical acceptability of two cardiac output (CO) monitoring systems: a pulse wave contour-based system (FloTrac-Vigileo) and a bioreactance-based system (NICOM), using continuous thermodilution (PAC-CCO) as a reference method.Consecutive patients, requiring PAC-CCO monitoring following cardiac surgery, were also monitored by the two other devices. CO values obtained simultaneously by the three systems were recorded continuously on a minute-by-minute basis.Continuous recording was performed on 29 patients, providing 12,099 simultaneous measurements for each device (417 +/- 107 per patient). In stable conditions, correlations of NICOM and Vigileo with PAC-CCO were 0.77 and 0.69, respectively. The bias was -0.01 +/- 0.84 for NICOM and -0.01 +/- 0.81 for Vigileo (NS). NICOM relative error was less than 30% in 94% of the patients and less than 20% in 79% vs. 91% and 79% for the Vigileo, respectively (NS). The variability of measurements around the trend line (precision) was not different between the three methods: 8 +/- 3%, 8 +/- 4% and 8 +/- 3% for PAC-CCO, NICOM and Vigileo, respectively. CO changes were 7.2 minutes faster with Vigileo and 6.9 minutes faster with NICOM (P0.05 both systems vs. PAC-CCO, NS). Amplitude of changes was not significantly different than thermodilution. Finally, the sensitivity and specificity for predicting significant CO changes were 0.91 and 0.95 respectively for the NICOM and 0.86 and 0.92 respectively for the Vigileo.This study showed that the NICOM and Vigileo devices have similar monitoring capabilities in post-operative cardiac surgery patients.

To evaluate the reliability of continuous cardiac output monitoring using pulse-contour analysis in critically ill patients.

Objective To evaluate the clinical utility of a new device for continuous noninvasive cardiac output monitoring (NICOM) based on chest bio-reactance compared with cardiac output measured semi-continuously by thermodilution using a pulmonary artery catheter (PAC-CCO).

A new arterial pressure waveform analysis device, which does not need external calibration (FloTrac/Vigileo; Edwards Lifesciences, Irvine, CA, USA), became recently available for cardiac output (CO) measurement. However, only limited validation data for this technique are so far available [1,2].

We surveyed adult ICUs, looking at cardiac output monitor use with a view to demonstrating a practice change over the last 3 years.

The management of severe respiratory failure (SRF) remains a challenging problem. With the availability of many options with variable results, the management of patients with SRF is likely to vary between different ICUs and these practices may not necessarily be evidence-based. In this study we aimed to define the respiratory and the general management of the patients with SRF, and to identify the treatment practices that are evidence-based in the surveyed ICUs in the UK.

Elderly patients tolerate trauma less well than younger patients. Early monitoring of the cardiac output to improve peripheral perfusion can diminish mortality and complications in elderly patients. Base deficit can be used as a marker of significant injury and to predict resource utilization and mortality. The purpose of this study is to determine which patients will require intervention.