Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2021.02.063
Brazilian Journal of Anesthesiology
Original Investigation

Comparative study between suprasternal and apical windows: a user-friendly cardiac output measurement for the anesthesiologist

Estudo comparativo entre janela supraesternal e apical: uma medida de débito cardíaco acessível ao anestesista

Rafaela Souto e Souza, Wendhell Barros de Melo, Claudia Maria Vilas Freire, Walkiria Wingester Vilas Boas

Downloads: 5
Views: 907

Abstract

Introduction
Transthoracic echocardiography is a safe and readily available tool for noninvasive monitoring of Cardiac Output (CO). The use of the suprasternal window situated at the sternal notch can be an alternative approach for estimating blood flow. The present study aimed to compare two methods of CO calculation. We compared the descending aorta Velocity-Time Integral (VTI) measurement from the suprasternal window view with the standard technique to determine CO that uses VTI measurements from the LVOT (Left Ventricular Outflow Tract) view. We also aimed to find out whether after basic training a non-echocardiographer operator can obtain reproducible measurements of VTI using this approach.

Methods
In the first part of the study, 26 patients without known cardiovascular diseases were evaluated and VTI data were acquired from the suprasternal window by a non-echocardiographer and an echocardiographer. Next, 17 patients were evaluated by an echocardiographer only and VTI and CO measurements were obtained from suprasternal and apical windows. Data were analyzed using the Bland and Altman method (BA), correlation and regression.

Results
We found a strong correlation between measurements obtained by a non-expert and an expert echocardiographer and detected that an inexperienced trainee can acquire VTI measurements from the suprasternal window view. Regarding agreement between CO measurements, data obtained showed a positive correlation and the Bland and Altman analysis presented a total variation of 38.9%.

Conclusion
Regarding accuracy, it is likely that TTE (Transthoracic Echocardiogram) measurements of CO from the suprasternal window view are comparable to other minimally invasive techniques currently available. Due to its user-friendliness and low cost, it can be a convenient technique for obtaining perioperative hemodynamic measurements, even by inexperienced operators.

Keywords

Non-invasive monitoring;  Echocardiogram;  Cardiac output;  Doppler ultrasonography

Resumo

Introdução

O ecocardiograma transtorácico tem sido considerado uma ferramenta segura e facilmente disponível para monitorização não invasiva do DC. A utilização da fúrcula esternal através da janela supraesternal pode ser uma alternativa para cálculo de fluxo sanguíneo. O objetivo deste trabalho é comparar as medidas do VTI na aorta descendente através da janela supraesternal com as medidas da VTI do fluxo na VSVE, normalmente utilizada para medir DC. Também pretende-se determinar se um avaliador não ecocardiografista consegue obter medidas reprodutíveis de VTI por esse método após treinamento básico.

Métodos

No primeiro tempo do estudo, foram avaliados 26 pacientes sem doenças cardiovasculares conhecidas e coletados dados de VTI na janela supraesternal por avaliador não experiente e por ecocardiografista. No segundo, foram avaliados 17 pacientes pelo ecocardiografista e coletados dados de VTI e DC nas janelas supraesternal e apical. Os dados foram analisados pelo método de Bland e Altman, correlação e regressão.

Resultados

Houve forte correlação entre as medidas realizadas por avaliador não especialista e ecocardiografista, identificando que treinador não experiente pode realizar medidas de VTI supraesternal. Em relação à concordância entre os DC, os dados obtidos mostraram que os valores apresentaram correlação positiva e o BA apresentou variação total de 38,9%.

Conclusão

É provável que as medidas do DC por ETT na janela supraesternal se assemelhem a técnicas minimamente invasivas disponíveis no mercado com relação a precisão. Devido à sua praticidade e baixo custo, pode ser uma técnica conveniente para obtenção de medidas hemodinâmicas no perioperatório, inclusive por examinadores não experientes.

Palavras-chave

Monitorização não invasiva; Ecocardiograma; Débito cardíaco; Ultrassonografia Doppler

References

1 O. Lairez, F. Ferré, N. Portet, et al. Cardiovascular effects of low-dose spinal anaesthesia as a function of age: An observational study using echocardiography Anaesth Crit Care Pain Med., 34 (2015), pp. 271-276

2 A. Joosten, O. Desebbe, K. Suehiro, et al. Accuracy and precision of non-invasive cardiac output monitoring devices in perioperative medicine: A systematic review and meta-analysis Br J Anaesth., 118 (2017), pp. 298-310

3 R.H. Thiele, K. Bartels, T.J. Gan Cardiac output monitoring: A contemporary assessment and review Crit Care Med., 43 (2015), pp. 177-185

4 J.D. Sandham, R.D. Hull, R.F. Brant, et al. A randomized, controlled trial of the use of pulmonary-artery catheters in high-risk surgical patients N Engl J Med., 348 (2003), pp. 5-14

5 C. Richard, J. Warszawski, N. Anguel, et al. Early use of the pulmonary artery catheter and outcomes in patients with shock and acute respiratory distress syndrome: a randomized controlled trial J Am Med Assoc., 290 (2003), pp. 2713-2720

6 S. Harvey, D.A. Harrison, M. Singer, et al. Assessment of the clinical effectiveness of pulmonary artery catheters in management of patients in intensive care (PAC-Man): A randomised controlled trial Lancet., 366 (2005), pp. 472-477

7 J. Porhomayon, A. El-Solh, P. Papadakos, et al. Cardiac output monitoring devices: An analytic review Intern Emerg Med., 7 (2012), pp. 163-171

8 PJ Peyton, SW Chong Minimally invasive measurement of cardiac output during surgery and critical care: A meta-analysis of accuracy and precision Anesthesiology., 113 (2010), pp. 1220-1235

9 SW Chong, PJ Peyton A meta-analysis of the accuracy and precision of the ultrasonic cardiac output monitor (USCOM) Anaesthesia., 67 (2012), pp. 1266-1271

10 J.F. Lewis, L.C. Kuo, J.G. Nelson, et al. Pulsed Doppler echocardiographic determination of stroke volume and cardiac output: clinical validation of two new methods using the apical window Circulation., 70 (1984), pp. 425-431

11 C. Mitchell, P.S. Rahko, L.A. Blauwet, et al. Guidelines for performing a comprehensive transthoracic echocardiographic examination in adults: recommendations from the American Society of Echocardiography J Am Soc Echocardiogr., 32 (2019), pp. 1-64

12 L. Sangkum, G.L. Liu, L. Yu, et al. Minimally invasive or noninvasive cardiac output measurement: an update J Anesth., 30 (2016), pp. 461-480

13 V. Parra, G. Fita, I. Rovira, et al. Transoesophageal echocardiography accurately detects cardiac output variation: A prospective comparison with thermodilution in cardiac surgery Eur J Anaesthesiol., 25 (2008), pp. 135-143

14 H. MØller-SØrensen, K. Graeser, K.L. Hansen, et al. Measurements of cardiac output obtained with transesophageal echocardiography and pulmonary artery thermodilution are not interchangeable Acta Anaesthesiol Scand., 58 (2014), pp. 80-88

15 V. Bergamaschi, G.L. Vignazia, A. Messina, et al. Transthoracic echocardiographic assessment of cardiac output in mechanically ventilated critically ill patients by intensive care unit physicians Braz J Anesthesiol., 69 (2019), pp. 20-26

16 CC Van Campen, FC Visser Validation of stroke volume measured with suprasternal aortic doppler imaging: comparison to transthoracic stroke volume measurements J Thrombo Cir., 106 (2018) Available from: https://www.gavinpublishers.com/articles/research-article/Journal-of-Thrombosis-and-Circulation/validation-of-stroke-volume-measured-with-suprasternal-aortic-doppler-imaging-comparison-to-transthoracic-stroke-volume-measurements

17 W. Armstrong Feigenbaum’s echocardiography (7th ed.) (2010)

18 J Martin Bland, DG Altman Statistical methods for assessing agreement between two methods of clinical measurement Lancet., 327 (1986), pp. 307-310

19 J. Cornette, S. Laker, B. Jeffery, et al. Validation of maternal cardiac output assessed by transthoracic echocardiography against pulmonary artery catheterization in severely ill pregnant women: prospective comparative study and systematic review Ultrasound Obstet Gynecol., 49 (2017), pp. 25-31

20 LAH Critchley, JAJH Critchley A meta-analysis of studies using bias and precision statistics to compare cardiac output measurement techniques J Clin Monit Comput., 15 (1999), pp. 85-91

21 Jm. Feldman Is It a bird? is it a plane? the role of patient monitors in medical decision making Anesth Analg., 108 (2009), pp. 707-710

22 RL Barber, SN Fletcher A review of echocardiography in anaesthetic and peri-operative practice. Part 1: Impact and utility Anaesthesia., 69 (2014), pp. 764-776

23 J.W. Petersen, J. Liu, Y.Y. Chi, et al. Comparison of multiple non-invasive methods of measuring cardiac output during pregnancy reveals marked heterogeneity in the magnitude of cardiac output change between women Physiol Rep., 5 (2017), Article e13223

24 T.R. Porter, S.K. Shillcutt, M.S. Adams, et al. Guidelines for the use of echocardiography as a monitor for therapeutic intervention in adults: A report from the american society of echocardiography J Am Soc Echocardiogr., 28 (2015), pp. 40-56

25 M. Cecconi, M. Grounds, A. Rhodes Methodologies for assessing agreement between two methods of clinical measurement: Are we as good as we think we are? Curr Opin Crit Care., 13 (2007), pp. 294-296

26 D.A. Reuter, C. Huang, T. Edrich, et al. Cardiac output monitoring using indicator-dilution techniques: Basics, limits, and perspectives Anesth Analg., 110 (2010), pp. 799-811

27 D.J. Funk, E.W. Moretti, T.J. Gan Minimally invasive cardiac output monitoring in the perioperative setting Anesth Analg [Internet]., 108 (2009), pp. 887-897
 

60f08363a9539511862415d4 rba Articles
Links & Downloads

Braz J Anesthesiol

Share this page
Page Sections