Abstract
The measurement of cardiac output may be crucial in the management of the parturient
with haemodynamic instability due to critical illness or cardiac disease. Invasive
haemodynamic monitoring may not be desirable due to the potential risk of complications
and issues with patient compliance. Minimally- and non-invasive techniques of cardiac
output measurement include those based on ultrasonic technology and pulse contour
waveform analysis. This review article provides a synopsis of the literature examining
currently available minimally- and non-invasive techniques for maternal cardiac output
monitoring and looks at their advantages and disadvantages with respect to the parturient.
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References
- Maternal cardiovascular dynamics. I. Cesarean section under subarachnoid block anesthesia.Am J Obstet Gynecol. 1968; 100: 42-54
- Central hemodynamic assessment of normal term pregnancy.Am J Obstet Gynecol. 1989; 161: 1439-1442
- Use of a pulmonary artery catheter in the management of the severe preeclamptic patient.Anesthesiol Rev. 1991; 17: 37-40
- Invasive hemodynamic monitoring in critically ill pregnant patients: role of Swan–Ganz catheterization.Am J Obstet Gynecol. 1980; 137: 127-134
- Assessment of fluid-responsiveness parameters for off-pump coronary artery bypass surgery: a comparison among LiDCO, transesophageal echochardiography, and pulmonary artery catheter.J Cardiothorac Vasc Anesth. 2008; 22: 243-248
- Stroke volume variation: from applied physiology to improved outcomes.Crit Care Med. 2011; 39: 402-403
- Changes in arterial pressure during mechanical ventilation.Anesthesiology. 2005; 103: 419-428
- Pulse pressure variation: beyond the fluid management of patients with shock.Crit Care. 2007; 11: 131
- Maternal hemodynamic monitoring and the Vigileo monitor.Anesthesiology. 2009; 111: 211-212
- Minimally invasive measurement of cardiac output during surgery and critical care: a meta-analysis of accuracy and precision.Anesthesiology. 2010; 113: 1220-1235
- Statistical methods for assessing agreement between two methods of clinical measurement.Lancet. 1986; 1: 307-310
- Minimally invasive cardiac output monitoring in the perioperative setting.Anesth Analg. 2009; 108: 887-897
- A meta-analysis of studies using bias and precision statistics to compare cardiac output measurement techniques.J Clin Monit Comput. 1999; 15: 85-91
- Clinical measurement and assessing agreement.Curr Anaesth Crit Care. 2008; : 328-329
- Maternal haemodynamic changes during spinal anaesthesia for caesarean section.Curr Opin Anaesthesiol. 2011; 24: 242-248
- Noninvasive measurement of cardiac output by continuous-wave Doppler echocardiography: initial experience and review of the literature.Mayo Clin Proc. 1984; 59: 484-489
- Pulsed Doppler echocardiographic determination of stroke volume and cardiac output: clinical validation of two new methods using the apical window.Circulation. 1984; 70: 425-431
- Determination of cardiac output by transcutaneous continuous-wave ultrasonic Doppler computer.Am J Cardiol. 1984; 53: 234-237
- Haemodynamic, invasive and echocardiographic monitoring in the hypertensive parturient.Best Pract Res Clin Obstet Gynaecol. 2001; 15: 605-622
- Maternal echocardiography in hypertensive pregnancies.Gynecol Obstet Invest. 1989; 27: 2-5
- Echocardiographic estimation of hemodynamics in hypertensive pregnancy.Am J Obstet Gynecol. 1982; 144: 430-437
- Transthoracic echocardiography in obstetric anaesthesia and obstetric critical illness.Int J Obstet Anesth. 2011; 20: 160-168
- General anesthesia using remifentanil for Cesarean delivery in a parturient with Marfan’s syndrome.Can J Anesth. 2008; 55: 526-531
- Fulminant peripartum cardiomyopathy rescue with extracorporeal membranous oxygenation.Int J Obstet Anesth. 2009; 18: 186-188
- Intraoperative diagnosis of aortic dissection in pregnancy.J Cardiothorac Vasc Anesth. 2010; 24: 116-118
- Volume manipulation by phlebotomy for cesarean section in a patient with pulmonary hypertension.J Anesth. 2009; 23: 449-452
- Surgical treatment of an amniotic fluid embolism with cardiopulmonary collapse.Ann Thorac Surg. 2010; 90: 1694-1696
- Successful surgical management of massive pulmonary embolism during the second trimester in a parturient with heparin-induced thrombocytopenia.Interact Cardiovasc Thorac Surg. 2010; 11: 679-681
- Combined Doppler and echocardiographic measurement of cardiac output: theory and application in pregnancy.BJOG. 1987; 94: 1014-1027
- Measurement of cardiac output in pregnancy by Doppler technique.Am J Perinatol. 1990; 7: 220-222
- Measurement of cardiac output during pregnancy: validation of Doppler technique and clinical observations in preeclampsia.Obstet Gynecol. 1987; 69: 845-850
- Perioperative plasma volume expansion reduces the incidence of gut mucosal hypoperfusion during cardiac surgery.Arch Surg. 1995; 130: 423-429
- Randomized controlled trial to investigate influence of the fluid challenge on duration of hospital stay and perioperative morbidity in patients with hip fractures.Br J Anaesth. 2002; 88: 65-71
- Randomized clinical trial assessing the effect of Doppler-optimized fluid management on outcome after elective colorectal resection.Br J Surg. 2006; 93: 1069-1076
- Intraoperative intravascular volume optimisation and length of hospital stay after repair of proximal femoral fracture: randomised controlled trial.BMJ. 1997; 315: 909-912
National Institute for Health and Clinical Excellence. CardioQ-ODM (oesophageal Doppler monitor) to guide intravenous fluid management in patients undergoing surgery, or in critical care: medical technologies consultation, MTG3. London: National Institute for Health and Clinical Excellence 2011.
- Transesophageal Doppler scanning versus thermodilution during general anesthesia. An initial comparison of cardiac output techniques.Am J Surg. 1987; 153: 490-494
- Training is required to improve the reliability of esophageal Doppler to measure cardiac output in critically ill patients.Intensive Care Med. 1998; 24: 347-352
- The validity of trans-esophageal Doppler ultrasonography as a measure of cardiac output in critically ill adults.Intensive Care Med. 2004; 30: 2060-2066
- A comparison of hemodynamic data derived by pulmonary artery flotation catheter and the esophageal Doppler monitor in preeclampsia.Am J Obstet Gynecol. 2000; 183: 658-661
- Continuous hemodynamic monitoring by esophageal Doppler.Crit Care Med. 1989; 17: 447-452
- Noninvasive monitoring of cardiac output in critically ill patients using transesophageal Doppler.Am J Respir Crit Care Med. 1998; 158: 77-83
- Echocardiographic monitoring during induction of general anesthesia with a miniaturized esophageal probe.Anesth Analg. 2003; 96: 21-27
- Clinical evaluation of USCOM ultrasonic cardiac output monitor in cardiac surgical patients in intensive care unit.Br J Anaesth. 2005; 94: 287-291
- Cardiac output estimation with a new Doppler device after off-pump coronary artery bypass surgery.J Cardiothorac Vasc Anesth. 2006; 20: 315-319
- Comparison of a supra-sternal cardiac output monitor (USCOM) with the pulmonary artery catheter.Br J Anaesth. 2009; 103: 800-804
- The dose-dependent effects of phenylephrine for elective cesarean delivery under spinal anesthesia.Anesth Analg. 2010; 111: 1230-1237
- The effects of crystalloid and colloid preload on cardiac output in the parturient undergoing planned cesarean delivery under spinal anesthesia: a randomized trial.Anesth Analg. 2009; 109: 1916-1921
McDonald S, Fernando R, Ashpole K, Columb M. Maternal cardiac output changes after crystalloid or colloid coload following spinal anesthesia for elective cesarean delivery: a randomized controlled trial. Anesth Analg, in press.
- Cardiac index in term pregnant women in the sitting, lateral, and supine positions: an observational, crossover study.Anesth Analg. 2011; 113: 318-322
- Colloid preload versus coload for spinal anesthesia for cesarean delivery: the effects on maternal cardiac output.Anesth Analg. 2009; 108: 1592-1598
- A critical review of the ability of continuous cardiac output monitors to measure trends in cardiac output.Anesth Analg. 2010; 111: 1180-1192
- Thoracic electrical bioimpedance measurement of cardiac output–not ready for prime time.Crit Care Med. 1993; 21: 1111-1112
- Electrical bioimpedance for noninvasive measurement of cardiac output.Crit Care Med. 1997; 25: 1455
- A meta-analysis of three decades of validating thoracic impedance cardiography.Crit Care Med. 1999; 27: 1203-1213
- The effect of lung injury and excessive lung fluid, on impedance cardiac output measurements, in the critically ill.Intensive Care Med. 2000; 26: 679-685
- An investigation to show the effect of lung fluid on impedance cardiac output in the anaesthetized dog.Br J Anaesth. 2005; 95: 458-464
- The effect of peripheral resistance on impedance cardiography measurements in the anesthetized dog.Anesth Analg. 2005; 100: 1708-1712
- Multicenter evaluation of noninvasive cardiac output measurement by bioreactance technique.J Clin Monit Comput. 2008; 22: 113-119
- Comparison between FloTrac–Vigileo and Bioreactance, a totally noninvasive method for cardiac output monitoring.Crit Care. 2009; 13: R73
- Noninvasive cardiac output monitoring (NICOM): a clinical validation.Intensive Care Med. 2007; 33: 1191-1194
- Comparison of electrical velocimetry and transpulmonary thermodilution for measuring cardiac output in piglets.Paediatr Anaesth. 2007; 17: 749-755
- Evaluation of the Aesculon cardiac output monitor by subxiphoidal Doppler flow measurement in children with congenital heart defects.Eur J Anaesthesiol. 2009; 26: 412-415
- Measurement of cardiac output with non-invasive Aesculon impedance versus thermodilution.Clin Physiol Funct Imaging. 2011; 31: 39-47
- Avaliação hemodinâmica não invasiva de mulheres não grávidas, gestantes saudáveis e gestantes com pré-eclâmpsia usando biorreatância.Rev Bras Anestesiol. 2010; 60: 608-613
- Non-invasive monitoring based on bioreactance reveals significant hemodynamic instability during elective cesarean delivery under spinal anesthesia.Rev Bras Anestesiol. 2011; 61: 320-332
- Comparison of Portapres with standard sphygmomanometry in pregnancy.Hypertens Pregnancy. 2002; 21: 65-76
- Physiological changes of pregnancy and monitoring.Best Pract Res Clin Obstet Gynaecol. 2008; 22: 801-823
- Noninvasive evaluation of cardiac output during postural change and exercise in humans: comparison between the modelflow and pulse dye-densitometry.Jpn J Physiol. 2004; 54: 153-160
- Modelflow estimates of cardiac output compared with Doppler ultrasound during acute changes in vascular resistance in women.Exp Physiol. 2010; 95: 561-568
- Monitoring non-invasive cardiac output and stroke volume during experimental human hypovolaemia and resuscitation.Br J Anaesth. 2011; 106: 23-30
- Modelflow underestimates cardiac output in heat-stressed individuals.Am J Physiol Regul Integr Comp Physiol. 2011; 300: R486-R491
- Maternal hemodynamic monitoring in obstetric anesthesia.Anesthesiology. 2008; 109: 765-767
- Continuous cardiac output by femoral arterial thermodilution calibrated pulse contour analysis: comparison with pulmonary arterial thermodilution.Crit Care Med. 1999; 27: 2407-2412
- Comparison of cardiac output assessed by pulse-contour analysis and thermodilution in patients undergoing minimally invasive direct coronary artery bypass grafting.J Cardiothorac Vasc Anesth. 1999; 13: 437-440
- A comparison of cardiac output derived from the arterial pressure wave against thermodilution in cardiac surgery patients.Br J Anaesth. 2001; 87: 212-222
- Agreement between PiCCO pulse-contour analysis, pulmonal artery thermodilution and transthoracic thermodilution during off-pump coronary artery by-pass surgery.Acta Anaesthesiol Scand. 2006; 50: 1050-1057
- Continuous cardiac output measurement: pulse contour analysis vs thermodilution technique in cardiac surgical patients.Br J Anaesth. 1999; 82: 525-530
- Cardiac index measurements during rapid preload changes: a comparison of pulmonary artery thermodilution with arterial pulse contour analysis.J Clin Anesth. 2005; 17: 241-248
- Performance of a minimally invasive uncalibrated cardiac output monitoring system (Flotrac/Vigileo) in haemodynamically unstable patients.Br J Anaesth. 2008; 100: 451-456
- Cross-comparison of cardiac output trending accuracy of LiDCO, PiCCO, FloTrac and pulmonary artery catheters.Crit Care. 2010; 14: R212
- Assessment of the clinical utility of an ultrasonic monitor of cardiac output (the USCOM) and agreement with thermodilution measurement.Crit Care Resusc. 2009; 11: 198-203
- Validation of pulse contour derived stroke volume variation during modifications of cardiac afterload.Br J Anaesth. 2007; 98: 591-597
- Influence of tidal volume on left ventricular stroke volume variation measured by pulse contour analysis in mechanically ventilated patients.Intensive Care Med. 2003; 29: 476-480
- Perioperative hemodynamics obtained by pulse contour analysis facilitated the management of a patient with chronic hypertension, renal insufficiency, and superimposed preeclampsia during cesarean delivery.J Clin Anesth. 2010; 22: 274-279
- Lithium dilution measurement of cardiac output and arterial pulse waveform analysis: an indicator dilution calibrated beat-by-beat system for continuous estimation of cardiac output.Curr Opin Crit Care. 2002; 8: 257-261
- Hemodynamic changes associated with spinal anesthesia for cesarean delivery in severe preeclampsia.Anesthesiology. 2008; 108: 802-811
- Acute normovolemic hemodilution, intraoperative cell salvage and PulseCO hemodynamic monitoring in a Jehovah’s Witness with placenta percreta.Int J Obstet Anesth. 2008; 17: 159-163
- Effects of vasodilation on cardiac output measured by PulseCO.J Clin Monit Comput. 2007; 21: 335-339
- Use of lithium dilution and pulse contour analysis cardiac output determination in anaesthetized horses: a clinical evaluation.Vet Anaesth Analg. 2005; 32: 201-211
- Continuous cardiac output monitoring with pulse contour analysis: a comparison with lithium indicator dilution cardiac output measurement.Crit Care Med. 2005; 33: 2015-2021
- Pressure wave analysis is useful to understand the pathophysiology of preeclampsia, but perhaps not the rapid changes during cesarean delivery.Anesthesiology. 2008; 108: 773-774
- Hemodynamic effects of ephedrine, phenylephrine, and the coadministration of phenylephrine with oxytocin during spinal anesthesia for elective cesarean delivery.Anesthesiology. 2009; 111: 753-765
- Continuous invasive blood pressure and cardiac output monitoring during cesarean delivery: a randomized, double-blind comparison of low-dose versus high-dose spinal anesthesia with intravenous phenylephrine or placebo infusion.Anesthesiology. 2008; 109: 856-863
- Haemodynamic effects of oxytocin in women with severe preeclampsia.Int J Obstet Anesth. 2011; 20: 26-29
- Comparison between pulse waveform analysis and thermodilution cardiac output determination in patients with severe pre-eclampsia.Br J Anaesth. 2011; 106: 77-81
- Continuous cardiac output monitoring via arterial pressure waveform analysis following severe hemorrhagic shock in dogs.Crit Care Med. 2007; 35: 1724-1729
- Continuous and intermittent cardiac output measurement: pulmonary artery catheter versus aortic transpulmonary technique.Br J Anaesth. 2002; 88: 350-356
- Cardiac output monitoring: aortic transpulmonary thermodilution and pulse contour analysis agree with standard thermodilution methods in patients undergoing lung transplantation.Can J Anesth. 2003; 50: 707-711
- Comparison of cardiac output and circulatory blood volumes by transpulmonary thermo-dye dilution and transcutaneous indocyanine green measurement in critically ill patients.Chest. 2002; 121: 559-565
- Effects of changes in vascular tone on the agreement between pulse contour and transpulmonary thermodilution cardiac output measurements within an up to 6-hour calibration-free period.Crit Care Med. 2008; 36: 434-440
- Comparison of two versions of the Vigileo-FloTrac system (1.03 and 1.07) for stroke volume estimation: a multicentre, blinded comparison with oesophageal Doppler measurements.Br J Anaesth. 2009; 102: 463-469
- Cardiac output determination from the arterial pressure wave: clinical testing of a novel algorithm that does not require calibration.J Cardiothorac Vasc Anesth. 2007; 21: 3-7
- Comparison of uncalibrated arterial waveform analysis in cardiac surgery patients with thermodilution cardiac output measurements.Crit Care. 2006; 10: R164
- Validation of a continuous, arterial pressure-based cardiac output measurement: a multicenter, prospective clinical trial.Crit Care. 2007; 11: R105
- Uncalibrated arterial pulse contour analysis versus continuous thermodilution technique: effects of alterations in arterial waveform.J Cardiothorac Vasc Anesth. 2007; 21: 636-643
- Evaluation of an uncalibrated arterial pulse contour cardiac output monitoring system in cirrhotic patients undergoing liver surgery.Br J Anaesth. 2009; 102: 47-54
- Pulsed dye densitometry with two different sensor types for cardiac output measurement after cardiac surgery: a comparison with the thermodilution technique.Acta Anaesthesiol Scand. 2004; 48: 653-657
- Cardiac output measurement by pulse dye densitometry in cardiac surgery.Anaesthesia. 2005; 60: 968-973
- Effects of crystalloid and colloid preload on blood volume in the parturient undergoing spinal anesthesia for elective Cesarean section.Anesthesiology. 1999; 91: 1571-1576
Article info
Publication history
Published online: September 19, 2011
Accepted:
July 5,
2011
Identification
Copyright
© 2011 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
