Korean J Anesthesiol.  2008 Jul;55(1):57-65. 10.4097/kjae.2008.55.1.57.

Modelflow method versus continuous thermodilution technique for cardiac output measurement in liver transplant patients

• Huh IY
• Park SE
• Yang HS
• Hwang GS

• KMID: 1782522
• DOI: http://doi.org/10.4097/kjae.2008.55.1.57

Abstract

BACKGROUND: In critically ill patients, cardiac output (CO) is used as a parameter for assessing hemodynamic status and efficacy of treatment. Continuous CO (CCO) could facilitate this assessment during general anesthesia. A new method of arterial pulse wave analysis has been introduced, which estimates beat to beat CO from arterial pressure via Modelflow. It remains uncertain how well this method performs in high output states. We analyzed the relationship between CCO and Modelflow computed from radial and femoral pressures (MFCO(RA), MFCO(FA)) during liver transplantation (LT).
METHODS
Measurements were performed in 100 liver transplant patients. Groups A had 36 patients, and group C had 64 patients with both groups composed of Child-Turcotte A, B and C patients Eighty patients had CCO < 10 L/min (group D), and 20 patients had CCO > 10 L/min (group E) during anhepatic phase.
RESULTS
CCO ranged from 5.0 to 15.4 L/min (MFCO(RA) 3.2 to 10.7 L/min, MFCO(FA) 4.3 to 11.8 L/min). Bland-Altman analyses showed the limit of agreement of MFCO(RA) (-1.5 to 5.2, bias = 1.9 L/min) and of MFCO(FA) (-2.6 to 4.4, bias = 0.9 L/min). CO measured by the two methods was significantly different in groups, except for MFCO(FA) in group C. In group D, bias was 1.5 L/min (SD 1.3 L/min) for MFCO(RA) and 0.9 L/min for MFCO(FA) (SD 1.4 L/min). In group E, biases of 3.5 L/min and 2.4 L/min were obtained for MFCO(RA) and MFCO(FA), respectively.
CONCLUSIONS
These results suggest that the group-average value of MFCO is not an accurate parameter for estimating CO during LT, with the exception of MFCO(FA) in groups C and D.

Keyword

cardiac output; liver transplantation; Modelflow; thermodilution

MeSH Terms

Anesthesia, General
Arterial Pressure
Bias (Epidemiology)
Cardiac Output
Critical Illness
Hemodynamics
Humans
Liver
Liver Transplantation
Pulse Wave Analysis
Thermodilution
Transplants