Non-Invasive Estimated Continuous Cardiac Output (escCO) during Severe Sepsis and Septic Shock Resuscitation
Chairat Permpikul MD*, Thongchai Leelayuthachai MD*
Affiliation : * Division of Critical Care Medicine, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
Background : Cardiac output (CO) is an important hemodynamic parameter during sepsis and septic shock resuscitation.
Conventionally, this value is obtained at bedside by the thermodilution technique, which requires a pulmonary artery catheter
(PAC). Estimated Continuous Cardiac Output (esCCO, Nihon Kohden®, Japan) calculated from pulse-wave transit time
(PWTT) was examined here as an alternative.
Material and Method: A prospective study was performed in a 14-bed ICU facility. Patients with severe sepsis and septic
shock who had PAC placed were included. Serial thermodilution cardiac outputs (COIBT) and esCCO (COesCCO) were obtained
at the beginning of resuscitation (t0), at 48 hours (t48), and at 72 hours (t72). Other parameters from the tested device; namely,
estimated continuous cardiac index (esCCI), estimated stroke volume (esSV), and estimated stroke volume index (esSVI),
were also achieved.
Results : A total of 90-paired readings from ten ICU patients were collected. The overall correlation coefficient (R) between
COesCCO and COIBT was 0.76. When focusing on the correlation from each time point, we found R at t0 = 0.65, t48 = 0.74, and
t72 = 0.84 (all p<0.001). Bland and Altman analysis corrected for repeated measures showed a bias of 1.2 liter/min and limits
of agreement from -2.8 to +5.2 liter/min. Results also showed fair to poor correlation with other parameters that derived from
this device (esCCI, esSV, esSVI).
Conclusion : The estimated continuous cardiac output (esCCO) correlated well with the cardiac output obtained by
thermodilution techniques, especially when patients were out of shock.
Keywords : Cardiac output, esCCO, Intermittent bolus thermodilution method, Sepsis, Septic shock
