PMID- 35613956 OWN - NLM STAT- MEDLINE DCOM- 20220622 LR - 20230802 IS - 1879-1913 (Electronic) IS - 0002-9149 (Print) IS - 0002-9149 (Linking) VI - 176 DP - 2022 Aug 1 TI - Comparison of Accuracy of Estimation of Cardiac Output by Thermodilution Versus the Fick Method Using Measured Oxygen Uptake. PG - 58-65 LID - S0002-9149(22)00431-3 [pii] LID - 10.1016/j.amjcard.2022.04.026 [doi] AB - The thermodilution (TD) method is routinely used for the estimation of cardiac output (Q̇(C)). However, its accuracy, compared with the gold-standard Fick method, where systemic oxygen uptake (V̇O(2)) is directly measured, and Q̇(C) calculated from V̇O(2) and the arterio-venous oxygen difference ("direct" Fick), has not been well validated. The present study determined the agreement between TD and Fick methods in consecutive patients who underwent pulmonary artery catheterization for a broad range of clinical conditions. This is a subanalysis of a previous study comparing the indirect versus Fick method based on a prospective, consecutive patient registry of 253 patients who underwent pulmonary artery catheterization for clinical indications at a single center between 1999 and 2005. We included patients that had an estimation of Q̇(C) both by the Fick method using measured V̇O(2) by exhaled gas analyses from timed Douglas bag collections and by TD. Cardiac index was classified as low when 2.2 L/min/m(2). The median (25th, 75th percentile) age of the cohort was 59 (50,67) years, and 50% were female. A total of 43.5% had normal left ventricular function by ventriculography, and 25.7% had ischemic heart disease. Median overall Fick and TD Q̇(C) were 4.4 (3.5, 5.5) and 4.3 (3.7, 5.2) L/min, respectively (p = 0.04). The median absolute percent error between Fick and TD Q̇(C) was 17.5 (7.7, 28.4)%, with a typical error of 0.88 L/min (95% confidence interval [CI] 0.82 to 0.95). Median absolute percent error was comparable in the low (n = 118) and normal Q̇(CI) (n = 135) groups (16.9% vs 18.9%, respectively, p = 0.88). typical error was 0.3 (95% CI 0.27 to 0.33) and 0.49 (95% CI 0.45 to 0.55) L/min/m(2) in that comparison. Percent error >25% between Fick and TD Q̇(C) was observed in over 30% of patients. Overall, Fick and TD Q̇(C) modestly correlated (R(s) = 0.64, p <0.001), with a nondirectional error introduced by TD Q̇(C) [mean bias of 0.21 (-2.2, 2.7) L/min]. There was poor agreement between TD and the gold-standard Fick method, highlighting the limitations of making clinical decisions based on TD. CI - Copyright (c) 2022 Elsevier Inc. All rights reserved. FAU - Narang, Nikhil AU - Narang N AD - Advocate Heart Institute, Advocate Christ Medical Center, Oak Lawn, Illinois; Division of Cardiology, Department of Medicine, University of Illinois-Chicago, Chicago, Illinois. Electronic address: nikhil.narang@aah.org. FAU - Thibodeau, Jennifer T AU - Thibodeau JT AD - Division of Cardiology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas. FAU - Parker, William F AU - Parker WF AD - Section of Pulmonary and Critical Care, Department of Medicine, University of Chicago, Chicago, Illinois. FAU - Grodin, Justin L AU - Grodin JL AD - Division of Cardiology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas. FAU - Garg, Sonia AU - Garg S AD - Division of Cardiology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas. FAU - Tedford, Ryan J AU - Tedford RJ AD - Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina. FAU - Levine, Benjamin D AU - Levine BD AD - Division of Cardiology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas; Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, Texas. FAU - McGuire, Darren K AU - McGuire DK AD - Division of Cardiology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas; Parkland Health and Hospital System, Dallas, Texas. FAU - Drazner, Mark H AU - Drazner MH AD - Division of Cardiology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas. LA - eng GR - K08 HL150291/HL/NHLBI NIH HHS/United States PT - Journal Article DEP - 20220522 PL - United States TA - Am J Cardiol JT - The American journal of cardiology JID - 0207277 RN - S88TT14065 (Oxygen) SB - IM MH - Cardiac Output MH - Female MH - Humans MH - Male MH - Oxygen MH - *Oxygen Consumption MH - Prospective Studies MH - *Thermodilution/methods PMC - PMC9648100 MID - NIHMS1840945 COIS- Disclosures The authors have no conflicts of interest to declare. EDAT- 2022/05/26 06:00 MHDA- 2022/06/23 06:00 PMCR- 2023/08/01 CRDT- 2022/05/25 22:02 PHST- 2022/02/11 00:00 [received] PHST- 2022/03/24 00:00 [revised] PHST- 2022/04/08 00:00 [accepted] PHST- 2022/05/26 06:00 [pubmed] PHST- 2022/06/23 06:00 [medline] PHST- 2022/05/25 22:02 [entrez] PHST- 2023/08/01 00:00 [pmc-release] AID - S0002-9149(22)00431-3 [pii] AID - 10.1016/j.amjcard.2022.04.026 [doi] PST - ppublish SO - Am J Cardiol. 2022 Aug 1;176:58-65. doi: 10.1016/j.amjcard.2022.04.026. Epub 2022 May 22.