Research

Transpulmonary thermodilution-derived cardiac function index identifies cardiac dysfunction in acute heart failure and septic patients: an observational study

Simon Ritter¹ , Alain Rudiger² and Marco Maggiorini²

¹Intensive Care Unit, Department of Internal Medicine, Triemli City Hospital, Birmensdorferstrasse 497, CH-8063 Zurich, Switzerland

²Intensive Care Unit, Department of Internal Medicine, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland

author email corresponding author email

Critical Care 2009, 13:R133doi:10.1186/cc7994

Published:	11 August 2009

See related commentary by Vernon and Phillips, http://ccforum.com/content/13/6/1003

Abstract

Introduction

There is limited clinical experience with the single-indicator transpulmonary thermodilution (pulse contour cardiac output, or PiCCO) technique in critically ill medical patients, particularly in those with acute heart failure (AHF). Therefore, we compared the cardiac function of patients with AHF or sepsis using the pulmonary artery catheter (PAC) and the PiCCO technology.

Methods

This retrospective observational study was conducted in the medical intensive care unit of a university hospital. Twelve patients with AHF and nine patients with severe sepsis or septic shock had four simultaneous hemodynamic measurements by PAC and PiCCO during a 24-hour observation period. Comparisons between groups were made with the use of the Mann-Whitney U test. Including all measurements, correlations between data pairs were established using linear regression analysis and are expressed as the square of Pearson's correlation coefficients (r²).

Results

Compared to septic patients, AHF patients had a significantly lower cardiac index, cardiac function index (CFI), global ejection fraction, mixed venous oxygen saturation (SmvO₂) and pulmonary vascular permeability index, but higher pulmonary artery occlusion pressure. All patients with a CFI less than 4.5 per minute had an SmvO₂ not greater than 70%. In both groups, the CFI correlated with the left ventricular stroke work index (sepsis: r² = 0.30, P < 0.05; AHF: r² = 0.23, P < 0.05) and cardiac power (sepsis: r² = 0.39, P < 0.05; AHF: r² = 0.45, P < 0.05).

Conclusions

In critically ill medical patients, assessment of cardiac function using transpulmonary thermodilution technique is an alternative to the PAC. A low CFI identifies cardiac dysfunction in both AHF and septic patients.