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Highly Accessed Letter

Use of minimally invasive hemodynamic monitoring to assess dynamic changes in cardiac output at the bedside

Michael R Pinsky

Author Affiliations

Professor of Critical Care Medicine, 606 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA 15261, USA

Critical Care 2011, 15:406  doi:10.1186/cc10024


See related research by Hadian et al., http://ccforum.com/content/14/6/R212, and related commentary by Critchley, http://ccforum.com/content/15/1/106.

Published: 7 March 2011

First paragraph (this article has no abstract)

I read with dismay the Commentary by Lester Critchley [1] on our recent pulse contour analysis study [2]. We disagree with his statement that, based on our data, one cannot use arterial pulse contour to assess changes in cardiac output (CO). We compared several commercially available arterial pulse contour methods of measuring CO with themselves and pulmonary artery catheter (PAC)-derived bolus thermodilution (COtd) and continuous CO (CCO) modes. We showed that none of these devices trended CO changes well when compared to the others, either separately or compared to a pooled CO value of all the devices. Thus, clinical trials using CO trending data from one device cannot be extrapolated to similar outcomes using other devices. Dr Critchley concluded that none of the pulse contour devices accurately trend CO changes. If that logic were true, then one could also not use PAC CO trending either, as it fared worse than the rest when compared to pooled CO values. Lack of proof of CO trending correlation amongst devices does not equate to lack of ability to trend CO by a device. His argument is based on four lines of reasoning that we dispute.