RT Book, Section A1 Smith, Sarah C. A2 Atchabahian, Arthur A2 Gupta, Ruchir SR Print(0) ID 57260834 T1 Chapter 41. Noninvasive Cardiac Output Monitoring T2 The Anesthesia Guide YR 2013 FD 2013 PB The McGraw-Hill Companies PP New York, NY SN 978-0-07-176049-2 LK accessanesthesiology.mhmedical.com/content.aspx?aid=57260834 RD 2024/03/28 AB Table Graphic Jump Location|Download (.pdf)|PrintComparison of Available Noninvasive Cardiac Output MonitorsAdvantagesLimitationsTruly noninvasive?CO2 Fick principle, for example, NICO®Good agreement between NICO® and ultrasound transit timePatient may be breathing spontaneously or on a ventilatorAccuracy adversely affected by hyperventilation and V/Q mismatch (preexisting lung disease or postoperative atelectasis)Yes; however, patient must be intubatedEsophageal Doppler, for example, CardioQ (single use), WAKIe TO (reusable)High validity for monitoring changes in cardiac output in critically ill patientsUsing esophageal Doppler to optimize fluid management has been shown to improve outcomesPatient must be intubated and sedatedSmall risk of injury to the esophagusLimited agreement with thermodilutionNo, requires placement of probe in the esophagusTranspulmonary lithium dilution, for example, LiDCOHigh signal-to-noise ratioGood agreement with thermodilutionLow risk of toxicityNot approved for patients 15% indicating fluid responsivenessEasy to useAdversely affected by a poor arterial waveform (arrhythmia, intra-aortic balloon pump)Older devices may not adequately compensate for changes in vascular toneNewer devices have good agreement with thermodilution and esophageal DopplerNo, requires an intra-arterial lineBioimpedance, for example, Cheetah NICOM®, BioZ Dx®Completely noninvasiveImpedance to high-frequency current between electrodes on chest; estimates thoracic blood volumeRelative hemodynamic stability requiredAccuracy reduced by arrhythmias, aortic insufficiency, intra-aortic balloon pumpContraindicated in patients with pacemakersYes, adhesive surface electrodes only