Cardiac Output Measurement: When and how?intensivo.sochipe.cl/subidos/catalogo3/CardiacOutputMeasurementBurns... · mediators, N-terminal pro-B-type natriuretic peptide and troponin

Cardiac Output Measurement: When and how?

Jeffrey Burns, M.D., M.P.H. Chief, Division of Critical Care Medicine

Children’s Hospital Boston Associate Professor of Anesthesia and Pediatrics

Harvard Medical School

[email protected]

No conflicts or financial disclosures to convey

2 Dr. J Burns, Chillan 2009


• Why measure cardiac output, what is the endpoint we are seeking?

• Currently available minimally invasive cardiac output monitors

• ScvO2: the Canary of the body? • What about other biomarkers: lactate and B-

type natriuretic peptide (BNP)?








Why measure cardiac output?

Pinsky MR. Why measure cardiac output? Critical Care. 2003 Apr;7(2):114-6.










Funk DJ, Moretti EW, Gan TJ. Minimally invasive cardiac output monitoring in the perioperative setting.

Anesthesia & Analgesia. 2009 Mar;108(3):887-97 9 Dr. J Burns, Chillan 2009







Is SvO2 the Canary of the body? • Dueck MH, Klimek M, Appenrodt S, Weigand C, Boerner U. Trends

but not individual values of central venous oxygen saturation agree with mixed venous oxygen saturation during varying hemodynamic conditions. Anesthesiology 2005; 103:249–257.

• Reinhart K, Rudolph T, Bredle DL, Hannemann L, Cain SM. Comparison of central-venous to mixed-venous oxygen saturation during changes in oxygen supply/demand. Chest 1989; 95: 1216–1221.

• Lee J, Wright F, Barber R, Stanley L. Central venous oxygen saturation in shock: a study in man. Anesthesiology 1972; 36: 472–478.

• Chawla LS, Zia H, Gutierrez G, Katz NM, Seneff MG, Shah M. Lack of equivalence between central and mixed venous oxygen saturation. Chest 2004; 126: 1891–1896.


Central Venous Oxygen Saturation: the Canary of the Body?


ScvO2 versus SvO2?

Pinsky MR. Hemodynamic evaluation and monitoring in the ICU. Chest. 2007 Dec;132(6):2020-9.


A decrease in SvO2 and ScvO2 represents an increased metabolic stress, because the O2 demands of the body are

not completely met by DO2.


Central Venous Oxygen Saturation: the Canary of the Body?


Rivers, E. et al. N Engl J Med 2001;345:1368-1377 16 Dr. J Burns, Chillan 2009

Rivers, E. et al. N Engl J Med 2001;345:1368-1377









• ScvO2: the Canary of the body? • What about other biomarkers: lactate and

B-type natriuretic peptide (BNP)?








Risk stratification in neonates and infants submitted to cardiac surgery with cardiopulmonary bypass: A multimarker approach combining inflammatory

mediators, N-terminal pro-B-type natriuretic peptide and troponin I Fabio Carmona, Paulo H. Manso, Walter V.A. Vicente, Margaret Castro, Ana P.C.P. Carlotti

• High N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels pre-operatively and high IL-8 levels or low platelet count 4 hours post operative were independent predictors of LCOS.

• In addition, high cardiac troponin I concentrations 4 hours post operative and prolonged CPB duration were independent predictors of in-hospital death.


Cardiac output measurement in children: What is lacking?

“Thus, what is lacking in cardiac output assessment in children? First, the new methods investigated…should undergo further validation in different real clinical situations. Second, the use of algorithms should then be applied in the management of children with shock and cardiac output measurement; this may be useful in the decision-making process and in the final outcome.”

Ronco R, Riquelme C: Cardiac output measurement in children: what is lacking? Pediatr Crit Care Med. 2008 May;9(3):333-4.


Cardiac output measurement in children: What is lacking?

A good intensivst at the bedside is better than any single technology or biomarker!

Implementing the best evidence; do not forget to be a good clinician


[email protected]

No conflicts or financial disclosures to convey


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Cardiac Output Measurement: When and how?intensivo.sochipe.cl/subidos/catalogo3/CardiacOutputMeasurementBurns... · mediators, N-terminal pro-B-type natriuretic peptide and troponin