CONTINUOUS MEASUREMENT OF CARDIAC-OUTPUT BY THE FICK PRINCIPLE - CLINICAL VALIDATION IN INTENSIVE-CARE

Objective: To compare continuous measurement of cardiac output by the Fick principle with the thermodilution cardiac output technique in hemodynamically unstable patients. Design: An open comparison of two methods. Setting: Multidisciplinary ICU in a university hospital. Patients: Eight patients after coronary bypass surgery and 13 patients with hyperdynamic septic shock. All patients were mechanically ventilated. Measurements and Main Results: The continuous Fick cardiac output technique was compared with the thermodilution cardiac output using both warm and cold injection in the coronary artery bypass surgery patients and using warm injection only in the patients with hyperdynamic septic shock. The mean difference between the continuous cardiac output technique and all thermodilution measurements (n = 201) was 0.6 +/- 19%. There was a good correlation between the continuous cardiac output and the warm thermodilution technique (n = 125, r2 = .79; p < .001). When consecutive measurements with warm and cold thermodilution were compared with the respective Fick-derived values (n = 76), the mean differences between the Fick-derived and the warm and cold thermodilution cardiac output values were 0.2 +/- 1.0 L/min and 0.3 +/- 1.0 L/min, respectively. The relationship between Fick-derived and both methods of thermodilution-derived cardiac output was relatively constant during different modes of ventilatory support. The correlation between the thermodilution measurements with cold and room temperature injectate was weak (r2 = .36; p < .001), whereas a good correlation was observed between the respective Fick-derived values (r2 = .73; p < .001). The mean difference between the warm and cold thermodilution cardiac output measurements was 0.1 +/- 1.1 L/min and between the corresponding Fick-derived measurements was 0.01 +/- 0.7 L/min. Conclusions: Continuous measurement of cardiac output by the Fick principle offers a convenient, reproducible method for hemodynamic monitoring of unstable patients. The variation between the two tested thermodilution techniques is likely to reflect relatively rapid dynamic variation of cardiac output, which is filtered in the 1-min average of cardiac output obtained by the continuous Fick technique.