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Critical Care  2011 

Cardiac output monitoring: an integrative perspective

DOI: 10.1186/cc9996

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The aim of this article is to provide a systematic update of the currently available and most commonly used cardiac output monitoring devices. In addition, an integrated approach for the use of these different devices in critically ill patients will be presented taking into consideration the devices' technical characteristics, their performance and typical limitations, and also any additional hemodynamic variables they may offer.When selecting a cardiac output monitoring device for clinical use, different factors play a role (Table 1): Institutional factors may largely limit the choice of the available devices. On the other hand important device-related factors, e.g., invasiveness (Figure 1), may restrict the area of application. Moreover, patient specific conditions may dictate the use of an invasive or a particular minimally-or non-invasive device.The PAC was the clinical standard for cardiac output monitoring for more than 20 years and the technique has been extensively investigated. Its complications are well known and despite developments in recent years, the PAC has a distinct role in patient care. An in-depth review is beyond the scope of this article, but some technical aspects and limitations need to be noted: Cardiac output measurement by intermittent pulmonary artery thermodilution, which is based on the Stewart-Hamilton principle, is considered to be the 'reference cardiac output monitoring standard' against which all new cardiac output measuring devices are compared. However, operator dependence, various patient conditions (e.g., mitral or tricuspid valve insufficiency, shunt) or misplacement of the PAC may influence reliable cardiac output assessment [6]. In contrast, continuous cardiac output assessment may overcome some of theselimitations. Intermittent thermal filament heating induces pulmonary artery temperature changes that are measured via a distal thermistor and matched with the input signal. Based on the cross correlation of in- and output sign


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