Paper
Wednesday, 19 July 2006
This presentation is part of : Strategies in the Acute Care Setting
Comparison of Non-Invasive Cardiac Output Measurement by Bioimpedance and Invasive Measurement by Intermittent Bolus Thermodilution Technique
Theresa Bucco, MSN, RN, Nursing Staff Education, Staten Island University Hospital, Staten Island, NY, USA
Learning Objective #1: Compare and contrast non-invasive and invasive methods of obtaining cardiac output/index in critically ill patients.
Learning Objective #2: Discuss implications of research findings for the delivery of evidence based nursing practice.
 
            The pulmonary artery catheter (PAC) has been used in critical care since 1977 to obtain hemodynamic measurements including CO by the bolus thermodilution technique (TD-CO).  An ethical consideration in hemodynamic monitoring is the assessment of risk versus benefit to the patient.  PAC placement is costly, labor intensive and associated with patient risks.  Thoracic electrical bioimpedance (TEB) is a noninvasive, alternative technique for the continuous measurement of cardiac output. TEB relies on the proportional change in the conduction of alternating current applied across the thorax as a function of blood volume in the heart and great vessels. This is accomplished through electrodes applied to the neck and thorax and attached via a cable to the bedside cardiac monitor.  TEB requires minimal technical support, is inexpensive, and is not associated with patient risk.             Our objective is to compare noninvasive CO measurement by TEB and invasive measurement by TD-CO via a PAC in critically ill medical and surgical patients, the hypothesis being there will be a positive correlation between CO measurement by TD-CO via the PAC and the non-invasive measurement by TEB.   A convenience sample of 60 patients with an Acute Physiology and Health Evaluation Severity of Illness Classification System (APACHE II) score of a least 12 and who have been admitted to the adult intensive care or cardiac care units of a university hospital will be selected.   The patient must have undergone right heart catheterization with a PAC as part of their medical/surgical management.  CO readings will be obtained by noninvasive TEB simultaneously with bolus TD-CO until a total of at least 120 data sets with a minimum of 2 sets per patient have been obtained.  A statistical analysis will be made.  A Pearson R significance level has been set at p<0.5 for all analysis.   
 

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