Journal of Clinical Monitoring and Computing

, Volume 26, Issue 2, pp 121–132 | Cite as

Continuous minimally invasive peri-operative monitoring of cardiac output by pulmonary capnotracking: comparison with thermodilution and transesophageal echocardiography

  • Philip J. Peyton


A number of technologies are available for minimally-invasive cardiac output measurement in patients during surgery but remain little used. A system has been developed based on CO2 elimination (VCO2) by the lungs for use in ventilated patients, which can be fully integrated into a modern anesthesia/monitoring platform, and provides semi-automated, continuous breath-by-breath cardiac output monitoring. A prototype measurement system was constructed to measure VCO2 and end-tidal CO2 concentration with each breath. A baseline measurement of non-shunt cardiac output was made during a brief change in ventilator rate, according to the differential CO2 Fick approach. Continuous breath-by-breath monitoring of cardiac output was then performed from measurement of VCO2, using a derivation of the Fick equation applied to pulmonary CO2 elimination. Automated recalibration was done periodically and data was processed and cardiac output displayed in real time. Measurements were compared with simultaneous measurements by bolus thermodilution in 77 patients undergoing cardiac surgery or liver transplantation. Overall mean bias [sd] for agreement in cardiac output measurement was −0.1 [1.2] L/min, percentage error +44.2%, r = 0.92. Concordance in measurement of changes of at least 15% in cardiac output was 80%. The method followed sudden changes in cardiac output due to arrythmias and run onto cardiopulmonary bypass in real time. The accuracy and precision were comparable to other clinical techniques. The method is relatively seamless and largely automated and has potential for continuous, cardiac output monitoring in ventilated patients during anesthesia and critical care.


Cardiac output Pulmonary blood flow Gas exchange 



Support was kindly provided from a Project Grant from the Australian and New Zealand College of Anaesthetists.


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Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Department of AnaesthesiaAustin HospitalMelbourneAustralia
  2. 2.Department of Surgery, Austin HospitalUniversity of MelbourneMelbourneAustralia

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