Comparison Of Cardiac Outputs In Major Burn Patients Undergoing Extensive Early Escharectomy: Esophageal Doppler Monitor Vs. Thermodilution Pulmonary Artery Catheter.

TaeHyung Han. Department of Anesthesiology and Pain Medicine, Hangang Sacred Heart Hospital Hallym University, School of Medicine Seoul, Korea

Background:

After major burn injury, severe hemodynamic fluctuations occur in a relatively short time, requiring invasive hemodynamic monitoring. Non-invasive esophageal Doppler monitor (EDM) offers an alternative to the pulmonary artery catheter (PAC). This study compares EDM derived cardiac output (CO) to that of a PAC during the large volume shifts seen in extensive early escharectomy. Methods:

Twenty critically ill, major burn patients, scheduled for elective early escharectomy, were recruited. Thermodilution (TD) PAC and EDM probes were inserted, in order to measure CO simultaneously at regular intervals. Results were analyzed by simple linear regression and Bland and Altman plots.

Results:

We analyzed 92 data pairs in 20 patients, most of whom were critically ill with major burns. Escharectomy caused large intraoperative fluid shifts. EDM CO correlated moderately well with PA CO, although it was a mean of 15% less than PAC CO. The mean bias was 0.77 L/min and the limits of agreement were ± 2.74 (L/min).

Conclusions:

In major burn patients undergoing early escharectomy, EDM allows changes in hemodynamics to be followed, but does not accurately measure the absolute values of CO.