![]() The V̇ o 2 estimates, and consequently eFick CO, are particularly prone to error in the setting of pulmonary hypertension, heart failure, or abnormal body habitus. ![]() 1 - 5 The accuracy of eFick hinges on correctly estimating oxygen consumption (V̇ o 2). Cardiac output measurement is most commonly performed using either the thermodilution (Td) technique or the estimated oxygen uptake Fick (eFick) method. Thermodilution CI better predicts mortality and should be favored over eFick in clinical practice.Īccurate measurement of cardiac output (CO) is central to diagnosis, management, and definition of prognosis across a diverse range of medical contexts. The results from the Vanderbilt cohort were similar in the context of a more balanced sex distribution (46.6% female).Ĭonclusions and Relevance There is only modest agreement between Td and eFick CI estimates. There was no significant additional risk for patients with a normal Td CI but a low eFick CI (12.9%, P = .51), whereas a low Td CI but normal eFick CI was associated with higher mortality (15.4%, P = .001). Patients with a normal CI by both methods had 12.3% 1-year mortality. Estimates differed by greater than 20% for 38.1% of patients. There was minimal mean difference (eFick minus Td = −0.02 L/min/m 2, or −0.4%) but wide 95% limits of agreement between methods (−1.3 to 1.3 L/min/m 2, or −50.1% to 49.4%). Results Among 12 232 VA patients (mean age, 66.4 years 3.3% female) who underwent right heart catheterization in this cohort study, Td and eFick CI estimates correlated modestly ( r = 0.65). Main Outcomes and Measures All-cause mortality over 90 days and 1 year after catheterization. Cardiac output was indexed to body surface area (cardiac index ) for all analyses. Participants were more than 15 000 adults who underwent right heart catheterization, including 12 232 in the Veterans Affairs cohort between October 1, 2007, and September 30, 2013, and 3391 in the Vanderbilt cohort between January 1, 1998, and December 31, 2014.Įxposures A single cardiac catheterization was performed on each patient with CO estimated by both Td and eFick methods. The findings were corroborated in a cohort of patients cared for at Vanderbilt University, an academic referral center. The study used data from the Veterans Affairs Clinical Assessment, Reporting, and Tracking (VA CART) program. Objectives To assess agreement between Td and eFick CO and to compare how well these methods predict mortality.ĭesign, Setting, and Participants This investigation was a retrospective cohort study with up to 1 year of follow-up. They are often used interchangeably to make critical clinical decisions, yet few studies have compared these approaches as applied in medical practice. Importance Thermodilution (Td) and estimated oxygen uptake Fick (eFick) methods are widely used to measure cardiac output (CO). Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography.
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