Determination of cardiac output during positive end-expiratory pressure--noninvasive electrical bioimpedance compared with standard thermodilution.

Many investigators have demonstrated the accuracy and reliability of thoracic electrical bioimpedance (TEB) in spontaneously breathing patients and under mechanical intermittent positive-pressure ventilation. Most of these studies showed a good correlation between TEB and invasive methods, such as thermodilution (TD) or the Fick method. But during PEEP, contrary results occur when comparing TEB and TD. In six patients undergoing neurosurgical interventions, TEB cardiac output measurements were compared during zero end-expiratory pressure (ZEEP) and during PEEP at 8 cm H2O with a low respiratory rate. The data revealed a good correlation during ZEEP (r = .93) and during PEEP (r = .91). There was no significant statistical difference when measuring cardiac output by TEB during ventilation with PEEP. During normal or decreased cardiac output, TEB overestimated cardiac output compared with TD, whereas TEB underestimated cardiac output compared with TD during increased cardiac output, especially during PEEP.