Minimally Invasive Determinations of Oxygen Delivery and Consumption in Cardiac Surgery: An Observational Study.

OBJECTIVE

Evaluate minimally invasive assessment of oxygen delivery (DO) and oxygen consumption (VO) and determine its level of agreement with the gold standard approach of those measurements in patients undergoing cardiac surgery.

DESIGN

Observational study.

SETTING

Single center, VU University Medical Center (Amsterdam, The Netherlands).

PARTICIPANTS

The study comprised 29 adult patients.

INTERVENTION

Parallel measurements of invasive and minimally invasive parameters required for the calculation of DO and VO.

MEASUREMENTS AND MAIN RESULTS

Measurements were performed after anesthesia induction (T1) and before sternal closure (T2) in adult cardiac surgery. The invasive approach included arterial and pulmonary artery catheter-derived blood sampling and cardiac output measurements. The minimally invasive approach included pulse oximetry, point-of-care hemoglobin, Nexfin-based cardiac output, and central venous catheter-derived blood sampling. Level of agreement was determined using Bland-Altman analysis and percentage error. DO and VO levels were determined in patients 71 ± 8 years old. DO measurements showed a level of agreement of -17 ± 57 L/min/m and -18 ± 72 L/min/m with percentage errors of 35% and 38% at T1 and T2, respectively. VO assessment showed a level of agreement of -5 ± 18 L/min/m and -12 ± 22 L/min/m, with percentage errors of 47% at T1 and T2. The highest percentage errors were for cardiac output measurements, 33% and 28% at T1 and T2, respectively.

CONCLUSION

Agreement between minimally invasive and invasive DO and VO determinations is, moderate and poor, respectively. These findings may be explained by the poor agreement between minimally invasive and invasive cardiac output measurements.