Cardiac output monitoring during abdominal aortic cross clamping: a comparison between Vigileo/FloTrac system and transoesophageal Doppler

Introduction

Cardiac output (CO) monitoring is one of the key points in the hemodynamic evaluation of critically ill patients, and can be useful in various settings of high-risk surgery. There is a lack of evidence that the extensive use of invasive devices in the hemodynamic monitoring has a good impact in terms of outcome [1], and less invasive systems have been proposed. Our aim was to compare the CO estimated by Vigileo/FloTrac with the blood flow in thoracic aorta as measured by transoesophageal Doppler in patients undergoing open abdominal aortic aneurysm repair, during the aortic cross-clamping (AoX) phase. We have measured the Augmentation Index (AI), a parameter related to vascular stiffness, using the applanation tonometry method, in order to have a better understanding of the effect of AoX on blood pressure waves.

Methods

We enrolled 10 consecutive patients (10 men; age 66 ± 6 years) undergoing elective open AAA repair (ASA II to III) under general anesthesia. Radial arterial access was used for semi-invasive determination of blood pressures and CO (APCO) with the Vigileo. An esophageal Doppler was positioned after clinical stabilization. Applanation tonometry was measured just before and after the aortic clamping.

Results

We found a significant (P < 0.05) increase in CO reported by Vigileo/FloTrac system in the post-clamping phase, when compared with the pre-clamping and basal phases, while the blood flow in thoracic aorta resulted decreased, according with the theory of redistribution of fluids in the splanchnic venous vasculature [2]. There was an important contribution of the wave reflection to the aortic pulse pressure wave after the AoX, as expressed by a significant increase in the AI.

Conclusions

The Vigileo/FloTrac system appears to overestimate CO after AoX when compared with the measure of blood flow in thoracic aorta, and this result could be influenced by the pulse pressure wave reflection occurring after clamping. In high-risk surgical settings, other situations of rapid change of systemic resistance vessels could be similarly misread, thus suggesting the necessity of a more tailored Vigileo algorithm.