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Prediction of cardiac index by body surface temperatures, ScvO2, central venous-arterial CO2 difference and lactate

Introduction

Monitoring of the cardiac index (CI) is a cornerstone of intensive care. Nevertheless, most of the techniques based on indicator dilution and/or pulse contour analysis require central venous and/or arterial catheters. Several surrogate markers have been suggested to estimate CI including ScvO2, central venous-arterial CO2 difference (CVACO2D) as well as body surface temperatures and their differences to body core temperature (BCT). It was the aim of our prospective study to evaluate the predictive capabilities of CVACO2D, ScvO2, surface temperatures and lactate regarding CI.

Methods

In 53 patients (33 male; 20 female) with PiCCO monitoring, 106 datasets including surface temperatures of great toe, finger pad, forearm and forehead using an infrared noncontact thermometer (Thermofocus; Tecnimed) as well as lactate, ScvO2, CVACO2D and pulse pressure (PP) were measured immediately before PiCCO thermodilution providing CI and SVRI. Statistics: SPSS 18.0.

Results

Patients: 17/53 (32%) ARDS; 14/53 (26%) liver cirrhosis; 13/53 (25%) sepsis; 4/53 (8%) cardiogenic shock; 5/53(9%) various aetiologies. Thermodilution-derived CI significantly correlated to the temperatures of the forearm (r = 0.465; P < 0.001), great toe (r = 0.454; P < 0.001), finger pad (r = 0.447; P < 0.001) and forehead (r = 0.392; P < 0.001) as well as to ScvO2 (r = 0.355; P < 0.001), SCVACO2D (r = -0.244; P = 0.011) and pulse pressure (r = 0.226; P = 0.019), but not to lactate (r = -0.067; P = 0.496). ROC analysis regarding the critical threshold of CI <2.5 l/minute*sqm demonstrated the highest predictive capabilities for the differences (BCT - T-forearm) (ROC-AUC 0.835; P = 0.002; cut-off 4.6°; sensitivity 89%; specificity 71%) and (BCT - T-finger pad) (ROC-AUC 0.757; P = 0.017) as well as ScvO2 (ROC-AUC 0.744; P = 0.024). SCVACO2D (ROC-AUC 0.706; P = 0.056) and lactate (ROC-AUC 0.539; P = 0.718) were not predictive. Multiple regression analysis (R = 0.725) demonstrated that age (P < 0.001), PP (P < 0.001), T-forearm (P = 0.024) and the difference (BCT - T-toe; P = 0.035) were independently associated with CI.

Conclusions

Body surface temperatures and their differences to BCT are useful to estimate CI. The difference (BCT - T-forearm) provided the largest ROC-AUC (0.835; P = 0.002) regarding CI <2.5 l/minute*sqm. SCVACO2D does not provide information in addition to body surface temperatures and ScvO2.

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Correspondence to W Huber.

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Huber, W., Haase, B., Saugel, B. et al. Prediction of cardiac index by body surface temperatures, ScvO2, central venous-arterial CO2 difference and lactate. Crit Care 15, P34 (2011). https://doi.org/10.1186/cc9454

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Keywords

  • Lactate
  • Liver Cirrhosis
  • Cardiac Index
  • Pulse Pressure
  • Cardiogenic Shock
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