Estimation of changes in cardiac output from the arterial blood pressure waveform in the upper limb†,†† N.W.F. Linton, R.A.F. Linton British Journal.

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Estimation of changes in cardiac output from the arterial blood pressure waveform in the upper limb†,†† N.W.F. Linton, R.A.F. Linton British Journal of Anaesthesia Volume 86, Issue 4, Pages 486-496 (April 2001) DOI: 10.1093/bja/86.4.486 Copyright © 2001 British Journal of Anaesthesia Terms and Conditions

Fig 1 Trend plots for cardiac output (CO) and systemic vascular resistance (SVR) in each patient. See p. 490 for details. Fig 1 (continued) Trend plots for cardiac output (CO) and systemic vascular resistance (SVR) in each patient. CO and SVR obtained using thermodilution are plotted with open circles. Filled circles indicate thermodilution measurements that were rejected. The diamonds connected by a solid line represent CO and SVR values obtained with PulseCO. The calibration factor was chosen so that the first PulseCO and TDCO determinations were the same in each patient. Patient 2 is not shown (see text). Cardiopulmonary bypass is indicated by a break in the line joining the PulseCO values (the duration of bypass has been omitted). British Journal of Anaesthesia 2001 86, 486-496DOI: (10.1093/bja/86.4.486) Copyright © 2001 British Journal of Anaesthesia Terms and Conditions

Fig 1 Trend plots for cardiac output (CO) and systemic vascular resistance (SVR) in each patient. See p. 490 for details. Fig 1 (continued) Trend plots for cardiac output (CO) and systemic vascular resistance (SVR) in each patient. CO and SVR obtained using thermodilution are plotted with open circles. Filled circles indicate thermodilution measurements that were rejected. The diamonds connected by a solid line represent CO and SVR values obtained with PulseCO. The calibration factor was chosen so that the first PulseCO and TDCO determinations were the same in each patient. Patient 2 is not shown (see text). Cardiopulmonary bypass is indicated by a break in the line joining the PulseCO values (the duration of bypass has been omitted). British Journal of Anaesthesia 2001 86, 486-496DOI: (10.1093/bja/86.4.486) Copyright © 2001 British Journal of Anaesthesia Terms and Conditions

Fig 2 Arterial pressure waveforms from patient 2. The position of the dicrotic notch could not be found. British Journal of Anaesthesia 2001 86, 486-496DOI: (10.1093/bja/86.4.486) Copyright © 2001 British Journal of Anaesthesia Terms and Conditions

Fig 3 Bland–Altman analysis for the within-patient change estimated by each method (n=142). PulseCO change is calculated as PulseCO/PulseCOstart and TDCO change as TDCO/TDCOstart, where ‘start' refers to the first determination in that patient (see Patients and methods). The line of identity is shown and the limits of agreement are marked on the Bland–Altman plots beneath. Least squares regression gave y=0.77x, r2=0.81 (95% confidence interval 0.75–0.86) and the limits of agreement were from –26% to +21%. British Journal of Anaesthesia 2001 86, 486-496DOI: (10.1093/bja/86.4.486) Copyright © 2001 British Journal of Anaesthesia Terms and Conditions

Fig 4 Bland–Altman analysis for the ratios of consecutive determinations estimated by each method (PulseCOi + 1/PulseCOi against TDCOi + 1/TDCOi) (n=142). The line of identity is shown and the limits of agreement are marked on the Bland–Altman plots beneath. Least squares regression gave y=0.71x, r2=0.70 (95% confidence interval 0.61–0.77) and the limits of agreement were from –21% to +25%. British Journal of Anaesthesia 2001 86, 486-496DOI: (10.1093/bja/86.4.486) Copyright © 2001 British Journal of Anaesthesia Terms and Conditions

Fig 5 Arterial pressure waveforms from patient 3 with similar mean values. In this patient, a marked decrease in systemic vascular resistance (SVR) (and in the magnitude of wave reflection) occurred during the operation but this was not associated with a change in MAP. Values of SVR (dyne s cm−5)) are indicated, as assessed by TDCO and PulseCO. Traces A, B and C correspond to determinations at 7, 95 and 145 min, respectively (see Figure 1). British Journal of Anaesthesia 2001 86, 486-496DOI: (10.1093/bja/86.4.486) Copyright © 2001 British Journal of Anaesthesia Terms and Conditions

Fig 6 Arterial pressure waveforms from patient 4 with a wide range of MAP. Trace a occurred after skin incision. Before cardiopulmonary bypass, the patient became hypotensive (b) and the algorithm correctly indicated that this was not due to a fall in systemic vascular resistance. After cardiopulmonary bypass, systemic vascular resistance was lower (c). Values of systemic vascular resistance (SVR; in dyne s cm−5) are indicated, as assessed by TDCO and PulseCO. Traces A, B and C correspond to determinations at 6, 57 and 71 min, respectively (see Figure 1). British Journal of Anaesthesia 2001 86, 486-496DOI: (10.1093/bja/86.4.486) Copyright © 2001 British Journal of Anaesthesia Terms and Conditions