Lithium dilution cardiac output measurement: A clinical assessment of central venous and peripheral venous indicator injection

Charles Garcia-Rodriguez, James Pittman, Cynthia H. Cassell, John Sum-Ping, Habib El-Moalem, Christopher Young, Jonathan B. Mark

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

Objective: The lithium indicator dilution technique has been shown to measure cardiac output (CO) accurately by using central venous injection of lithium chloride (Li-CCO). This study aimed to compare the measurement of CO by using peripheral venous administration of lithium chloride (Li-PCO) with Li-CCO. Design: Prospective, observational human study. Setting: Surgical intensive care unit. Patients: Thirty-one patients were studied after major surgery. All patients had arterial, central, and peripheral venous catheters. A total of 24 patients had pulmonary artery catheters. Measurements: Serial measurements of Li-CCO and Li-PCO were made during hemodynamically stable conditions. CO was also measured using thermodilution (TDCO) when a pulmonary artery catheter was present. Data were analyzed by linear regression, the generalized estimating equation, and the comparison method described by Bland and Altman. Main Results: There were 93 Li-CC0s, 93 Li-PC0s, and 216 TDCOs recorded. The ranges of COs were similar: Li-CCO, 2.36-11.52 L/min (mean, 5.22 L/min; n = 31); Li-PCO, 1.63-9.99 L/min (mean, 5.22 L/min; n = 31), and TDCO, 3.28-10.4 L/min (mean, 5.75 L/min; n = 24). There was good linear correlation between Li-CCO and Li-PCO (R2 = .845). The mean difference for Li-CCO-Li-PCO was very small and insignificant (p = .97), and the limits of agreement were acceptable (mean difference ± SD, 0.0005 ± 0.64 L/min). The mean difference for Li-CCO-Li-PCO was smaller if the peripheral injection site was proximal rather than distal to the wrist (p = .053). Li-PCO and Li-CCO values were lower than simultaneously obtained TDCO measurements (Li-PCO-TDCO, -0.538 ± 0.95 L/min, p = .003; Li-CCO-TDCO, -0.526 ± 0.67 L/min, p = .0001). Conclusions: Li-PCO gives a measurement that agrees well with Li-CCO. Accuracy of Li-PCO is probably improved if a proximal arm vein is used. Li-PCO provides accurate measurements of CO without the risks of pulmonary artery or central venous catheterization.

Original languageEnglish (US)
Pages (from-to)2199-2204
Number of pages6
JournalCritical Care Medicine
Volume30
Issue number10
StatePublished - Oct 1 2002

Fingerprint

Lithium
Cardiac Output
Pulmonary Artery
Lithium Chloride
Injections
Catheters
Central Venous Catheterization
Indicator Dilution Techniques
Thermodilution
Central Venous Catheters
Critical Care
Wrist
Observational Studies
Intensive Care Units
Veins
Linear Models
Arm

Keywords

  • Cardiac output
  • Lithium dilution
  • Measurement techniques

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Garcia-Rodriguez, C., Pittman, J., Cassell, C. H., Sum-Ping, J., El-Moalem, H., Young, C., & Mark, J. B. (2002). Lithium dilution cardiac output measurement: A clinical assessment of central venous and peripheral venous indicator injection. Critical Care Medicine, 30(10), 2199-2204.

Lithium dilution cardiac output measurement : A clinical assessment of central venous and peripheral venous indicator injection. / Garcia-Rodriguez, Charles; Pittman, James; Cassell, Cynthia H.; Sum-Ping, John; El-Moalem, Habib; Young, Christopher; Mark, Jonathan B.

In: Critical Care Medicine, Vol. 30, No. 10, 01.10.2002, p. 2199-2204.

Research output: Contribution to journalArticle

Garcia-Rodriguez, C, Pittman, J, Cassell, CH, Sum-Ping, J, El-Moalem, H, Young, C & Mark, JB 2002, 'Lithium dilution cardiac output measurement: A clinical assessment of central venous and peripheral venous indicator injection', Critical Care Medicine, vol. 30, no. 10, pp. 2199-2204.
Garcia-Rodriguez, Charles ; Pittman, James ; Cassell, Cynthia H. ; Sum-Ping, John ; El-Moalem, Habib ; Young, Christopher ; Mark, Jonathan B. / Lithium dilution cardiac output measurement : A clinical assessment of central venous and peripheral venous indicator injection. In: Critical Care Medicine. 2002 ; Vol. 30, No. 10. pp. 2199-2204.
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T2 - A clinical assessment of central venous and peripheral venous indicator injection

AU - Garcia-Rodriguez, Charles

AU - Pittman, James

AU - Cassell, Cynthia H.

AU - Sum-Ping, John

AU - El-Moalem, Habib

AU - Young, Christopher

AU - Mark, Jonathan B.

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N2 - Objective: The lithium indicator dilution technique has been shown to measure cardiac output (CO) accurately by using central venous injection of lithium chloride (Li-CCO). This study aimed to compare the measurement of CO by using peripheral venous administration of lithium chloride (Li-PCO) with Li-CCO. Design: Prospective, observational human study. Setting: Surgical intensive care unit. Patients: Thirty-one patients were studied after major surgery. All patients had arterial, central, and peripheral venous catheters. A total of 24 patients had pulmonary artery catheters. Measurements: Serial measurements of Li-CCO and Li-PCO were made during hemodynamically stable conditions. CO was also measured using thermodilution (TDCO) when a pulmonary artery catheter was present. Data were analyzed by linear regression, the generalized estimating equation, and the comparison method described by Bland and Altman. Main Results: There were 93 Li-CC0s, 93 Li-PC0s, and 216 TDCOs recorded. The ranges of COs were similar: Li-CCO, 2.36-11.52 L/min (mean, 5.22 L/min; n = 31); Li-PCO, 1.63-9.99 L/min (mean, 5.22 L/min; n = 31), and TDCO, 3.28-10.4 L/min (mean, 5.75 L/min; n = 24). There was good linear correlation between Li-CCO and Li-PCO (R2 = .845). The mean difference for Li-CCO-Li-PCO was very small and insignificant (p = .97), and the limits of agreement were acceptable (mean difference ± SD, 0.0005 ± 0.64 L/min). The mean difference for Li-CCO-Li-PCO was smaller if the peripheral injection site was proximal rather than distal to the wrist (p = .053). Li-PCO and Li-CCO values were lower than simultaneously obtained TDCO measurements (Li-PCO-TDCO, -0.538 ± 0.95 L/min, p = .003; Li-CCO-TDCO, -0.526 ± 0.67 L/min, p = .0001). Conclusions: Li-PCO gives a measurement that agrees well with Li-CCO. Accuracy of Li-PCO is probably improved if a proximal arm vein is used. Li-PCO provides accurate measurements of CO without the risks of pulmonary artery or central venous catheterization.

AB - Objective: The lithium indicator dilution technique has been shown to measure cardiac output (CO) accurately by using central venous injection of lithium chloride (Li-CCO). This study aimed to compare the measurement of CO by using peripheral venous administration of lithium chloride (Li-PCO) with Li-CCO. Design: Prospective, observational human study. Setting: Surgical intensive care unit. Patients: Thirty-one patients were studied after major surgery. All patients had arterial, central, and peripheral venous catheters. A total of 24 patients had pulmonary artery catheters. Measurements: Serial measurements of Li-CCO and Li-PCO were made during hemodynamically stable conditions. CO was also measured using thermodilution (TDCO) when a pulmonary artery catheter was present. Data were analyzed by linear regression, the generalized estimating equation, and the comparison method described by Bland and Altman. Main Results: There were 93 Li-CC0s, 93 Li-PC0s, and 216 TDCOs recorded. The ranges of COs were similar: Li-CCO, 2.36-11.52 L/min (mean, 5.22 L/min; n = 31); Li-PCO, 1.63-9.99 L/min (mean, 5.22 L/min; n = 31), and TDCO, 3.28-10.4 L/min (mean, 5.75 L/min; n = 24). There was good linear correlation between Li-CCO and Li-PCO (R2 = .845). The mean difference for Li-CCO-Li-PCO was very small and insignificant (p = .97), and the limits of agreement were acceptable (mean difference ± SD, 0.0005 ± 0.64 L/min). The mean difference for Li-CCO-Li-PCO was smaller if the peripheral injection site was proximal rather than distal to the wrist (p = .053). Li-PCO and Li-CCO values were lower than simultaneously obtained TDCO measurements (Li-PCO-TDCO, -0.538 ± 0.95 L/min, p = .003; Li-CCO-TDCO, -0.526 ± 0.67 L/min, p = .0001). Conclusions: Li-PCO gives a measurement that agrees well with Li-CCO. Accuracy of Li-PCO is probably improved if a proximal arm vein is used. Li-PCO provides accurate measurements of CO without the risks of pulmonary artery or central venous catheterization.

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