Hemodynamic monitoring and correlation between electrical cardiometry and esophageal Doppler in patients undergoing major abdominal surgery

Figures & data

Table 1. Demographic data, ASA status, types, duration of surgery, fluid balance, hemodynamics, HR, and mean blood pressure at different times of followup of the studied group.

		N = 35
Age (years)		46.0 ± 10.1
Sex	Female	40%
	Male	60%
Weight (Kg)		80.5 ± 11.6
Height (cm)		167.4 ± 8.6
BMI (Kg/m^2)		31.5 ± 3.2
ASA Status		2.4 ± 0.2
Type of surgery	Exploration	34.3%
	Gastrectomy	14.3%
	Radical Cystectomy	20%
	RT Hemicolectomy	14.3%
	Whipple	5.7%
	Radical prostatectomy	2.9%
	Extended Rt Hemicolectomy	2.9%
	Hepaticojejunostomy	2.9%
	Splenectomy	2.9%
Duration of surgery(hrs.)		3.8 ± 1.4
Fluid Input (ml)		4248.6 ± 798.7
Fluid Output (ml)		3068.6 ± 740.7
Mean of HR (beat/min)		79.72 ± 9.6
Mean Blood Pressure (mmHg)		87.3 ± 15.2
HR (beat/min)	T1	78.2 ± 7.9
	T2	84.5 ± 9.6
	T3	79.6 ± 8.7
	T4	76.7 ± 9.1
	T5	79.6 ± 11.1
MBP (mmHg)	T1	76.6 ± 25.9
	T2	90.5 ± 6.9
	T3	88.7 ± 7.3
	T4	90.9 ± 8.5
	T5	89.9 ± 14.2

Note: Data are presented as mean ± SD or frequency (%). BMI: Body mass index, ASA: American Society of Anesthesiologists, HR: Heart rate, MBP: Mean Blood Pressure.

Figure 1. (A) Receiver operator characteristic curve demonstrating the sensitivity and the specificity of ICON and ED, (B) Bland Altman analysis of ICONCO and EDCO of CO results.

Table 2. Cardiac output (l/min) by the two methods at different time of follow-up.

CO	ICON	ED	Bias	Limits of Agreement	P E	Precision of ICON	Precision of ED	Sn.	Sp.	Area ROC curve	P. value
T1	5.6 ± 0.9	5.7 ± 0.8	−0.13	−0.78–0.52	−5.2	15.26	13.39	72.6	30.9	0.505	0.3
T2	5.9 ± 0.9	6.0 ± 0.9	−0.11	−1.03–0.81	−8.2	15.19	14.57				0.2
T3	6.0 ± 1.0	6.0 ± 0.9	0.05	−0.70–0.80	14.6	15.77	14.80				0.4
T4	6.2 ± 1.0	6.2 ± 1.1	−0.01	−0.73–0.72	−126.5	16.61	16.97				0.9
T5	6.2 ± 1.1	7.6 ± 8.5	0.06	−0.68–0.80	11.8	17.99	17.08				0.4

Note: CO: Cardiac output, Sn: Sensitivity, Sp: Specificity.

Table 3. CI (l/min/m²), SV (ml/beat), SVI (ml/m²/beat), SVR (mmHg/min/ml), DO₂I (ml O₂/min/m²) by the two methods among the studied groups at different times of follow-up.

		ICON	ED	Bias	Limits of Agreement	P E	Precision of ICON	Precision of ED	P. value
CI	T1	3.0 ± 0.5	3.0 ± 0.4	−0.01	−0.51–0.49	−58.5	16.25	12.19	0.9 NS
	T2	3.1 ± 0.4	3.2 ± 0.4	−0.04	−0.57–0.49	−13.3	13.40	13.11	0.4 NS
	T3	3.3 ± 0.4	3.2 ± 0.4	0.08	−0.45–0.61	6.4	13.42	13.17	0.08 NS
	T4	3.3 ± 0.5	3.2 ± 0.5	0.04	−0.34–0.41	10.1	14.75	14.99	0.3 NS
	T5	4.9 ± 6.7	3.3 ± 0.5	0.01	−0.46–0.47	82.0	14.07	14.81	0.2 NS
SV	T1	75.7 ± 10.3	77.7 ± 13.5	−2.00	−35.17–31.17	−16.6	13.37	17.06	0.5
	T2	69.6 ± 7.9	82.6 ± 8.9	−13.03	−31.18–5.13	−1.4	11.16	10.59	0.001**
	T3	75.3 ± 7.1	79.0 ± 6.7	−3.69	−22.83–15.45	−5.2	9.23	8.30	0.03*
	T4	77.5 ± 13.6	83.3 ± 10.0	−5.86	−39.15–27.44	−5.7	17.27	11.83	0.04*
	T5	77.6 ± 12.5	81.3 ± 5.0	−3.71	−31.48–24.05	−7.5	15.81	6.03	0.1
SVI	T1	41.4 ± 5.4	40.1 ± 5.1	1.26	−8.37–10.89	7.7	12.84	12.41	0.1
	T2	37.1 ± 3.6	38.8 ± 4.7	−1.74	−9.35–5.86	−4.4	9.59	11.82	0.01*
	T3	39.1 ± 3.4	39.0 ± 3.5	0.09	−9.02–9.19	106.2	8.59	8.86	0.9
	T4	39.5 ± 3.9	42.7 ± 4.0	−3.29	−16.48–9.91	−4.0	9.70	9.21	0.01*
	T5	42.4 ± 3.4	40.8 ± 3.7	1.60	−8.91–12.11	6.6	7.86	9.03	0.09
SVR	T1	971.1 ± 147.5	968.9 ± 146.8	2.11	−445.41–449.64	211.7	14.98	14.93	0.9 NS
	T2	997.1 ± 135.8	986.5 ± 119.4	10.69	−320.75–342.12	31.0	13.42	11.93	0.7 NS
	T3	1016.7 ± 138.3	1072.6 ± 118.3	−55.89	−367.15–255.38	−5.6	13.40	10.87	0.04*
	T4	1002.2 ± 189.5	1020.0 ± 112.8	−17.74	−337.07–301.59	−18.0	18.64	10.90	0.5 NS
	T5	988.7 ± 177.8	947.9 ± 80.9	40.80	−327.65–409.25	9.0	17.73	8.41	0.2 NS
DO2I	T1	541.2 ± 31.3	539.6 ± 18.5	1.57	−69.63–72.77	45.3	5.70	3.39	0.8 NS
	T2	561.1 ± 23.7	547.1 ± 28.0	13.97	−51.05–78.99	4.7	4.17	5.04	0.02*
	T3	541.7 ± 27.9	541.5 ± 26.6	0.11	−71.48–71.71	626.5	5.08	4.84	0.9 NS
	T4	554.6 ± 25.2	548.9 ± 21.9	5.71	−58.07–69.50	11.2	4.48	3.93	0.3 NS
	T5	547.8 ± 25.5	535.1 ± 21.9	12.66	−51.04–76.35	5.0	4.60	4.04	0.03*

Note: CI: Cardiac Index, SV: Stroke volume, SVI: Stroke Volume Index, SVR: Systemic vascular resistance, DO₂I: Oxygen delivery index.

Figure 2. Bland Altman analysis of (A) ICONCI and EDCI of CI results, (B) ICONSV and EDSV of SV results, (C) ICONSVI and EDSVI of SVI results, (D) ICONSVR and EDSVR of SVR results, (E) ICONDO₂I and EDDO₂I of DO₂ results.

Table 4. The studied parameters in the base line time (T1), T3, T4, and T5 by the two methods.

		ICON	ED	P. value	Intraclass correlation
					Correlation Coefficient	P. value
T1	CO (l/min)	5.6 ± 0.9	5.7 ± 0.8	0.3	0.952	0.001**
	CI (l/min/m^2)	3.0 ± 0.5	3.0 ± 0.4	0.9	0.832	0.001*
	SV (ml/beat)	75.7 ± 10.3	77.7 ± 13.5	0.5	−0.03	0.6
	SVI (ml/m^2/beat)	41.4 ± 5.4	40.1 ± 5.1	0.1	0.537	0.001*
	SVR (mmHg/min/ml)	971.1 ± 147.5	968.9 ± 146.8	0.9	0.248	0.9
	DO21 (ml/min/m^2)	541.2 ± 31.3	539.6 ± 18.5	0.8	−0.027	0.6
T3	CO (l/min)	6.0 ± 1.0	6.0 ± 0.9	0.4	0.955	0.001**
	CI (l/min/m^2)	3.3 ± 0.4	3.2 ± 0.4	0.08	0.789	0.001*
	SV (ml/beat)	75.3 ± 7.1	79.0 ± 6.7	0.03*	−0.04	0.6
	SVI (ml/m^2/beat)	39.1 ± 3.4	39.0 ± 3.5	0.9	0.07	0.3
	SVR (mmHg/min/ml)	1016.7 ± 138.3	1072.6 ± 118.3	0.04*	0.201	0.1
	DO21 (ml/min/m^2)	541.7 ± 27.9	541.5 ± 26.6	0.9	0.079	0.3
T4	CO (l/min)	6.2 ± 1.0	6.2 ± 1.1	0.9	0.968	0.001**
	CI (l/min/m^2)	3.3 ± 0.5	3.2 ± 0.5	0.3	0.922	0.001*
	SV (ml/beat)	77.5 ± 13.6	83.3 ± 10.0	0.04*	−0.04	0.6
	SVI (ml/m^2/beat)	39.5 ± 3.9	42.7 ± 4.0	0.01*	−0.386	0.9
	SVR (mmHg/min/ml)	1002.2 ± 189.5	1020.0 ± 112.8	0.5	0.442	0.004*
	DO21 (ml/min/m^2)	554.6 ± 25.2	548.9 ± 21.9	0.3	0.023	0.4
T5	CO (l/min)	6.2 ± 1.1	7.6 ± 1.04	0.4	−0.003	0.5
	CI (l/min/m^2)	4.9 ± 6.7	3.3 ± 0.5	0.2	−0.002	0.5
	SV (ml/beat)	77.6 ± 12.5	81.3 ± 5.0	0.1	−0.14	0.8
	SVI (ml/m^2/beat)	42.4 ± 3.4	40.8 ± 3.7	0.09	−0.15	0.8
	SVR (mmHg/min/ml)	988.7 ± 177.8	947.9 ± 80.9	0.2	0.046	0.4
	DO21 (ml/min/m^2)	547.8 ± 25.5	535.1 ± 21.9	0.03*	0.036	0.4

CO: Cardiac output, CI: Cardiac Index, SV: Stroke volume, SVI: Stroke Volume Index, SVR: Systemic vascular resistance, DO₂I: Oxygen delivery index.