Key result
Transpulmonary thermodilution requires three cold boluses of 15 ml each to achieve a precision of less than 10% when measuring cardiac output in critically ill patients.
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Standardized transpulmonary thermodilution provides precise cardiac output measurements, suggesting the threshold for fluid responsiveness could be lowered from the currently accepted 15%.
When incorporating the values of a hemodynamic parameter into the care of patients, the precision of the measurement method should always be considered. A prospective analysis in the previous issue of Critical Care showed that the precision of transpulmonary thermodilution (TPTD) allows for reliable mean values if a standardised procedure is used. The present finding has a physiological basis, as TPTD requires a more prolonged transit time, which in turn reduces the effects that airway pressure and arrhythmia have on venous return-cardiac output steady states. Moreover, this result suggests that the current accepted threshold value of a 15% increase in cardiac output to identify a positive response to a fluid challenge could be reduced in the future. Indeed, this value is mainly related to the precision of the pulmonary artery catheter.
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Giraud et al. (2011) conducted an editorial in Critically ill (n=91). Transpulmonary thermodilution (TPTD) was evaluated on Precision of cardiac output, global end-diastolic volume, and extra-vascular lung water measurements. Transpulmonary thermodilution requires three cold boluses of 15 ml each to achieve a precision of less than 10% when measuring cardiac output in critically ill patients.
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