Thoracic Electrical Bioimpedance Theory and Clinical Possibilities in Perioperative Medicine
Thoracic Electrical Bioimpedance Theory and Clinical Possibilities in Perioperative Medicine
REVIEW
Thoracic electrical
bioimpedance theory and
clinical possibilities in
perioperative medicine
PREDRAG STEVANOVI RADISAV EPANOVI
DRAGAN RADOVANOVI \OR\E BAJEC RADOSLAV PERUNOVI
DRAGO STOJANOVI DEJAN STEVANOVI
PREDRAG STEVANOVI ( )
RADISAV EPANOVI
DRAGAN RADOVANOVI
\OR\E BAJEC
RADOSLAV PERUNOVI
DRAGO STOJANOVI
DEJAN STEVANOVI
Department of Anesthesiology
and Reanimatology
University Clinical Hospital Dr. D. Miovi
11000 Belgrade, Serbia
Phone/Fax: +381 11 26 61 939
E-mail: [email protected]
ABSTRACT
This article is a short review of thoracic electrical bioimpedance (TEB) theory and clinical capabilities. Cardiac output
measurement is used primarily to guide therapy in complex, critically ill patients. Thoracic electrical bioimpedance is one of
several noninvasive techniques that have been investigated to measure cardiac output and other hemodynamic parameters.
Opinions in current literature continue to be conflicting as to the utility of thoracic electrical bioimpedance to that purpose.
There is a limited number of good designed studies but they imply TEB is an accurate and reliable noninvasive method for
determining cardiac output/cardiac index and it would be valuable for patients and circumstances in which intracardiac
pressures and mixed venous blood samples are not necessary.
Key words: bioimpedance, non-invasive hemodynamic monitoring, cardiac output, pulmonary artery catheter,
thermo dilution
There are many high-risk patients who
need the measurement of cardiac output (CO) in the operation theatre and
postoperative settings. (1,2) It is still at
present a dilemma about invasive and
noninvasive way of monitoring hemodynamic function.
Invasive cardiac monitoring mea-surement is used primarily to guide therapy in complex, critically ill patients,
and during the per operative period in
patients with high morbidity and mortality risk. Invasive pulmonary artery
catheterization has been the method
of choice for the accurate evaluation of
hemodynamic status.
The pulmonary artery catheter (PAC)
is routinely used to measure cardiac
output by thermo dilution (TD) method
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V (t) b (L 2 /Z 0 2 ) Z ; where Z 0
is the nonpulsatile base impedance
measured.
I=V/R
R=V/I
If I = constant, a change in resistance
(R) is proportional to a change in voltage (V):
R V
For alternating current flow, resistance
is known as impedance (Z) and is complex, frequency-dependent parameter.
For alternating current we can say that:
Z = V/ I
Z is measured in ohms. If I remains
constant, then periodic changes in voltage (V) produce concurrent changes
in impedance (Z):
Z V
This simple equation is fundamental
to understanding SV determination by
thoracic electrical bioimpedance (TEB).
Thoracic Electrical Bioimpedance (TEB),
with a symbol Z, is an electrical resistance of the thorax to a high-frequency,
very-low magnitude TEB measurement
current. TEB utilizes a patients thorax as
an impedance transducer.
The impedance to alternating current
flow of a simple cylindrical electrical
conductor is equal to its specific resistance () times it length (L), divided by
its cross-sectional area (A):
Z = L/A)
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a)
b)
Figure 4. Location of the 8 electrodes along the TEB transducer - a patients thorax. The top and bottom pair is a
source and sink of the TEB measurement current, the inner pairs, located at the root of the neck (the beginning of the
transducer) and the diaphragm level, i.e., the xiphoid process level (the end of the transducer), are used for sensing
both the TEB signal and 4 different vectors of the ECG signal. a) Front view b) Lateral view
department, sub acute care, hypertension and heart failure). The latest
TEB technology for determining CO is
less variable and more reproducible
in an intrapatient sense than is COTD. TEB is reproducible, especially
in comparison to serial measurements
using Thermo dilution. The historical
standard for hemodynamic measurement, thermo dilution (TD), shows only
modest correlation when compared
to itself. The SD for thermodilution is
about 1 liter/minute or about 20% of the
average CO. TEB shows very high correlation when compared to itself, and
lower standard deviation for multiple
TEB measurements.
In the other study of 23 adults in the
intraoperative and post operative settings, the correlation coefficient between
the two methods was r=0.89, p<0.001.
(10) In a study of 68 critically ill patients,
changes in cardiac output estimated
by TEB were found to closely correlate
with values obtained with TD method r
= 0.86, p<0.001. (11)
Shock and shock-related organ failure
account for most deaths in trauma and
surgical patients. The study of Asensio
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Conclusion
Thoracic electrical bioimpedance is one
of several noninvasive techniques that
have been used to measure cardiac
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Parameter
Cardiac Output
Cardiac index
Stroke Volume
Stroke Index
Systemic Vascular Resistance
Systemic Vascular Resistance
Index
Thoracic Fluid Content
Pre-ejection Period
Acceleration Index
LV Ejection Time
Velocity Index
Systolic Time Ratio
Left Stroke Work Index
Indexed Left Cardiac Work
Heart Rate
Estimated Delivered O2 Index
Table 2. The hemodynamic parameters measured and calculated by TEB reflect cardiac flow (output) and the four
determinants of cardiac output (HR, preload, afterload, and contractility).
Flow
Resistance
Contractility
Fluid
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