Objective: To determine the effect of patient position on the reproducibility of cardiac output measurements.
Design: Prospective, two-group quasi-experimental design. Convenience sample.
Setting: The study involved two intensive care units in two adult acute care hospitals.
Patients: Thirty patients admitted to the intensive care unit who had a thermodilution pulmonary artery catheter in place. Ages ranged from 39 to 80 years (mean of 66.4 +/- 11.3 years).
Outcome measures: Thermodilution cardiac output measurements.
Intervention: The subjects were placed in one of two groups, initially by flipping a coin then into alternate groups. Group A subjects were placed supine, and after 5 minutes had cardiac output measurements performed. They were then placed in the 45-degree upright position, and after an additional 5 minutes had cardiac output measurements performed. Group B subjects were first placed in the 45-degree upright position, and after 5 minutes had cardiac output measurements performed. They were then placed in the supine flat position, and after an additional 5 minutes had cardiac output measurements performed.
Results: Seventy percent (n = 30) of the sample population displayed a lower cardiac output in the 45-degree upright position than that obtained in the supine position, with the decrease ranging from 1% to 32% (mean decrease 11%). Forty percent (n = 30) of cardiac output measurements obtained in the 45-degree upright were greater than or equal to 10% less than those obtained in the supine flat position. The differences in cardiac output were analyzed with the paired t test. which produced a 95% confidence interval from -0.539 to -0.083. The two-group Wilcoxon test was used to analyze the mean cardiac output with the patient in the supine, flat position and in the 45-degree upright position. The mean cardiac output at 0 degrees was found to be statistically significant higher (p = 0.0083) than the mean cardiac output at 45 degrees. The effect of coexisting variables was analyzed with the Kruskal-Wallis. The use of vasoconstrictors was the only variable that had a statistically significant change in cardiac output associated with a change in position.
Conclusions: These results indicate that cardiac output measurements are affected by alterations in patient position. To ensure accurate comparisons between consecutive cardiac output measurements, the researchers recommend that the position in which the cardiac output measurements are performed be documented and the cardiac output measurements be conducted in a uniform position.