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Intensive Care Medicine
Published in: Intensive Care Medicine 2/2011

Open Access 01-02-2011 | Original

Arterial pressure-based cardiac output monitoring: a multicenter validation of the third-generation software in septic patients

Authors: Daniel De Backer, Gernot Marx, Andrew Tan, Christopher Junker, Marc Van Nuffelen, Lars Hüter, Willy Ching, Frédéric Michard, Jean-Louis Vincent

Published in: Intensive Care Medicine | Issue 2/2011

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Abstract

Purpose

Second-generation FloTrac software has been shown to reliably measure cardiac output (CO) in cardiac surgical patients. However, concerns have been raised regarding its accuracy in vasoplegic states. The aim of the present multicenter study was to investigate the accuracy of the third-generation software in patients with sepsis, particularly when total systemic vascular resistance (TSVR) is low.

Methods

Fifty-eight septic patients were included in this prospective observational study in four university-affiliated ICUs. Reference CO was measured by bolus pulmonary thermodilution (iCO) using 3–5 cold saline boluses. Simultaneously, CO was computed from the arterial pressure curve recorded on a computer using the second-generation (COG2) and third-generation (COG3) FloTrac software. CO was also measured by semi-continuous pulmonary thermodilution (CCO).

Results

A total of 401 simultaneous measurements of iCO, COG2, COG3, and CCO were recorded. The mean (95%CI) biases between COG2 and iCO, COG3 and iCO, and CCO and iCO were −10 (−15 to −5)% [−0.8 (−1.1 to −0.4) L/min], 0 (−4 to 4)% [0 (−0.3 to 0.3) L/min], and 9 (6–13)% [0.7 (0.5–1.0) L/min], respectively. The percentage errors were 29 (20–37)% for COG2, 30 (24–37)% for COG3, and 28 (22–34)% for CCO. The difference between iCO and COG2 was significantly correlated with TSVR (r 2 = 0.37, p < 0.0001). A very weak (r 2 = 0.05) relationship was also observed for the difference between iCO and COG3.

Conclusions

In patients with sepsis, the third-generation FloTrac software is more accurate, as precise, and less influenced by TSVR than the second-generation software.
Appendix
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Literature
1.
Erlanger J, Hooker DR (1904) An experimental study of blood pressure and of pulse-pressure in man. John Hopkins Hosp Rep 12:145–378
2.
van Lieshout JJ, Wesseling KH (2001) Continuous cardiac output by pulse contour analysis? Br J Anaesth 86:467–469CrossRefPubMed
3.
4.
Hamzaoui O, Monnet X, Richard C, Osman D, Chemla D, Teboul JL (2008) Effects of changes in vascular tone on the agreement between pulse contour and transpulmonary thermodilution cardiac output measurements within an up to 6-hour calibration-free period. Crit Care Med 36:434–440CrossRefPubMed
5.
Pratt B, Roteliuk L, Hatib F, Frazier J, Wallen RD (2007) Calculating arterial pressure-based cardiac output using a novel measurement and analysis method. Biomed Instrum Technol 41:403–411CrossRefPubMed
6.
Langewouters GJ, Wesseling KH, Goedhard WJ (1985) The pressure dependent dynamic elasticity of 35 thoracic and 16 abdominal human aortas in vitro described by a five component model. J Biomech 18:613–620CrossRefPubMed
7.
Langewouters GJ, Wesseling KH, Goedhard WJ (1984) The static elastic properties of 45 human thoracic and 20 abdominal aortas in vitro and the parameters of a new model. J Biomech 17:425–435CrossRefPubMed
8.
Sander M, Spies CD, Grubitzsch H, Foer A, Muller M, von Heymann C (2006) Comparison of uncalibrated arterial waveform analysis in cardiac surgery patients with thermodilution cardiac output measurements. Crit Care 10:R164CrossRefPubMed
9.
Mayer J, Boldt J, Schollhorn T, Rohm KD, Mengistu AM, Suttner S (2007) Semi-invasive monitoring of cardiac output by a new device using arterial pressure waveform analysis: a comparison with intermittent pulmonary artery thermodilution in patients undergoing cardiac surgery. Br J Anaesth 98:176–182CrossRefPubMed
10.
Mehta Y, Chand RK, Sawhney R, Bhise M, Singh A, Trehan N (2008) Cardiac output monitoring: comparison of a new arterial pressure waveform analysis to the bolus thermodilution technique in patients undergoing off-pump coronary artery bypass surgery. J Cardiothorac Vasc Anesth 22:394–399CrossRefPubMed
11.
Prasser C, Bele S, Keyl C, Schweiger S, Trabold B, Amann M, Welnhofer J, Wiesenack C (2007) Evaluation of a new arterial pressure-based cardiac output device requiring no external calibration. BMC Anesthesiol 7:9CrossRefPubMed
12.
Mayer J, Boldt J, Wolf MW, Lang J, Suttner S (2008) Cardiac output derived from arterial pressure waveform analysis in patients undergoing cardiac surgery: validity of a second generation device. Anesth Analg 106:867–872, table
13.
Senn A, Button D, Zollinger A, Hofer CK (2009) Assessment of cardiac output changes using a modified FloTrac/Vigileo algorithm in cardiac surgery patients. Crit Care 13:R32CrossRefPubMed
14.
Sakka SG, Kozieras J, Thuemer O, van Hout N (2007) Measurement of cardiac output: a comparison between transpulmonary thermodilution and uncalibrated pulse contour analysis. Br J Anaesth 99:337–342CrossRefPubMed
15.
Biais M, Nouette-Gaulain K, Cottenceau V, Vallet A, Cochard JF, Revel P, Sztark F (2008) Cardiac output measurement in patients undergoing liver transplantation: pulmonary artery catheter versus uncalibrated arterial pressure waveform analysis. Anesth Analg 106:1480–1486CrossRefPubMed
16.
Biancofiore G, Critchley LA, Lee A, Bindi L, Bisa M, Esposito M, Meacci L, Mozzo R, DeSimone P, Urbani L, Filipponi F (2009) Evaluation of an uncalibrated arterial pulse contour cardiac output monitoring system in cirrhotic patients undergoing liver surgery. Br J Anaesth 102:47–54CrossRefPubMed
17.
Della Rocca G, Costa MG, Chiarandini P, Bertossi G, Lugano M, Pompei L, Coccia C, Sainz-Barriga M, Pietropaoli P (2008) Arterial pulse cardiac output agreement with thermodilution in patients in hyperdynamic conditions. J Cardiothorac Vasc Anesth 22:681–687CrossRefPubMed
18.
Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, Cohen J, Opal SM, Vincent JL, Ramsay G (2003) 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med 31:1250–1256CrossRefPubMed
19.
Stetz CW, Miller RG, Kelly GE, Raffin TA (1982) Reliability of the thermodilution method in the determination of cardiac output in clinical practice. Am Rev Respir Dis 126:1001–1004PubMed
20.
Critchley LA, Critchley JA (1999) A meta-analysis of studies using bias and precision statistics to compare cardiac output measurement techniques. J Clin Monit Comput 15:85–91CrossRefPubMed
21.
Squara P, Cecconi M, Rhodes A, Singer M, Chiche JD (2009) Tracking changes in cardiac output: methodological considerations for the validation of monitoring devices. Intensive Care Med 35:1801–1808CrossRefPubMed
22.
Sun JX, Reisner AT, Saeed M, Heldt T, Mark RG (2009) The cardiac output from blood pressure algorithms trial. Crit Care Med 37:72–80CrossRefPubMed
23.
Bland JM, Altman DG (1999) Measuring agreement in method comparison studies. Stat Methods Med Res 8:135–160CrossRefPubMed
24.
Myles PS, Cui J (2007) Using the Bland-Altman method to measure agreement with repeated measures. Br J Anaesth 99:309–311CrossRefPubMed
25.
Stern DH, Gerson JI, Allen FB, Parker FB (1985) Can we trust the direct radial artery pressure immediately following cardiopulmonary bypass? Anesthesiology 62:557–561CrossRefPubMed
26.
Bilo HJ, Strack van Schijndel RJ, Schreuder WO, Groeneveld AB, Thijs LG (1989) Decreased reflection coefficient as a possible cause of low blood pressure in severe septicaemia. Intensive Care Med 15:137–139CrossRefPubMed
27.
Hynson JM, Katz JA, Mangano DT (1998) On the accuracy of intra-arterial pressure measurement: the pressure gradient effect. Crit Care Med 26:1623–1624CrossRefPubMed
28.
Dorman T, Breslow MJ, Lipsett PA, Rosenberg JM, Balser JR, Almog Y, Rosenfeld BA (1998) Radial artery pressure monitoring underestimates central arterial pressure during vasopressor therapy in critically ill surgical patients. Crit Care Med 26:1646–1649CrossRefPubMed
29.
Smith J, Camporota L, Beale R (2009) Monitoring arterial blood pressure and cardiac output using central or peripheral arterial pressure waveforms. In: Vincent JL (ed) 2009 Yearbook of intensive care and emergency medicine. Springer, Heidelberg, pp 285–296CrossRef
30.
Jellema WT, Wesseling KH, Groeneveld AB, Stoutenbeek CP, Thijs LG, van Lieshout JJ (1999) Continuous cardiac output in septic shock by simulating a model of the aortic input impedance: a comparison with bolus injection thermodilution. Anesthesiology 90:1317–1328CrossRefPubMed
31.
Yamashita K, Nishiyama T, Yokoyama T, Abe H, Manabe M (2008) The effects of vasodilation on cardiac output measured by PiCCO. J Cardiothorac Vasc Anesth 22:688–692CrossRefPubMed
32.
Yamashita K, Nishiyama T, Yokoyama T, Abe H, Manabe M (2007) Effects of vasodilation on cardiac output measured by PulseCO. J Clin Monit Comput 21:335–339CrossRefPubMed
Metadata
Title
Arterial pressure-based cardiac output monitoring: a multicenter validation of the third-generation software in septic patients
Authors
Daniel De Backer
Gernot Marx
Andrew Tan
Christopher Junker
Marc Van Nuffelen
Lars Hüter
Willy Ching
Frédéric Michard
Jean-Louis Vincent
Publication date
01-02-2011
Publisher
Springer-Verlag
Published in
Intensive Care Medicine / Issue 2/2011
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-010-2098-8

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