Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Journal of Anesthesia
Published in: Journal of Anesthesia 3/2019

01-06-2019 | Transesophageal Echocardiography | Original Article

Accuracy of the ClearSight™ system in patients undergoing abdominal aortic aneurysm surgery

Authors: Miho Sumiyoshi, Takuma Maeda, Erika Miyazaki, Naoshi Hotta, Hitoshi Sato, Eisuke Hamaguchi, Hiroko Kanazawa, Yoshihiko Ohnishi, Masataka Kamei

Published in: Journal of Anesthesia | Issue 3/2019

Login to get access

Abstract

Purpose

The ClearSight™ device monitors continuous pressure and cardiac output via pulse contour analysis. ClearSight™, however, may not be reliable in patients with reduced peripheral perfusion caused by high peripheral resistance. This study aimed to elucidate the accuracy and trending ability of ClearSight™ in patients undergoing abdominal aortic aneurysm (AAA) surgery by comparing the ClearSightTM-derived cardiac index (CICS) with that measured using three-dimensional echocardiography (CI3D).

Methods

The study included 20 patients who underwent elective AAA surgery. CICS and CI3D were measured simultaneously at eight time points during the surgery. Trending ability was investigated after aortic clamping and unclamping. We used CI3D as the reference method.

Results

Bland–Altman analysis showed a wide limit of agreement between CICS and CI3D (percentage error 41.3%). Subgroup analysis showed a lower percentage error (33.2%) in patients with CI ≥ 2.5 L/min/m2. The cubic splines related to the CI3D and CI discrepancy were negatively sloped, indicating that CI3D had significant influence on the CI discrepancy (p < 0.001). Four-quadrant plot analysis showed that the tracking ability of ClearSight™ after aortic clamping and declamping were clinically unacceptable (81.3% and 78.6%, respectively). Also, the polar plot analysis showed that the concordance rate of ClearSight™ after aortic clamping and declamping were clinically unacceptable (58.3% and 66.7%, respectively).

Conclusions

ClearSight™ was not sufficiently accurate in patients undergoing AAA surgery. The tracking ability of ClearSight™ after aortic clamping was below the acceptable limit.
Appendix
Available only for authorised users
Literature
1.
Mor-Avi V, Jenkins C, Kuhl HP, Nesser HJ, Marwick T, Franke A, Ebner C, Freed BH, Steringer-Mascherbauer R, Pollard H, Weinert L, Niel J, Sugeng L, Lang RM. Real-time 3-dimensional echocardiographic quantification of left ventricular volumes: multicenter study for validation with magnetic resonance imaging and investigation of sources of error. JACC Cardiovasc Imaging. 2008;1:413–23.CrossRefPubMed
2.
Mor-Avi V, Sugeng L, Lang RM. Real-time 3-dimensional echocardiography: an integral component of the routine echocardiographic examination in adult patients? Circulation. 2009;119:314–29.CrossRefPubMed
3.
Shimada YJ, Ishikawa K, Kawase Y, Ladage D, Tilemann L, Shiota T, Hajjar RJ. Comparison of left ventricular stroke volume assessment by two- and three-dimensional echocardiography in a swine model of acute myocardial infarction validated by thermodilution method. Echocardiography. 2012;29:1091–5.CrossRefPubMed
4.
Jenkins C, Bricknell K, Hanekom L, Marwick TH. Reproducibility and accuracy of echocardiographic measurements of left ventricular parameters using real-time three-dimensional echocardiography. J Am Coll Cardiol. 2004;44:878–86.CrossRefPubMed
5.
Balluz R, Liu L, Zhou X, Ge S. Real time three-dimensional echocardiography for quantification of ventricular volumes, mass, and function in children with congenital and acquired heart diseases. Echocardiography. 2013;30:472–82.CrossRefPubMed
6.
Jakubovic BD, Wald R, Goldstein MB, Leong-Poi H, Yuen DA, Perl J, Lima JA, Liu JJ, Kirpalani A, Dacouris N, Wald R, Connelly KA, Yan AT. Comparative assessment of 2-dimensional echocardiography vs cardiac magnetic resonance imaging in measuring left ventricular mass in patients with and without end-stage renal disease. Can J Cardiol. 2013;29:384–90.CrossRefPubMed
7.
Maeda T, Yoshitani K, Inatomi Y, Ohnishi Y. Inaccuracy of the FloTrac/Vigileo system in patients with low cardiac index. J Cardiothorac Vasc Anesth. 2014;28:1521–6.CrossRefPubMed
8.
McNamara H, Barclay P, Sharma V. Accuracy and precision of the ultrasound cardiac output monitor (USCOM 1A) in pregnancy: comparison with three-dimensional transthoracic echocardiography. Br J Anaesth. 2014;113:669–76.CrossRefPubMed
9.
Maeda T, Sakurai R, Nakagawa K, Morishima K, Maekawa M, Furumoto K, Kono T, Egawa A, Kubota Y, Kato S, Okamura H, Yoshitani K, Ohnishi Y. Cardiac resynchronization therapy-induced cardiac index increase measured by three-dimensional echocardiography can predict decreases in brain natriuretic peptide. J Cardiothorac Vasc Anesth. 2016;30:599–605.CrossRefPubMed
10.
Ameloot K, Palmers PJ, Malbrain ML. The accuracy of noninvasive cardiac output and pressure measurements with finger cuff: a concise review. Curr Opin Crit Care. 2015;21:232–9.CrossRefPubMed
11.
Ameloot K, Van De Vijver K, Broch O, Van Regenmortel N, De Laet I, Schoonheydt K, Dits H, Bein B, Malbrain ML. Nexfin noninvasive continuous hemodynamic monitoring: validation against continuous pulse contour and intermittent transpulmonary thermodilution derived cardiac output in critically ill patients. Sci World J. 2013;2013:519080.CrossRef
12.
Ameloot K, Van De Vijver K, Van Regenmortel N, De Laet I, Schoonheydt K, Dits H, Broch O, Bein B, Malbrain ML. Validation study of Nexfin(R) continuous non-invasive blood pressure monitoring in critically ill adult patients. Miner Anestesiol. 2014;80:1294–301.
13.
Maeda T, Hattori K, Sumiyoshi M, Kanazawa H, Ohnishi Y. Accuracy and trending ability of the fourth-generation FloTrac/Vigileo System in patients undergoing abdominal aortic aneurysm surgery. J Anesth. 2018;32:387–93.CrossRefPubMed
14.
Kusaka Y, Yoshitani K, Irie T, Inatomi Y, Shinzawa M, Ohnishi Y. Clinical comparison of an echocardiograph-derived versus pulse counter-derived cardiac output measurement in abdominal aortic aneurysm surgery. J Cardiothorac Vasc Anesth. 2012;26:223–6.CrossRefPubMed
15.
Hattori K, Maeda T, Masubuchi T, Yoshikawa A, Ebuchi K, Morishima K, Kamei M, Yoshitani K, Ohnishi Y. Accuracy and trending ability of the fourth-generation Flotrac/Vigileo system in patients with low cardiac index. J Cardiothorac Vasc Anesth. 2017;31:99–104.CrossRefPubMed
16.
Wesseling KH, Jansen JR, Settels JJ, Schreuder JJ. Computation of aortic flow from pressure in humans using a nonlinear, three-element model. J Appl Physiol 1985 1993;74:2566–73.CrossRefPubMed
17.
Kanda Y. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant. 2013;48:452–8.CrossRef
18.
Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986;1:307–10.CrossRefPubMed
19.
Givertz MM, Colucci WS, LeJemtel TH, Gottlieb SS, Hare JM, Slawsky MT, Leier CV, Loh E, Nicklas JM, Lewis BE. Acute endothelin A receptor blockade causes selective pulmonary vasodilation in patients with chronic heart failure. Circulation. 2000;101:2922–7.CrossRefPubMed
20.
Pica S, Ghio S, Tonti G, Camporotondo R, Turco A, Pazzano AS, Scelsi L, Raineri C, Oltrona Visconti L. Analyses of longitudinal and of transverse right ventricular function provide different clinical information in patients with pulmonary hypertension. Ultrasound Med Biol. 2014;40:1096–103.CrossRefPubMed
21.
Critchley LA, Lee A, Ho AM. A critical review of the ability of continuous cardiac output monitors to measure trends in cardiac output. Anesth Analg. 2010;111:1180–92.CrossRefPubMed
22.
Suehiro K, Tanaka K, Funao T, Matsuura T, Mori T, Nishikawa K. Systemic vascular resistance has an impact on the reliability of the Vigileo-FloTrac system in measuring cardiac output and tracking cardiac output changes. Br J Anaesth. 2013;111:170–7.CrossRefPubMed
23.
Critchley LA, Yang XX, Lee A. Assessment of trending ability of cardiac output monitors by polar plot methodology. J Cardiothorac Vasc Anesth. 2011;25:536–46.CrossRefPubMed
24.
Bubenek-Turconi SI, Craciun M, Miclea I, Perel A. Noninvasive continuous cardiac output by the Nexfin before and after preload-modifying maneuvers: a comparison with intermittent thermodilution cardiac output. Anesth Analg. 2013;117:366–72.CrossRefPubMed
25.
Chen G, Meng L, Alexander B, Tran NP, Kain ZN, Cannesson M. Comparison of noninvasive cardiac output measurements using the Nexfin monitoring device and the esophageal Doppler. J Clin Anesth. 2012;24:275–83.CrossRefPubMed
26.
Monnet X, Picard F, Lidzborski E, Mesnil M, Duranteau J, Richard C, Teboul JL. The estimation of cardiac output by the Nexfin device is of poor reliability for tracking the effects of a fluid challenge. Crit Care. 2012;16:R212.CrossRefPubMedPubMedCentral
27.
Fischer MO, Coucoravas J, Truong J, Zhu L, Gerard JL, Hanouz JL, Fellahi JL. Assessment of changes in cardiac index and fluid responsiveness: a comparison of Nexfin and transpulmonary thermodilution. Acta Anaesthesiol Scand. 2013;57:704–12.CrossRefPubMed
28.
Zoghbi WA, Enriquez-Sarano M, Foster E, Grayburn PA, Kraft CD, Levine RA, Nihoyannopoulos P, Otto CM, Quinones MA, Rakowski H, Stewart WJ, Waggoner A, Weissman NJ, American Society of E. Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr. 2003;16:777–802.CrossRefPubMed
Metadata
Title
Accuracy of the ClearSight™ system in patients undergoing abdominal aortic aneurysm surgery
Authors
Miho Sumiyoshi
Takuma Maeda
Erika Miyazaki
Naoshi Hotta
Hitoshi Sato
Eisuke Hamaguchi
Hiroko Kanazawa
Yoshihiko Ohnishi
Masataka Kamei
Publication date
01-06-2019
Publisher
Springer Japan
Published in
Journal of Anesthesia / Issue 3/2019
Print ISSN: 0913-8668
Electronic ISSN: 1438-8359
DOI
https://doi.org/10.1007/s00540-019-02632-6

Other articles of this Issue 3/2019

Journal of Anesthesia 3/2019 Go to the issue

Letter to the Editor

Dexmedetomidine and clinical outcomes of non-cardiac surgery

Special Article

Perioperative point of care ultrasound in pediatric anesthesiology: a case series highlighting real-time intraoperative diagnosis and alteration of management augmenting physical examination

Original Article

Association of perioperative weight-based fluid balance with 30-day mortality and acute kidney injury among patients in the surgical intensive care unit

Letter to the Editor

Three versus five lumbar PVB injections for herniorrhaphy

Review Article

Infraclavicular brachial plexus block in adults: a comprehensive review based on a unified nomenclature system

Original Article

Acute and long-term effects of haloperidol on surgery-induced neuroinflammation and cognitive deficits in aged rats