Clinical evaluation of the FloTrac/Vigileo system and two established continuous cardiac output monitoring devices in patients undergoing cardiac surgery

Assessment of stroke volume variation for prediction of fluid responsiveness using the modified FloTrac and PiCCOplus system

Introduction

Stroke volume variation (SVV) has repeatedly been shown to be a reliable predictor of fluid responsiveness. Various devices allow automated clinical assessment of SVV. The aim of the present study was to compare prediction of fluid responsiveness using SVV, as determined by the FloTrac™/Vigileo™ system and the PiCCOplus™ system.

Methods

In patients who had undergone elective cardiac surgery, SVV_FloTrac was determined via radial FloTrac sensor, and SVV_PiCCO and pulse pressure variation were assessed via a femoral PiCCO catheter. Stroke volume was assessed by transpulmonary thermodilution. All variables were recorded before and after a volume shift induced by a change in body positioning (from 30° head-up position to 30° head-down position). Pearson correlation, t-test, and Bland-Altman analysis were performed. Area under the curve was determined by plotting receiver operating characteristic curves for changes in stroke volume in excess of 25%. P < 0.05 was considered statistically significant.

Results

Body positioning resulted in a significant increase in stroke volume; SVV_FloTrac and SVV_PiCCO decreased significantly. Correlations of SVV_FloTrac and SVV_PiCCO with change in stroke volume were similar. There was no significant difference between the areas under the curve for SVV_FloTrac and SVV_PiCCO; the optimal threshold values given by the receiver operating characteristic curves were 9.6% for SVV_FloTrac (sensitivity 91% and specificity 83%) and 12.1% for SVV_PiCCO (sensitivity 87% and specificity 76%). There was a clinically acceptable agreement and strong correlation between SVV_FloTrac and SVV_PiCCO.

Conclusion

SVVs assessed using the FloTrac™/Vigileo™ and the PiCCOplus™ systems exhibited similar performances in terms of predicting fluid responsiveness. In comparison with SVV_PiCCO, SVV_FloTrac has a lower threshold value.

Perioperative anesthetic management for esophagectomy

Esophageal resection is a formidable operation associated with high morbidity and mortality. Anesthetic management may contribute to the containment of respiratory failure and anastomotic leakage by the use of thoracic epidural analgesia, protective ventilation strategies, prevention of tracheal aspiration, and judicious fluid management.

Arterial pulse cardiac output agreement with thermodilution in patients in hyperdynamic conditions

OBJECTIVE

This study aimed to compare continuous cardiac output (CCO) obtained using the arterial pulse wave (APCO) measurement with a simultaneous measurement of the intermittent cardiac output (ICO) and CCO obtained with a pulmonary artery catheter (PAC) in liver transplant patients.

DESIGN

A prospective, single-center evaluation.

SETTING

A university hospital intensive care unit.

PATIENTS

Eighteen patients after liver transplantation.

INTERVENTIONS

Pulmonary artery catheters were placed in all patients, and ICO and CCO were determined using thermodilution. APCO measurements were made with the Vigileo System (Edwards Lifesciences, Irvine, CA).

MEASUREMENTS AND MAIN RESULTS

The authors obtained 126 data pairs of ICO and APCO and 864 pairs of CCO and APCO. ICO data were collected after intensive care unit admission and every 8 hours until the 48th postoperative hour. CCO and APCO data were collected every hour from admission until the 48th postoperative hour. Bias and precision were 0.95 +/- 1.41 L/min for ICO versus APCO and 1.29 +/- 1.28 L/min for CCO and APCO. Bias and precision for cardiac output (CO) data pairs less than 8 L/min were 0.32 +/- 1.14 L/min between ICO and APCO and 0.71 +/- 0.98 L/min between CCO and APCO. For CO data pairs higher than 8 L/min, bias and precision were 1.79 +/- 1.54 L/min between ICO and APCO and 2.25 +/- 1.14 L/min between CCO and APCO.

CONCLUSIONS

APCO enables the assessment of CO with clinically acceptable bias and precision. At higher CO levels, APCO underestimates PAC measurements and it is not as reliable as thermodilution in hyperdynamic liver transplant patients.