Breukers RMBGE, Sepehrkhouy S, Spiegelenberg SR, Groeneveld ABJ. Cardiac Output Measured by a New Arterial Pressure Waveform Analysis Method Without Calibration Compared With Thermodilution After Cardiac Surgery.
J Cardiothorac Vasc Anesth 2007;
21:632-5. [PMID:
17905265 DOI:
10.1053/j.jvca.2007.01.001]
[Citation(s) in RCA: 73] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2006] [Indexed: 11/11/2022]
Abstract
OBJECTIVES
To investigate whether measuring cardiac output and its course after cardiac surgery by a new analysis technique of radial artery pressure waves, without need for calibration (FloTrac/Vigileo [FV]; Edwards Lifesciences, Irvine, CA), conforms to the standard bolus thermodilution method via a pulmonary artery catheter (PAC).
DESIGN
Prospective study.
SETTING
Intensive care unit of university hospital.
PARTICIPANTS
Twenty patients for up to 24 hours after cardiac surgery.
INTERVENTIONS
Simultaneous and triplicate PAC thermodilution and FV cardiac output measurements at 1 and 3 hours after surgery and the following morning.
MEASUREMENTS AND MAIN RESULTS
Fifty-six simultaneous measurement sets were obtained. Mean cardiac output (PAC) ranged between 2.8 and 10.3 L/min and for the FV method between 3.3 and 8.8 L/min. The coefficient of variation for pooled measurements was 7.3% for the PAC and 3.0% for the FV method. For pooled data, the r2 was 0.55 (p < 0.001), with a bias of -0.14, precision of 1.00 L/min, and 95% limits of agreement between -2.14 and 1.87 L/min in a Bland-Altman plot. Also, the FV method tended to overestimate cardiac output when <7 L/min and increased with time, whereas mean arterial pressure increased and PAC cardiac output did not change. Changes in cardiac output correlated (r2 = 0.52, p < 0.001).
CONCLUSIONS
The FV arterial pressure waveform analysis method is a clinically applicable method for cardiac output assessment without calibration, after cardiac surgery. It performs well at low cardiac outputs but remains sensitive to changes in vascular tone.
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