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Ordoñez-Rufat P, Mancho-Fora N, Tebe-Cordomi C, Polit-Martinez V, Abellan-Lencina R, Fernandez-Alvarez J, Lopez-Delgado JC. Study of the accuracy of a radial arterial pressure waveform cardiac output measurement device after cardiac surgery. J Cardiothorac Surg 2023; 18:32. [PMID: 36650554 PMCID: PMC9843904 DOI: 10.1186/s13019-023-02128-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 01/02/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Less invasive monitoring, such as radial arterial pulse contour analysis (ProAQT® sensor), represents an alternative when hemodynamic monitoring is necessary to guide postoperative management and invasive monitoring is not technically feasible. The aim of the study is to evaluate the accuracy of the ProAQT® sensor cardiac output measurements in comparison with Pulmonary Artery Catheter (PAC) during the postoperative course of patients who underwent cardiac surgery with cardiopulmonary bypass. CASE PRESENTATION Prospective observational study in a Surgical Intensive Care Unit of a tertiary university hospital. Ten patients with a mean age of 73.5 years were included. The main comorbidities were hypertension, diabetes, dyslipidemia and the preoperative left ejection fraction was 43.8 ± 14.5%. Regarding the type of surgery, six patients underwent valve surgery, two underwent coronary artery bypass grafting and two underwent aortic surgery. The cardiac index measured simultaneously by the ProAQT® sensor was compared with the PAC. The parameters were evaluated at predefined time points during the early postoperative courses (6 h, 12 h, 24 h, 48 h and 72 h). The degree of agreement with the cardiac index between the PAC and the ProAQT® sensor along the time points was measured using the concordance correlation coefficient, Bland-Altman analysis, and four-quadrant plot. Sixty-three pairs of measurements were analyzed. We showed that measurements of cardiac index were slightly higher with PAC (β ̂ = - 0.146, p-value = 0.094). The concordance correlation coefficient for the additive model of cardiac index was 0.64 (95% Confidence Interval: 0.36, 0.82), indicating a high concordance between both sensors. Bland-Altmann analysis showed a mean bias of 0.45 L·min-1·m-2, limits of agreement from - 1.65 to 2.3 L·min-1·m-2, and percentage of error was 82.5%. Four-quadrant plot of changes in cardiac index showed a good concordance rate (75%), which increases after applying the exclusion zone (87%). CONCLUSIONS In patients undergoing cardiac surgery, the ProAQT® sensor may be useful to monitor cardiac index during the postoperative period, especially when more invasive monitoring is not possible.
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Affiliation(s)
- Pilar Ordoñez-Rufat
- grid.411129.e0000 0000 8836 0780Intensive Care Department, Bellvitge University Hospital, C/ Feixa Llarga s/n, 08907 Hospitalet de Llobregat, Barcelona Spain
| | - Nuria Mancho-Fora
- grid.5841.80000 0004 1937 0247Biostatistics Department, Universitat de Barcelona, Campus Bellvitge, Av. Mare de Déu de Bellvitge, 3, 08907 Hospitalet de Llobregat, Barcelona Spain
| | - Cristian Tebe-Cordomi
- grid.5841.80000 0004 1937 0247Biostatistics Department, Universitat de Barcelona, Campus Bellvitge, Av. Mare de Déu de Bellvitge, 3, 08907 Hospitalet de Llobregat, Barcelona Spain
| | - Victoria Polit-Martinez
- grid.411129.e0000 0000 8836 0780Intensive Care Department, Bellvitge University Hospital, C/ Feixa Llarga s/n, 08907 Hospitalet de Llobregat, Barcelona Spain
| | - Ricardo Abellan-Lencina
- grid.411129.e0000 0000 8836 0780Intensive Care Department, Bellvitge University Hospital, C/ Feixa Llarga s/n, 08907 Hospitalet de Llobregat, Barcelona Spain
| | - Joaquin Fernandez-Alvarez
- grid.411129.e0000 0000 8836 0780Intensive Care Department, Bellvitge University Hospital, C/ Feixa Llarga s/n, 08907 Hospitalet de Llobregat, Barcelona Spain
| | - Juan Carlos Lopez-Delgado
- grid.411129.e0000 0000 8836 0780Intensive Care Department, Bellvitge University Hospital, C/ Feixa Llarga s/n, 08907 Hospitalet de Llobregat, Barcelona Spain ,grid.418284.30000 0004 0427 2257IDIBELL (Biomedical Research Institute of Bellvitge), Avda. de La Granvia de L’Hospitalet, 199, 08908 Hospitalet de Llobregat, Barcelona Spain
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Kalmar AF, Allaert S, Pletinckx P, Maes JW, Heerman J, Vos JJ, Struys MMRF, Scheeren TWL. Phenylephrine increases cardiac output by raising cardiac preload in patients with anesthesia induced hypotension. J Clin Monit Comput 2018; 32:969-976. [PMID: 29569112 PMCID: PMC6209056 DOI: 10.1007/s10877-018-0126-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 03/07/2018] [Indexed: 10/29/2022]
Abstract
Induction of general anesthesia frequently induces arterial hypotension, which is often treated with a vasopressor, such as phenylephrine. As a pure α-agonist, phenylephrine is conventionally considered to solely induce arterial vasoconstriction and thus increase cardiac afterload but not cardiac preload. In specific circumstances, however, phenylephrine may also contribute to an increase in venous return and thus cardiac output (CO). The aim of this study is to describe the initial time course of the effects of phenylephrine on various hemodynamic variables and to evaluate the ability of advanced hemodynamic monitoring to quantify these changes through different hemodynamic variables. In 24 patients, after induction of anesthesia, during the period before surgical stimulus, phenylephrine 2 µg kg-1 was administered when the MAP dropped below 80% of the awake state baseline value for > 3 min. The mean arterial blood pressure (MAP), heart rate (HR), end-tidal CO2 (EtCO2), central venous pressure (CVP), stroke volume (SV), CO, pulse pressure variation (PPV), stroke volume variation (SVV) and systemic vascular resistance (SVR) were recorded continuously. The values at the moment before administration of phenylephrine and 5(T5) and 10(T10) min thereafter were compared. After phenylephrine, the mean(SD) MAP, SV, CO, CVP and EtCO2 increased by 34(13) mmHg, 11(9) mL, 1.02(0.74) L min-1, 3(2.6) mmHg and 4.0(1.6) mmHg at T5 respectively, while both dynamic preload variables decreased: PPV dropped from 20% at baseline to 9% at T5 and to 13% at T10 and SVV from 19 to 11 and 14%, respectively. Initially, the increase in MAP was perfectly aligned with the increase in SVR, until 150 s after the initial increase in MAP, when both curves started to dissociate. The dissociation of the evolution of MAP and SVR, together with the changes in PPV, CVP, EtCO2 and CO indicate that in patients with anesthesia-induced hypotension, phenylephrine increases the CO by virtue of an increase in cardiac preload.
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Affiliation(s)
- A F Kalmar
- Department of Anesthesia and Critical Care Medicine, Maria Middelares Hospital, Buitenring Sint-Denijs 30, 9000, Ghent, Belgium. .,Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - S Allaert
- Department of Anesthesia and Critical Care Medicine, Maria Middelares Hospital, Buitenring Sint-Denijs 30, 9000, Ghent, Belgium
| | - P Pletinckx
- Department of Surgery, Maria Middelares Hospital, Ghent, Belgium
| | - J-W Maes
- Department of Anesthesia and Critical Care Medicine, Maria Middelares Hospital, Buitenring Sint-Denijs 30, 9000, Ghent, Belgium
| | - J Heerman
- Department of Anesthesia and Critical Care Medicine, Maria Middelares Hospital, Buitenring Sint-Denijs 30, 9000, Ghent, Belgium
| | - J J Vos
- Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - M M R F Struys
- Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Anesthesia, Ghent University, Ghent, Belgium
| | - T W L Scheeren
- Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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