Leonard J Montenij1, Johannes P Sonneveld2, Arno P Nierich2, Wolfgang F Buhre3, Eric E De Waal4. 1. *Department of Anaesthesiology, University Medical Centre Utrecht, Utrecht, The Netherlands;. Electronic address: l.j.montenij@umcutrecht.nl. 2. Department of Anaesthesia and Intensive Care, Isala Clinics, Zwolle, The Netherlands. 3. Department of Anaesthesia and Pain Therapy, Maastricht University Medical Centre, Maastricht, The Netherlands. 4. *Department of Anaesthesiology, University Medical Centre Utrecht, Utrecht, The Netherlands;
Abstract
OBJECTIVES: Uncalibrated arterial waveform analysis provides minimally invasive and continuous measurement of cardiac output (CO). This technique could be of great value in patients with impaired left ventricular function, but the validity in these patients is not well established. The aim of this study was to investigate the accuracy, precision, and trending ability of uncalibrated arterial waveform analysis of cardiac output in patients with impaired left ventricular function. DESIGN: Prospective, observational, method-comparison study. SETTING: Nonuniversity teaching hospital, single center. PARTICIPANTS: The study included 22 patients with a left ventricular ejection fraction of 40% or less undergoing elective coronary artery bypass grafting. INTERVENTIONS: In the period between induction of anesthesia and sternotomy, CO was measured using the FloTrac/Vigileo system (third-generation software) and intermittent pulmonary artery thermodilution before and after volume loading. MEASUREMENTS AND MAIN RESULTS: Accuracy and precision as determined using Bland-Altman analysis revealed a bias of -0.7 L/min, limits of agreement of -2.9 to 1.5 L/min, and a mean error of 55% for pooled data. Proportional bias and spread were present, indicating that bias and limits of agreement were underestimated for high CO values. Trending ability was assessed using 4-quadrant analysis, which revealed a concordance of 86%. Concordance from a clinical perspective was 36%. Polar plot analysis showed an angular bias of 13° degrees, with radial limits of agreement of -55° to 51°. Polar concordance at±30° was 50%. CONCLUSIONS: Arterial waveform analysis of cardiac output and pulmonary artery thermodilution cardiac output were not interchangeable in patients with impaired left ventricular function.
OBJECTIVES: Uncalibrated arterial waveform analysis provides minimally invasive and continuous measurement of cardiac output (CO). This technique could be of great value in patients with impaired left ventricular function, but the validity in these patients is not well established. The aim of this study was to investigate the accuracy, precision, and trending ability of uncalibrated arterial waveform analysis of cardiac output in patients with impaired left ventricular function. DESIGN: Prospective, observational, method-comparison study. SETTING: Nonuniversity teaching hospital, single center. PARTICIPANTS: The study included 22 patients with a left ventricular ejection fraction of 40% or less undergoing elective coronary artery bypass grafting. INTERVENTIONS: In the period between induction of anesthesia and sternotomy, CO was measured using the FloTrac/Vigileo system (third-generation software) and intermittent pulmonary artery thermodilution before and after volume loading. MEASUREMENTS AND MAIN RESULTS: Accuracy and precision as determined using Bland-Altman analysis revealed a bias of -0.7 L/min, limits of agreement of -2.9 to 1.5 L/min, and a mean error of 55% for pooled data. Proportional bias and spread were present, indicating that bias and limits of agreement were underestimated for high CO values. Trending ability was assessed using 4-quadrant analysis, which revealed a concordance of 86%. Concordance from a clinical perspective was 36%. Polar plot analysis showed an angular bias of 13° degrees, with radial limits of agreement of -55° to 51°. Polar concordance at±30° was 50%. CONCLUSIONS: Arterial waveform analysis of cardiac output and pulmonary artery thermodilution cardiac output were not interchangeable in patients with impaired left ventricular function.
Authors: Sebastian Roth; Henrik Fox; Uwe Fuchs; Uwe Schulz; Angelika Costard-Jäckle; Jan F Gummert; Dieter Horstkotte; Olaf Oldenburg; Thomas Bitter Journal: Clin Res Cardiol Date: 2018-01-19 Impact factor: 5.460
Authors: Alexandre R Carvalho; Solange Guizilini; Gustavo M Murai; Isis Begot; Isadora S Rocco; Nelson A Hossne; Eduardo G Chamlian; João Manoel T Santos; Ricardo A Macedo; Gustavo C O Lisboa; Alberto C Nasciutti; Carlos Eduardo R Santos; João Paulo M Figueiredo; Walter J Gomes Journal: Braz J Cardiovasc Surg Date: 2018 Sep-Oct