A Review of Intraoperative Goal-Directed Therapy Using Arterial Waveform Analysis for Assessment of Cardiac Output

Abstract

Increasing evidence shows that goal-directed hemodynamic management can improve outcomes in surgical and intensive care settings. Arterial waveform analysis is one of the different techniques used for guiding goal-directed therapy. Multiple proprietary systems have developed algorithms for obtaining cardiac output from an arterial waveform, including the FloTrac, LiDCO, and PiCCO systems. These systems vary in terms of how they analyze the arterial pressure waveform as well as their requirements for invasive line placement and calibration. Although small-scale clinical trials using these monitors show promising data, large-scale multicenter trials are still needed to better determine how intraoperative goal-directed therapy with arterial waveform analysis can improve patient outcomes. This review provides a comparative analysis of the different arterial waveform monitors for intraoperative goal-directed therapy.

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“…In addition, use of some neuromuscular blocking agents containing quaternary ammonium residues may be detected by the lithium sensor, making CO calibration inaccurate. 54…”

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“…Hence, during systole increased pressure in the vessel causes expansion and distention which is expelled during diastole as pressure decreases. The cardiac output and aortic compliance are measured by using transpulmonary thermodilution and arterial waveform is used for obtaining pressures (25). Souto Moura and colleagues in a recent study demonstrated that the PiCCO system when compared to echocardiography for assessment of cardiac output estimation and concordance, was able to produce values in high agreement in normothermic patients (26).…”

“…To calculate the stroke volume (SV), arterial pulse pressure (PP) standard deviation is calculated by sampling arterial pressure data points at 100 Hz for 20 seconds, which is used to calculate the standard deviation around these points. Then a conversion factor is applied which represents calculated systemic vascular resistance, arterial compliance and modifiers such as age, sex, body weight and height are taken into account (25). FloTrac system has the ability to continuously update and reproduce the hemodynamic parameters such as CO, cardiac index (CI), stroke volume variation (SVV), SV, stroke volume index (SVI), and in contrast to PiCCO method, does not require recalibration (31).…”