Calibrated versus uncalibrated arterial pressure waveform analysis in monitoring cardiac output with transpulmonary thermodilution in patients with severe sepsis and septic shock

Slagt, Cornelis; Helmi, Mochamat; Malagon, Ignacio; Groeneveld, Abj

doi:10.1097/eja.0000000000000173

Cited by 15 publications

(6 citation statements)

References 42 publications

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“…The lowest bias and MPE are found in validation studies during cardiac surgery [68,77,78]. The worst results are found during sepsis and septic shock as the bias of most non-invasive devices is negatively influenced by a low systemic vascular resistance (SVR) [68,74,75,[79][80][81]. Which device should be the reference method and under which clinical condition the validation needs to be performed, remains subject of discussion.…”

Section: Summary Of Evidencementioning

confidence: 99%

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Accuracy and precision of non-invasive cardiac output monitoring by electrical cardiometry: a systematic review and meta-analysis

Sanders

Servaas

Slagt

2019

J Clin Monit Comput

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Cardiac output monitoring is used in critically ill and high-risk surgical patients. Intermittent pulmonary artery thermodilution and transpulmonary thermodilution, considered the gold standard, are invasive and linked to complications. Therefore, many non-invasive cardiac output devices have been developed and studied. One of those is electrical cardiometry. The results of validation studies are conflicting, which emphasize the need for definitive validation of accuracy and precision. We performed a database search of PubMed, Embase, Web of Science and the Cochrane Library of Clinical Trials to identify studies comparing cardiac output measurement by electrical cardiometry and a reference method. Pooled bias, limits of agreement (LoA) and mean percentage error (MPE) were calculated using a random-effects model. A pooled MPE of less than 30% was considered clinically acceptable. A total of 13 studies in adults (620 patients) and 11 studies in pediatrics (603 patients) were included. For adults, pooled bias was 0.03 L min −1 [95% CI − 0.23; 0.29], LoA − 2.78 to 2.84 L min −1 and MPE 48.0%. For pediatrics, pooled bias was − 0.02 L min −1 [95% CI − 0.09; 0.05], LoA − 1.22 to 1.18 L min −1 and MPE 42.0%. Inter-study heterogeneity was high for both adults (I 2 = 93%, p < 0.0001) and pediatrics (I 2 = 86%, p < 0.0001). Despite the low bias for both adults and pediatrics, the MPE was not clinically acceptable. Electrical cardiometry cannot replace thermodilution and transthoracic echocardiography for the measurement of absolute cardiac output values. Future research should explore it's clinical use and indications.

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Section: Summary Of Evidencementioning

confidence: 99%

“…All reference methods have their own inherent error and do not provide an accurate and precise measurement of CO. For example, the precision of different TD devices is proved to be 13% by Stetz et al [83]. Slagt et al showed a precision of 6.7% for TPTD [81]. For intermittent PAC, precisions of 6.4% [84] Table 6 in Appendix 3) [38].…”

Section: Limitationsmentioning

confidence: 99%

Accuracy and precision of non-invasive cardiac output monitoring by electrical cardiometry: a systematic review and meta-analysis

Sanders

Servaas

Slagt

2019

J Clin Monit Comput

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“…The level of agreement as well as bias between the methods were evaluated by Bland-Altman analysis and corrected with repeated measurement [27]. The percentage errors were calculated as: 1.96 times of standard deviation of the bias divided by the mean CI of reference methods [19,20,28,29]; a percentage error less than 45% was considered clinically acceptable [30,31]. The trending ability of CI was assessed by 4-quadrant plot analysis, with an exclusion zone of 10% [22].…”

Section: Discussionmentioning

confidence: 99%

“…Boettger et al reported the bias of 0.72 L/min and limits of agreement of -2.16-3.6 L/min between FloTrac and thermodilution by PiCCO, and also demonstrated that FloTrac underestimation at high cardiac output but an overestimation at low cardiac output relative to transpulmonary thermodilution by PiCCO in septic patients [14]. Slagt et al compared CI derived by the 3rd generation of FloTrac with transpulmonary thermodilution by VolumeView/EV1000 in sepsis patients [29]. They found moderate agreement between the two methods, with a percentage error of 48%, with poor to moderate CI tracking abilities.…”

Section: Discussionmentioning

confidence: 99%

Comparison the accuracy and trending ability of cardiac index measured by the fourth-generation of FloTrac with the PiCCO device in septic shock patients

Khwannimit¹,

Jomsuriya²

2020

Turk J Med Sci

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Background/aim FloTrac/Vigileo is a noncalibrated arterial pressure waveform analysis for cardiac index (CI) monitoring. The aim of our study was to compare the CI measured by the 4th generation of FloTrac with PiCCO in septic shock patients. Materials and methods We simultaneously measured the CI using FloTrac (CIv) and compared it with the CI derived from transpulmonary thermodilution (CItd) as well as the pulse contour-derived CI using PiCCO (CIp). Results Thirty-one septic shock patients were included. The CIv correlated with CItd (r = 0.62, P < 0.0001). The Bland-Altman analysis showed a bias of 0.14, and the limits of agreement were –1.62–1.91 L/min/m2 with a percentage error of 47.4%. However, the concordance rate between CIv and CItd was 93.6%. The comparison of CIv with CIp (n = 352 paired measurements) revealed a bias of -0.16, and the limits of agreement were –1.45–1.79 L/min/m2 with a percentage error of 44.8%. The overall correlation coefficient between CIv and CIp was 0.63 (P < 0.0001), and the concordance rate was 85.4%. Conclusion The 4th generation of FloTrac has not acceptable agreement to assess CI; however, it has the ability to tracked changes of CI, when compared with the transpulmonary thermodilution method by PiCCO.

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“…It has to be emphasized that in our study cardiac output was measured by pulse wave analysis via a Vigileo Ò monitor (Edwards Lifesciences, Irvine, USA). Referring to Slagt et al an inherent shortcoming of this technique using uncalibrated arterial pressure waveform analysis is a reduced ability of exact measurement of cardiac output [17]. Additionally, transient vasopressor therapy could have led to further errors in cardiac output estimation [18].…”

Section: Discussionmentioning

confidence: 99%

A novel pump-driven veno-venous gas exchange system during extracorporeal CO2-removal

et al. 2015

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Calibrated versus uncalibrated arterial pressure waveform analysis in monitoring cardiac output with transpulmonary thermodilution in patients with severe sepsis and septic shock

Cited by 15 publications

References 42 publications

Accuracy and precision of non-invasive cardiac output monitoring by electrical cardiometry: a systematic review and meta-analysis

Accuracy and precision of non-invasive cardiac output monitoring by electrical cardiometry: a systematic review and meta-analysis

Comparison the accuracy and trending ability of cardiac index measured by the fourth-generation of FloTrac with the PiCCO device in septic shock patients

A novel pump-driven veno-venous gas exchange system during extracorporeal CO2-removal

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