Cardiac Output Measurement in Patients Undergoing Liver Transplantation: Pulmonary Artery Catheter Versus Uncalibrated Arterial Pressure Waveform Analysis

Biais, M.; Karine, Nouette-Gaulain; Cottenceau, Vincent; Alain, Vallet; Francois, Cochard Jean; Revel, Philippe; Sztark, F.

doi:10.1213/ane.0b013e318168b309

Cited by 169 publications

(41 citation statements)

References 41 publications

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“…Not surprisingly the CO measurements suffer from a similar level of disagreement. These findings were in accordance with most of the published literature regarding the minimal-invasive pulse-contour analysis devices such as the Vigileo/FloTrac monitor [15][16][17], but none of these studies compared devices produced by the same company, with similar software, in septic shock patients on high doses of norepinephrine.…”

Section: Discussionsupporting

confidence: 89%

Assessment of method agreement between two minimally invasive hemodynamic measurements in septic shock patients on high doses of vasopressor drugs. A preliminary study

Antal

Mărginean

Hagău

2017

Rom J Anaesth Intensive Care

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Background: Minimally invasive hemodynamic monitoring is still controversial among the methods used to assess the hemodynamic profile of the septic shock patient. The aim of this study was to test the level of agreement between two different devices.Methods. We collected 385 data entries during 12-hour intervals from four critically ill patients with septic shock and high doses of vasoactive therapy using two minimally invasive methods at the same time: Vigileo™ device which uses the pulse contour principle, and EV1000™ monitoring platform which uses the transpulmonary thermodilution principle. The studied parameters were Stroke Volume (SV), Cardiac Output (CO) and Mean Arterial Pressure (MAP). We tested the agreement by performing the visual examination of data patterns using graphs and studying the bias, limits of agreement and creating BlandAltman plots. For assessing the systematic, proportional and random differences, we computed a PassingBablock regression with the CUSUM test for linearity.Results. The one sample t-Test for the differences between the two methods against the null value was statistically significant for the studied parameters (p < 0.0001). The Bland-Altman analysis found no agreement between the data obtained using the two techniques, with calculated error percent as high as 88.28% for SV, 82.02% for CO and 42.06% for MAP. The Passing-Bablock regression analysis tested positive for systematic differences, but this could not be accounted for.Conclusion. We found no agreement between data obtained from the studied devices; therefore, these cannot be used interchangeably for critically ill septic shock patients on high doses of vasoactive substances.

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Section: Discussionsupporting

confidence: 89%

Assessment of method agreement between two minimally invasive hemodynamic measurements in septic shock patients on high doses of vasopressor drugs. A preliminary study

Antal

Mărginean

Hagău

2017

Rom J Anaesth Intensive Care

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“…The measure of cardiac output by pulse contour analysis is very precise, more so than with TPTD [5], but it may drift over time, especially when the arterial resistance changes [19–21]. Then, the PiCCO and Volume View devices calibrate pulse contour analysis by the value obtained by TPTD each time TPTD is performed.…”

Section: Measurement Of Cardiac Outputmentioning

confidence: 99%

“…The first is when the patient is particularly complex and when more variables than just cardiac output are mandatory, such as during cardiac surgery and prolonged major surgery for instance [84]. The second is when less invasive techniques are more likely to be unreliable, as for instance uncalibrated pulse contour analysis during liver surgery because major changes in vasomotor tone are expected [19]. Several studies conducted in cardiac surgery and major abdominal surgery have shown that cardiac output monitoring led to a reduction in the rate of complications and the length of stay [85].…”

Section: The Place Of Tptd Among Haemodynamic Monitoring Devicesmentioning

confidence: 99%

Transpulmonary thermodilution: advantages and limits

2017

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Background: For complex patients in the intensive care unit or in the operating room, many questions regarding their haemodynamic management cannot be answered with simple clinical examination. In particular, arterial pressure allows only a rough estimation of cardiac output. Transpulmonary thermodilution is a technique that provides a full haemodynamic assessment through cardiac output and other indices. Main body: Through the analysis of the thermodilution curve recorded at the tip of an arterial catheter after the injection of a cold bolus in the venous circulation, transpulmonary thermodilution intermittently measures cardiac output. This measure allows the calibration of pulse contour analysis. This provides continuous and real time monitoring of cardiac output, which is not possible with the pulmonary artery catheter. Transpulmonary thermodilution provides several variables beyond cardiac output. It estimates the end-diastolic volume of the four cardiac cavities, which is a marker of cardiac preload. It provides an estimation of the systolic function of the combined ventricles. It is more direct than the pulmonary artery catheter, but does not allow the distinct estimation of right and left cardiac function. It is easier and faster to perform than echocardiography, but does not provide a full evaluation of the cardiac structure and function. Transpulmonary thermodilution has the unique advantage of being able to estimate at the bedside extravascular lung water, which quantifies the volume of pulmonary oedema, and pulmonary vascular permeability, which quantifies the degree of a pulmonary capillary leak. Both indices are helpful for guiding fluid strategy, especially in case of acute respiratory distress syndrome. Conclusions: Transpulmonary thermodilution provides a full cardiovascular evaluation that allows one to answer many questions regarding haemodynamic management. It belongs to the category of "advanced" devices that are indicated for the most critically ill and/or complex patients.

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“…However, hemodynamic parameters are affected by complex fluctuating exponential interactions of inotropy, chronotropy, temperature, and viscosity that can produce non-linear perturbations. This explains why blood pressure and cardiac output are not linearly related [454,455]. Reptilian red cells enhance systolic turbulence at the expense of cardiac output to prevent atherosclerosis caused by lipoprotein solidification at cool temperatures that exaggerates blood viscosity [456,457].…”

Section: The Turbulence Mechanismmentioning

confidence: 99%

Stress repair mechanism activity explains inflammation and apoptosis

Coleman¹

2012

ABB

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Cardiac Output Measurement in Patients Undergoing Liver Transplantation: Pulmonary Artery Catheter Versus Uncalibrated Arterial Pressure Waveform Analysis

Abstract: Our results suggest that Vigileo/FloTrac CO monitoring data do not agree well with those of automatic thermodilution in patients undergoing liver transplantation, especially in Child-Pugh grade B and C patients with low systemic vascular resistance.

Cited by 169 publications

References 41 publications

Assessment of method agreement between two minimally invasive hemodynamic measurements in septic shock patients on high doses of vasopressor drugs. A preliminary study

Assessment of method agreement between two minimally invasive hemodynamic measurements in septic shock patients on high doses of vasopressor drugs. A preliminary study

Transpulmonary thermodilution: advantages and limits

Stress repair mechanism activity explains inflammation and apoptosis

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