Comparison of pulmonary artery catheter, echocardiography, and arterial waveform analysis monitoring in predicting the hemodynamic state during and after cardiac surgery

Abstract

Objective:The aim of this trial was to determine whether Flotrac Vigileo™ (FV™) provides a reliable representation of the hemodynamic state of a cardiac surgical patient population when compared to pulmonary artery catheter (PAC) and echocardiography in the peril-operative period.Design:This was a prospective observational trial comparing perioperative hemodynamic states using transesophageal echocardiography (TEE), transthoracic echocardiography (TTE), FV™ and PAC during and post cardiothoracic surgery.Setting:Tertiary regional hospital Intensive Care Unit (ICU).Participants:50 consecutive adult cardiothoracic patients with written consent provided.Intervention:Comparison of the perioperative hemodynamic states using echocardiography, FV™ and PAC was performed. Evaluation of the hemodynamic state (HDS) was performed using TEE, TTE, PAC and FV™ during and after cardiac surgery. Data were compared between the three hemodynamic assessment modalities.Main Outcome Measure:Predicted hemodynamic state.Results:FV™ and PAC were shown to correlate poorly with TEE/TTE assessment of the hemodynamic state. Both PAC and FV™ showed significant discordance with echocardiographic assessment of the hemodynamic state.Conclusions:In this trial, FV™ and PAC were shown to agree poorly with TTE/TEE assessment of the HDS in an adult cardiothoracic population. Agreement between the FV™ and PAC was also poor. Caution is recommended in interpreting isolated hemodynamic monitoring data. All hemodynamic monitoring devices have inherent sources of error. Caution is advised in interpreting any single device or measurement as a gold standard. We suggest that hemodynamic measuring devices such as FV™/PAC may act as triggers for a global hemodynamic assessment including consideration of TTE/TEE.

Hemodynamic monitoring with Hypotension Prediction Index versus arterial waveform analysis alone and incidence of perioperative hypotension

“…The minimally invasive hemodynamic monitoring is only a mathematical analysis, the calculations are highly depending on the quality of the arterial waveform signal, making it unreliable with weaker signals 36,37 . Published data conclude that the different invasive and noninvasive hemodynamic measurements only have poor accordance 38‐40 …”

Pulmonary artery catheter receipt among cardiac surgery patients from the national inpatient sample (1999–2019): Prevalence, predictors and hospitalization charges

“…Because of its descriptive nature, this study cannot be used to change clinical practice. However, given that evidence for or against use of PAC originates mainly from observational studies [ 1 , 8 , 10 , 16 , 17 , 20 , 21 , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] ], it can provide insights for the future design and conduct of large randomized trials aimed at evaluating safety, efficacy, and cost-effectiveness of PAC use within this clinical population.…”

Advanced airway management and respiratory care in decompensated pulmonary hypertension

“…Intensivists may elect to use minimally invasive hemodynamic monitoring such as the FloTrac device, which uses arterial wave form analysis to provide hemodynamic information. In dPH patients, FloTrac device has been demonstrated in one small study and commentary to be inferior to the PA catheter in patients with a CI < 2.2 in determining accurate hemodynamic information using echocardiography in both groups [41,42].…”