Continuous non-invasive hemodynamic monitoring in early onset severe preeclampsia

Abstract

Objectives: Continuous hemodynamic monitoring offers the opportunity to individualize management in severe preeclampsia (PEC). We compared cardiac output (CO) and systemic vascular resistance (SVR) measured by bioreactance (NICOM), ClearsiteTM Fingercuff [CS), and 3D echocardiography (3DE). Study Design: This prospective observational study included 12 pregnant patients with early PEC. CO and SVR were measured simultaneously by NICOM, CS, and 3DE antepartum and 1 to 2 days postpartum. Using 3DE as the standard, CS and NICOM interchangeability, precision, accuracy, and correlation were assessed. Results: Compared to 3DE CO, CS CO was highly correlated (R2=0.70, p=<0.0001) with low percentage error (PE 29%) which met criteria for interchangeablity. CS-SVR had strong correlation (R2=0.81, p=<0.0001) and low PE (29%). While CS tended to slightly overestimate CO (bias +2.05 +/– 1.18 L/min, limit of agreement (LOA) –0.20 – 4.31) and underestimate SVR (bias –279 +/ –156 dyes/sec/cm5; LOA –580 –18.4) these differences were unlikely to be clinically significant. Thus CS could be interchangeable with 3DE for CO and SVR. NICOM-CO had only moderate correlation with 3DE-CO (R2=0.29, p=0.01) with high PE (52%) above threshold for interchangeability. NICOM CO had low mean bias (–1.2 +/–1.68 L/min) but wide 95% LOA (–4.41 – 2.14) suggesting adequate accuracy but low precision in relation to 3DE CO. NICOM SVR had poor correlation with 3DE SVR (R2=0.32, p=0.001) with high PE (67%), relatively low mean bias (238 +/–256), and wide 95% LOA (– 655–1131). NICOM did not meet the criteria for interchangeable with 3DE for CO and SVR. Conclusions: Clearsite Fingercuff, but not NICOM, has potential to be clinically useful for CO and SVR monitoring in severe preeclampsia.