Disagreement in cardiac output measurements between fourth-generation FloTrac and critical care ultrasonography in patients with circulatory shock: a prospective observational study

Abstract

Background Cardiac output measurements may inform diagnosis and provide guidance of therapeutic interventions in patients with hemodynamic instability. The FloTrac™ algorithm uses uncalibrated arterial pressure waveform analysis to estimate cardiac output. Recently, a new version of the algorithm has been developed. The aim was to assess the agreement between FloTrac™ and routinely performed cardiac output measurements obtained by critical care ultrasonography in patients with circulatory shock. Methods A prospective observational study was performed in a tertiary hospital from June 2016 to January 2017. Adult critically ill patients with circulatory shock were eligible for inclusion. Cardiac output was measured simultaneously using FloTrac™ with a fourth-generation algorithm (CO AP ) and critical care ultrasonography (CO CCUS ). The strength of linear correlation of both methods was determined by the Pearson coefficient. Bland-Altman plot and four-quadrant plot were used to track agreement and trending ability. Result Eighty-nine paired cardiac output measurements were performed in 17 patients during their first 24 h of admittance. CO AP and CO CCUS had strong positive linear correlation ( r 2 = 0.60, p < 0.001). Bias of CO AP and CO CCUS was 0.2 L min −1 (95% CI − 0.2 to 0.6) with limits of agreement of − 3.6 L min −1 (95% CI − 4.3 to − 2.9) to 4.0 L min −1 (95% CI 3.3 to 4.7). The percentage error was 65.6% (95% CI 53.2 to 77.3). Concordance rate was 64.4%. Conclusions In critically ill patients with circulatory shock, there was disagreement and clinically unacceptable trending ability between values of cardiac output obtained by uncalibrated arterial pressure waveform analysis and critical care ultrasonography. Trial registration Clinicaltrials.gov, NCT02912624 , registered on September 23, 2016 Electronic supplementary material The online version of this article (10.1186/s40560-019-0373-5) contains supplementary material, which is available to authorized users.

Haemodynamic monitoring and management in COVID-19 intensive care patients: an International survey

“…5 ). This is somewhat surprising given the fact that uncalibrated pulse contour methods are known to have limited accuracy and precision to measure cardiac output in septic shock [17] , and their use is not recommended beyond the surgical population [18] . The Swan Ganz catheter was rarely used.…”

Prediction of Fluid Responsiveness Using Combined End-Expiratory and End-Inspiratory Occlusion Tests in Cardiac Surgical Patients

“…In our study, we used the latest, fourth generation software, which seems to have improved performance in scenarios with acute vascular resistance changes [ 42 , 43 ]. However, these advances may still not be sufficient to monitor patients receiving vasoactive agents with adequate precision [ 42 , 44 ]. Furthermore, the EEO-induced changes in hemodynamic parameters last only several seconds [ 45 ] while the FloTrac TM algorithm displays CO, SV and SVV based on data averaged over 20-s periods [ 42 , 46 ].…”

Updates in Hemodynamic Monitoring: A Review for Pharmacists

“…In general, with the fourth generation version, CO deviated by around 0.5 L/min, and concordance when trending CO was approximately 75%. 26 This is not surprising since pulse pressure analysis relies on SV to derive CO, and changes in vasomotor tone are not captured by this medium. Calibrated devices may perform better in unstable patients with fluctuating vasopressor requirements or rapid changes in SVR.…”