Performance of cardiac output measurement derived from arterial pressure waveform analysis in patients requiring high-dose vasopressor therapy

Metzelder, S.; Coburn, Mark; Fries, Michael; Reinges, M. H. T.; Reich, Stanley B.; Rossaint, Rolf; Marx, Gernot; Rex, Steffen

doi:10.1093/bja/aer066

Cited by 60 publications

(17 citation statements)

References 42 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The basic physiological principle of these techniques is that changes in arterial pulse pressure relate directly to changes in stroke volume (SV); thus, changes in CO can be continuously estimated from analysis of the arterial waveform. However, this relationship can be affected by arterial load [4,5]; therefore, if changes in arterial load occur, the reliability of CO measurements by PPA techniques may be affected [6-10]. Although each PPA algorithm is different, they all have to tackle similar limitations.…”

Section: Introductionmentioning

confidence: 99%

“…For this reason, most modern systems based on PPA use a calibration (internal or external) to determine the individual arterial load of the patient in order to convert the pressure signal into a volume-based parameter. Subsequent recalibrations are then required when significant variations in arterial load occur [6-9]. …”

Section: Introductionmentioning

confidence: 99%

“…Previous studies have demonstrated that changes in arterial load can affect the reliability of pulse pressure-derived cardiac output (PPCO) measurements [6-9,11,12]; however, these studies have focused on only one aspect of the arterial load: the systemic vascular resistance. This approach ignores the pulsatile nature of the cardiovascular system and provides only a partial description of arterial load, ignoring other components such as arterial compliance or wave reflections [13].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Impact of arterial load on the agreement between pulse pressure analysis and esophageal Doppler

et al. 2013

View full text Add to dashboard Cite

IntroductionThe reliability of pulse pressure analysis to estimate cardiac output is known to be affected by arterial load changes. However, the contribution of each aspect of arterial load could be substantially different. In this study, we evaluated the agreement of eight non-commercial algorithms of pulse pressure analysis for estimating cardiac output (PPCO) with esophageal Doppler cardiac output (EDCO) during acute changes of arterial load. In addition, we aimed to determine the optimal arterial load parameter that could detect a clinically significant difference between PPCO and the EDCO.MethodsWe included mechanically ventilated patients monitored with a prototype esophageal Doppler (CardioQ-Combi™, Deltex Medical, Chichester, UK) and an indwelling arterial catheter who received a fluid challenge or in whom the vasoactive medication was introduced or modified. Initial calibration of PPCO was made with the baseline value of EDCO. We evaluated several aspects of arterial load: total systemic vascular resistance (TSVR = mean arterial pressure [MAP]/EDCO * 80), net arterial compliance (C = EDCO-derived stroke volume/pulse pressure), and effective arterial elastance (Ea = 0.9 * systolic blood pressure/EDCO-derived stroke volume). We compared CO values with Bland-Altman analysis, four-quadrant plot and a modified polar plot (with least significant change analysis).ResultsA total of 16,964-paired measurements in 53 patients were performed (median 271; interquartile range: 180-415). Agreement of all PPCO algorithms with EDCO was significantly affected by changes in arterial load, although the impact was more pronounced during changes in vasopressor therapy. When looking at different parameters of arterial load, the predictive abilities of Ea and C were superior to TSVR and MAP changes to detect a PPCO-EDCO discrepancy ≥ 10% in all PPCO algorithms. An absolute Ea change > 8.9 ± 1.7% was associated with a PPCO-EDCO discrepancy ≥ 10% in most algorithms.ConclusionsChanges in arterial load profoundly affected the agreement of PPCO and EDCO, although the contribution of each aspect of arterial load to the PPCO-EDCO discrepancies was significantly different. Changes in Ea and C mainly determined PPCO-EDCO discrepancy.

show abstract

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Impact of arterial load on the agreement between pulse pressure analysis and esophageal Doppler

et al. 2013

View full text Add to dashboard Cite

show abstract

“…Based on the results of a previous study [13], we presumed a correlation of −55% between the bias (difference between APCO and SCO) and log PP. Twenty-three subjects were needed with a type I error of 0.05 and a power of 80%.…”

Section: Methodsmentioning

confidence: 99%

Effects of pulse pressure alterations on cardiac output measurements derived from analysis of arterial pressure waveform

et al. 2016

View full text Add to dashboard Cite

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.Background: Changes in pulse pressure (PP) may alter the morphology of arterial pressure waveforms, thereby affecting the accuracy of cardiac output (CO) measurements derived from such waveforms. This study evaluated the influence of PP on the accuracy of FloTrac/Vigileo TM system-measured CO (APCO).Pulmonary artery catheter (PAC) measured stat mode CO (SCO) is used as a reference standard. Methods: Hemodynamic variables were measured at various time points in 24 patients. APCO and SCO were compared using Bland-Altman analysis of the overall data pairs. The data pairs were divided into a low PP group and a high PP group, and subgroup analysis was conducted. Results:The mean APCO (5.3 ± 1.7 L/min) was higher than the mean SCO (5.1 ± 1.6 L/min) for all data pairs (P ＜ 0.001). The Bland-Altman analysis revealed an overall percentage error of 41.7% between the APCO and SCO, which exceeds a 30% limit of agreement. There was a significant relationship between PP and the difference between APCO and SCO (P = 0.031, R = 0.151

show abstract

“…The trial was not registered because it was observational and not randomized. All of these patients were simultaneously included in another observational study with a similar study design, comparing the validity of arterial pressure waveform analysis of cardiac output using the FloTrac/Vigileo™-device with TPCO [25]. Patients <18 years of age, pregnant patients, patients from whom written informed consent could not be obtained and patients with occlusive peripheral arterial disease were excluded from the study.…”

Section: Methodsmentioning

confidence: 99%

Accuracy and precision of calibrated arterial pulse contour analysis in patients with subarachnoid hemorrhage requiring high-dose vasopressor therapy: a prospective observational clinical trial

et al. 2014

View full text Add to dashboard Cite

IntroductionCalibrated arterial pulse contour analysis has become an established method for the continuous monitoring of cardiac output (PCCO). However, data on its validity in hemodynamically instable patients beyond the setting of cardiac surgery are scarce. We performed the present study to assess the validity and precision of PCCO-measurements using the PiCCO™-device compared to transpulmonary thermodilution derived cardiac output (TPCO) as the reference technique in neurosurgical patients requiring high-dose vasopressor-therapy.MethodsA total of 20 patients (16 females and 4 males) were included in this prospective observational clinical trial. All of them suffered from subarachnoid hemorrhage (Hunt&Hess grade I-V) due to rupture of a cerebral arterial aneurysm and underwent high-dose vasopressor therapy for the prevention/treatment of delayed cerebral ischemia (DCI). Simultaneous CO measurements by bolus TPCO and PCCO were obtained at baseline as well as 2 h, 6 h, 12 h, 24 h, 48 h and 72 h after inclusion.ResultsPCCO- and TPCO-measurements were obtained at baseline as well as 2 h, 6 h, 12 h, 24 h, 48 h and 72 h after inclusion. Patients received vasoactive support with (mean ± standard deviation, SD) 0.57 ± 0.49 μg · kg-1 · min-1 norepinephrine resulting in a mean arterial pressure of 103 ± 13 mmHg and a systemic vascular resistance of 943 ± 248 dyn · s · cm-5. 136 CO-data pairs were analyzed. TPCO ranged from 5.2 to 14.3 l · min-1 (mean ± SD 8.5 ± 2.0 l · min-1) and PCCO ranged from 5.0 to 14.4 l · min-1 (mean ± SD 8.6 ± 2.0 l · min-1). Bias and limits of agreement (1.96 SD of the bias) were −0.03 ± 0.82 l · min-1 and 1.62 l · min-1, resulting in an overall percentage error of 18.8%. The precision of PCCO-measurements was 17.8%. Insufficient trending ability was indicated by concordance rates of 74% (exclusion zone of 15% (1.29 l · min-1)) and 67% (without exclusion zone), as well as by polar plot analysis.ConclusionsIn neurosurgical patients requiring extensive vasoactive support, CO values obtained by calibrated PCCO showed clinically and statistically acceptable agreement with TPCO-measurements, but the results from concordance and polar plot analysis indicate an unreliable trending ability.

show abstract

Performance of cardiac output measurement derived from arterial pressure waveform analysis in patients requiring high-dose vasopressor therapy

Cited by 60 publications

References 42 publications

Impact of arterial load on the agreement between pulse pressure analysis and esophageal Doppler

Impact of arterial load on the agreement between pulse pressure analysis and esophageal Doppler

Effects of pulse pressure alterations on cardiac output measurements derived from analysis of arterial pressure waveform

Accuracy and precision of calibrated arterial pulse contour analysis in patients with subarachnoid hemorrhage requiring high-dose vasopressor therapy: a prospective observational clinical trial

Contact Info

Product

Resources

About