The Accuracy of the Vigileo/FloTrac System Has Been Improved—Follow-up After a Software Update: A Blinded Comparative Study of 30 Cardiosurgical Patients

Zimmermann, Andreas; Steinwendner, J.; Hofbauer, S.; Kirnbauer, Michael; Schneider, Jens; Moser, Leo; Pauser, G

doi:10.1053/j.jvca.2008.12.012

Cited by 13 publications

(7 citation statements)

References 14 publications

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“…All patients in the study required CO monitoring and were mostly in either septic or cardiogenic shock. When pooled together, our results demonstrated that the comparability between APCO and CO Echo was poor, and the bias and LOA were similar to previous studies 7, [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] . However, after excluding patients with atrial fibrillation and aortic stenosis, APCO and CO Echo compared favourably with each other in this cohort.…”

Section: Discussionsupporting

confidence: 85%

“…A number of studies have compared FloTrac/ Vigileo with other methods, e.g. PAC thermodilution and transpulmonary thermodilution ( Figure 6) [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] . The results were not consistent -some studies demonstrated moderate bias while others reported large LOAs and percentage errors 19 .…”

Section: Previous Studiesmentioning

confidence: 99%

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Comparison of Cardiac Output Measurements in Critically Ill Patients: Flotrac/Vigileo Vs Transthoracic Doppler Echocardiography

McLean

Huang

Kot

et al. 2011

Anaesth Intensive Care

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Measurement of cardiac output is an integral part of patient management in the intensive care unit. FloTrac/Vigileo is a continuous cardiac output monitoring device that does not need re-calibration. However, its reliability has been questioned in some studies, especially involving surgical patients. In this study, we evaluated the comparability of FloTrac/Vigileo and transthoracic Doppler echocardiography in 53 critically ill patients requiring continuous cardiac output monitoring. Most of these patients had septic or cardiogenic shock. Cardiac output was measured by both FloTrac/Vigileo and transthoracic Doppler echocardiography. The bias and precision (mean and SD) between the two devices was 0.35±1.35 l/minute. The limits of agreement were-2.3 to 3.0 l/minute (%error=49.3%). When patients with irregular heart rhythms and aortic stenosis were excluded, the bias and precision was 0.02±0.80 l/minute (n=42). The limits of agreement were-1.55 to 1.59 l/minute (%error=29.5%). Patient demographics (body surface area, gender and age) did not affect the bias, but there was a mild tendency for FloTrac/ Vigileo to register a higher cardiac output at high heart rates. Changes in cardiac output for two consecutive days correlated well between the two methods (r=0.86; P <0.001). In summary, with the exceptions of patients with irregular heart rhythms and significant aortic stenosis, FloTrac/Vigileo is clinically comparable to transthoracic Doppler echocardiography in cardiac output measurements in critically ill patients.

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Section: Discussionsupporting

confidence: 85%

Section: Previous Studiesmentioning

confidence: 99%

Comparison of Cardiac Output Measurements in Critically Ill Patients: Flotrac/Vigileo Vs Transthoracic Doppler Echocardiography

McLean

Huang

Kot

et al. 2011

Anaesth Intensive Care

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“…Although mixed results have been reported in prior validation studies [41], particularly with the earlier software [42], later iterations have improved the accuracy of the device [43], with an acceptable percentage error [41] and concordance rate [44] in comparison to PAC thermodilution. Aortic valve abnormalities are still likely to cause discrepancy [45] through distortion of the pulse contour, although they were not actively screened for in our analysis.…”

Section: Discussionmentioning

confidence: 99%

Augmented renal clearance in septic and traumatized patients with normal plasma creatinine concentrations: identifying at-risk patients

et al. 2013

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IntroductionImproved methods to optimize drug dosing in the critically ill are urgently needed. Traditional prescribing culture involves recognition of factors that mandate dose reduction (such as renal impairment), although optimizing drug exposure, through more frequent or augmented dosing, represents an evolving strategy. Elevated creatinine clearance (CLCR) has been associated with sub-therapeutic antibacterial concentrations in the critically ill, a concept termed augmented renal clearance (ARC). We aimed to determine the prevalence of ARC in a cohort of septic and traumatized critically ill patients, while also examining demographic, physiological and illness severity characteristics that may help identify this phenomenon.MethodsThis prospective observational study was performed in a 30-bed tertiary level, university affiliated, adult intensive care unit. Consecutive traumatized and septic critically ill patients, receiving antibacterial therapy, with a plasma creatinine concentration ≤110 μmol/L, were eligible for enrolment. Pulse contour analysis (Vigileo / Flo Trac® system, Edwards Lifesciences, Irvine, CA, USA), was used to provide continuous cardiac index (CI) assessment over a single six-hour dosing interval. Urinary CLCR measures were obtained concurrently.ResultsSeventy-one patients contributed data (sepsis n = 43, multi-trauma n = 28). Overall, 57.7% of the cohort manifested ARC, although there was a greater prevalence in trauma (85.7% versus 39.5%, P <0.001). In all patients, a weak correlation was noted between CI and CLCR (r = 0.346, P = 0.003). This was mostly driven by septic patients (r = 0.508, P = 0.001), as no correlation (r = -0.012, P = 0.951) was identified in trauma. Those manifesting ARC were younger (P <0.001), male (P = 0.012), with lower acute physiology and chronic health evaluation (APACHE) II (P= 0.008) and modified sequential organ failure assessment (SOFA) scores (P = 0.013), and higher cardiac indices (P = 0.013). In multivariate analysis, age ≤50 years, trauma, and a modified SOFA score ≤4, were identified as significant risk factors. These had greater utility in predicting ARC, compared with CI assessment alone.ConclusionsDiagnosis, illness severity and age, are likely to significantly influence renal drug elimination in the critically ill, and must be regularly considered in future study design and daily prescribing practice.See related commentary by De Waele and Carlier, http://ccforum.com/content/17/2/130

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“…Differences in patient populations, study environments (intraoperative, postoperative, nonsurgical), FloTrac software versions, ventilatory settings, medical interventions, and reference standard(s) used (intermittent thermodilution CO, continuous thermodilution CO, esophageal Doppler, PiCCO), combined with the relatively small patient numbers in each study, are all central to this issue. [23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] However, there are several general summary statements that seem warranted. First, there appear to be enough data available to question the accuracy of the system's measurements in a variety of situations.…”

Section: The Flotrac Systemmentioning

confidence: 99%

Cardiac Output Monitoring: Is There a Gold Standard and How Do the Newer Technologies Compare?

Pugsley

Lerner

2010

Semin Cardiothorac Vasc Anesth

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As a principal determinant of oxygen delivery and of blood pressure, cardiac output (CO) represents an important hemodynamic variable. Its accurate measurement, therefore, is important to the clinician caring for critically ill patients in a variety of care environments. Though the first clinical measurement of CO occurred 70 years ago, it was the introduction of the pulmonary artery catheter (PAC) with thermodilution-based determination of CO in the 1970s that set the stage for practical and widespread clinical measurement of CO. Although the usefulness and accuracy of this technique have justified its consideration as a "practical" gold standard in CO measurement, its drawbacks have driven the search for newer, less invasive measurement techniques. The last decade has seen the introduction of several such devices into the clinical arena. This article will serve to give a brief review of the history of CO measurement, to provide a discussion of the measurement of accuracy as it relates to CO measurement, and to discuss some of the newer methods and devices for CO measurement and how they have fared against a "practical" gold standard.

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The Accuracy of the Vigileo/FloTrac System Has Been Improved—Follow-up After a Software Update: A Blinded Comparative Study of 30 Cardiosurgical Patients

Cited by 13 publications

References 14 publications

Comparison of Cardiac Output Measurements in Critically Ill Patients: Flotrac/Vigileo Vs Transthoracic Doppler Echocardiography

Comparison of Cardiac Output Measurements in Critically Ill Patients: Flotrac/Vigileo Vs Transthoracic Doppler Echocardiography

Augmented renal clearance in septic and traumatized patients with normal plasma creatinine concentrations: identifying at-risk patients

Cardiac Output Monitoring: Is There a Gold Standard and How Do the Newer Technologies Compare?

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