Abstract
IntroductionAlthough less invasive than pulmonary artery catheters (PACs), arterial pulse pressure analysis techniques for estimating cardiac output (CO) have not been simultaneously compared to PAC bolus thermodilution CO (COtd) or continuous CO (CCO) devices.MethodsWe compared the accuracy, bias and trending ability of LiDCO™, PiCCO™ and FloTrac™ with PACs (COtd, CCO) to simultaneously track CO in a prospective observational study in 17 postoperative cardiac surgery patients for the first 4 hours following intensive care unit admission. Fifty-five paired simultaneous quadruple CO measurements were made before and after therapeutic interventions (volume, vasopressor/dilator, and inotrope).ResultsMean CO values for PAC, LiDCO, PiCCO and FloTrac were similar (5.6 ± 1.5, 5.4 ± 1.6, 5.4 ± 1.5 and 6.1 ± 1.9 L/min, respectively). The mean CO bias by each paired method was -0.18 (PAC-LiDCO), 0.24 (PAC-PiCCO), -0.43 (PAC-FloTrac), 0.06 (LiDCO-PiCCO), -0.63 (LiDCO-FloTrac) and -0.67 L/min (PiCCO-FloTrac), with limits of agreement (1.96 standard deviation, 95% confidence interval) of ± 1.56, ± 2.22, ± 3.37, ± 2.03, ± 2.97 and ± 3.44 L/min, respectively. The instantaneous directional changes between any paired CO measurements displayed 74% (PAC-LiDCO), 72% (PAC-PiCCO), 59% (PAC-FloTrac), 70% (LiDCO-PiCCO), 71% (LiDCO-FloTrac) and 63% (PiCCO-FloTrac) concordance, but poor correlation (r2 = 0.36, 0.11, 0.08, 0.20, 0.23 and 0.11, respectively). For mean CO < 5 L/min measured by each paired devices, the bias decreased slightly.ConclusionsAlthough PAC (COTD/CCO), FloTrac, LiDCO and PiCCO display similar mean CO values, they often trend differently in response to therapy and show different interdevice agreement. In the clinically relevant low CO range (< 5 L/min), agreement improved slightly. Thus, utility and validation studies using only one CO device may potentially not be extrapolated to equivalency of using another similar device.
Highlights
Less invasive than pulmonary artery catheters (PACs), arterial pulse pressure analysis techniques for estimating cardiac output (CO) have not been simultaneously compared to pulmonary arterial catheter (PAC) bolus thermodilution CO (COtd) or continuous CO (CCO) devices
Introduction the pulmonary arterial catheter (PAC) measures cardiac output (CO) at the bedside in critically ill patients [1,2,3], the recent trend in intensive care unit (ICU) monitoring is toward minimally invasive methods [4,5,6,7,8]
We are unable to comment on the ability of FloTracTM- or PiCCO plusTM-guided therapy to improve outcome because they have not been studied in this context
Summary
Less invasive than pulmonary artery catheters (PACs), arterial pulse pressure analysis techniques for estimating cardiac output (CO) have not been simultaneously compared to PAC bolus thermodilution CO (COtd) or continuous CO (CCO) devices. The pulmonary arterial catheter (PAC) measures cardiac output (CO) at the bedside in critically ill patients [1,2,3], the recent trend in intensive care unit (ICU) monitoring is toward minimally invasive methods [4,5,6,7,8]. Arterial pulse contour and pulse power analyses have emerged as less invasive alternatives to PAC-derived CO measures [9,10] The accuracy of these devices for PAC-derived CO measures has not been systematically compared in response to therapies other than volume resuscitation [11,12]. We compared three pulse contour devices (LiDCO Plus, PiCCO Plus and FloTrac) (Edwards Lifesciences, Irvine, CA, USA) and two PAC thermodilution techniques: CO by thermodilution (COtd) and continuous cardiac output (CCO) in postoperative cardiac surgery patients during the first 4 postoperative ICU hours when most of the aggressive treatments occurred. To minimize initial CO differences, we calibrated the PiCCO and LiDCO devices using the initial PAC CO values, whereas the FloTrac did not allow external calibration
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