Abstract
A new non-invasive continuous cardiac output (esCCO) monitoring system solely utilizing a routine cardiovascular monitor was developed, even though a reference cardiac output (CO) is consistently required. Subsequently, a non-invasive patient information CO calibration together with a new automated exclusion algorithm was implemented in the esCCO system. We evaluated the accuracy and trending ability of the new esCCO system. Either operative or postoperative data of a multicenter study in Japan for evaluation of the accuracy of the original version of esCCO system were used to develop the new esCCO system. A total of 207 patients, mostly cardiac surgical patients, were enrolled in the study. Data were manually reviewed to formulate a new automated exclusion algorithm with enhanced accuracy. Then, a new esCCO system based on a patient information calibration together with the automated exclusion algorithm was developed. CO measured with a new esCCO system was compared with the corresponding intermittent bolus thermodilution CO (ICO) utilizing statistical methods including polar plots analysis. A total of 465 sets of CO data obtained using the new esCCO system were evaluated. The difference in the CO value between the new esCCO and ICO was 0.34 ± 1.50 (SD) L/min (95 % confidence limits of −2.60 to 3.28 L/min). The percentage error was 69.6 %. Polar plots analysis showed that the mean polar angle was −1.6° and radial limits of agreement were ±53.3°. This study demonstrates that the patient information calibration is clinically useful as ICO, but trending ability of the new esCCO system is not clinically acceptable as judged by percentage error and polar plots analysis, even though it’s trending ability is comparable with currently available arterial waveform analysis methods.
Highlights
Continuous cardiac output (CCO) measurement calculated by a thermodilution method (CCOpa) utilizing pulmonaryJ Clin Monit Comput (2012) 26:465–471 artery catheter measurements is being used to optimize cardiovascular management of critically ill patients
This study demonstrates that the patient information calibration is clinically useful as intermittent bolus thermodilution CO (ICO), but trending ability of the new esCCO system is not clinically acceptable as judged by percentage error and polar plots analysis, even though it’s trending ability is comparable with currently available arterial waveform analysis methods
Data collected during the three surgical procedures in which limitations of accurate measurement became evident had been excluded before the development of the new automated exclusion algorithm, the results of this study suggest that the new automated exclusion algorithm is as effective as a retrospective manual review, as judged by the Bland-Altman plots and percentage error, even though 26 CO data were excluded by the automated exclusion algorithm in the new esCCO system, since its threshold level was set lower compared to the original esCCO system
Summary
Continuous cardiac output (CCO) measurement calculated by a thermodilution method (CCOpa) utilizing pulmonaryJ Clin Monit Comput (2012) 26:465–471 artery catheter measurements is being used to optimize cardiovascular management of critically ill patients. Continuous cardiac output (CCO) measurement calculated by a thermodilution method (CCOpa) utilizing pulmonary. It would be clinically useful to measure CCO solely using routine cardiovascular monitors, without any need for further sensors or procedures. A novel non-invasive continuous cardiac output (esCCO) measurement method solely utilizing the routine clinical monitor, based on pulse contour analysis combined with pulse wave transit time (PWTT) was devised by Sugo et al [1], and this method was demonstrated to have the potential to give rise to an alternative non-invasive cardiac output (CO) trend for post-cardiac surgical patients without apparent arrhythmia [2]. Thereafter, an automated exclusion algorithm for the esCCO system was further developed to promote the reliability of the measurement, even though its limitations became evident during some surgical procedures, such as cardiopulmonary bypass (CPB). We examined whether the new esCCO system based on a patient information calibration together with a new automated exclusion algorithm would have acceptable trending ability
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