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      Comparison the accuracy and trending ability of cardiac index measured by the fourth-generation of FloTrac with the PiCCO device in septic shock patients

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          Abstract

          Background/aim

          FloTrac/Vigileo is a noncalibrated arterial pressure waveform analysis for cardiac index (CI) monitoring. The aim of our study was to compare the CI measured by the 4th generation of FloTrac with PiCCO in septic shock patients.

          Materials and methods

          We simultaneously measured the CI using FloTrac (CIv) and compared it with the CI derived from transpulmonary thermodilution (CItd) as well as the pulse contour-derived CI using PiCCO (CIp).

          Results

          Thirty-one septic shock patients were included. The CIv correlated with CItd (r = 0.62, P < 0.0001). The Bland-Altman analysis showed a bias of 0.14, and the limits of agreement were –1.62–1.91 L/min/m2 with a percentage error of 47.4%. However, the concordance rate between CIv and CItd was 93.6%. The comparison of CIv with CIp (n = 352 paired measurements) revealed a bias of -0.16, and the limits of agreement were –1.45–1.79 L/min/m2 with a percentage error of 44.8%. The overall correlation coefficient between CIv and CIp was 0.63 (P < 0.0001), and the concordance rate was 85.4%.

          Conclusion

          The 4th generation of FloTrac has not acceptable agreement to assess CI; however, it has the ability to tracked changes of CI, when compared with the transpulmonary thermodilution method by PiCCO.

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          Most cited references27

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          Minimally invasive measurement of cardiac output during surgery and critical care: a meta-analysis of accuracy and precision.

          Philip Peyton, Simon Chong (2010)
          When assessing the accuracy and precision of a new technique for cardiac output measurement, the commonly quoted criterion for acceptability of agreement with a reference standard is that the percentage error (95% limits of agreement/mean cardiac output) should be 30% or less. We reviewed published data on four different minimally invasive methods adapted for use during surgery and critical care: pulse contour techniques, esophageal Doppler, partial carbon dioxide rebreathing, and transthoracic bioimpedance, to assess their bias, precision, and percentage error in agreement with thermodilution. An English language literature search identified published papers since 2000 which examined the agreement in adult patients between bolus thermodilution and each method. For each method a meta-analysis was done using studies in which the first measurement point for each patient could be identified, to obtain a pooled mean bias, precision, and percentage error weighted according to the number of measurements in each study. Forty-seven studies were identified as suitable for inclusion: N studies, n measurements: mean weighted bias [precision, percentage error] were: pulse contour N = 24, n = 714: -0.00 l/min [1.22 l/min, 41.3%]; esophageal Doppler N = 2, n = 57: -0.77 l/min [1.07 l/min, 42.1%]; partial carbon dioxide rebreathing N = 8, n = 167: -0.05 l/min [1.12 l/min, 44.5%]; transthoracic bioimpedance N = 13, n = 435: -0.10 l/min [1.14 l/min, 42.9%]. None of the four methods has achieved agreement with bolus thermodilution which meets the expected 30% limits. The relevance in clinical practice of these arbitrary limits should be reassessed.
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            Arterial pressure-based cardiac output in septic patients: different accuracy of pulse contour and uncalibrated pressure waveform devices

            Xavier Monnet, Nadia Anguel, Brice Naudin … (2010)
            Introduction We compared the ability of two devices estimating cardiac output from arterial pressure-curve analysis to track the changes in cardiac output measured with transpulmonary thermodilution induced by volume expansion and norepinephrine in sepsis patients. Methods In 80 patients with septic circulatory failure, we administered volume expansion (40 patients) or introduced/increased norepinephrine (40 patients). We measured the pulse contour-derived cardiac index (CI) provided by the PiCCO device (CIpc), the arterial pressure waveform-derived CI provided by the Vigileo device (CIpw), and the transpulmonary thermodilution CI (CItd) before and after therapeutic interventions. Results The changes in CIpc accurately tracked the changes in CItd induced by volume expansion (bias, -0.20 ± 0.63 L/min/m2) as well as by norepinephrine (bias, -0.05 ± 0.74 L/min/m2). The changes in CIpc accurately detected an increase in CItd ≥ 15% induced by volume expansion and norepinephrine introduction/increase (area under ROC curves, 0.878 (0.736 to 0.960) and 0.924 (0.795 to 0.983), respectively; P < 0.05 versus 0.500 for both). The changes in CIpw were less reliable for tracking the volume-induced changes in CItd (bias, -0.23 ± 0.95 L/min/m2) and norepinephrine-induced changes in CItd (bias, -0.01 ± 1.75 L/min/m2). The changes in CIpw were unable to detect an increase in CItd ≥ 15% induced by volume expansion and norepinephrine introduction/increase (area under ROC curves, 0.564 (0.398 to 0.720) and 0.541 (0.377 to 0.700, respectively, both not significantly different from versus 0.500). Conclusions The CIpc was reliable and accurate for assessing the CI changes induced by volume expansion and norepinephrine. By contrast, the CIpw poorly tracked the trends in CI induced by those therapeutic interventions.
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              Clinical evaluation of the FloTrac/Vigileo system and two established continuous cardiac output monitoring devices in patients undergoing cardiac surgery.

              D Button, L Weibel, O Reuthebuch … (2007)
              Assessment of cardiac output (CO) by the FloTrac/Vigileo system may offer a less invasive means of determining the CO than either the pulmonary artery catheter (PAC) or the PiCCOplus system. The aim of this study was to compare CO measurements made using the FloTrac/Vigileo system with upgraded software (FCO, Edwards Lifesciences, Irvine CA, USA), the PiCCOplus system (PCO, Pulsion Medical Systems, Munich, Germany) and continuous CO monitoring using a PAC (CCO; Vigilance monitoring, Edwards Lifesciences, Irvine CA, USA) with intermittent pulmonary artery thermodilution (ICO). The study was conducted in patients undergoing elective cardiac surgery. Thirty-one patients with preserved left ventricular function were enrolled. CCO, FCO, and PCO were recorded in the perioperative period at six predefined time points after achieving stable haemodynamic conditions; ICO was determined from the mean of three bolus injections. Bland-Altman analysis was used to compare CCO, FCO, and PCO with ICO. Bland-Altman analysis revealed a comparable mean bias and limits of agreement for all tested continuous CO monitoring devices using ICO as reference method. Agreement for all devices decreased in the postoperative period. The performance of the FloTrac/Vigileo system, the PiCCOplus, and the Vigilance CCO monitoring for CO measurement were comparable when tested against intermittent thermodilution in patients undergoing elective cardiac surgery.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Turk J Med Sci
                Journal ID (iso-abbrev): Turk J Med Sci
                Title: Turkish Journal of Medical Sciences
                Publisher: The Scientific and Technological Research Council of Turkey
                ISSN (Print): 1300-0144
                ISSN (Electronic): 1303-6165
                Publication date Collection: 2020
                Publication date (Electronic): 23 June 2020
                Volume: 50
                Issue: 4
                Pages: 860-869
                Affiliations
                [1 ] Division of Critical Care Medicine, Department of Internal Medicine, Prince of Songkla University, Hat Yai, Songkhla Thailand
                Author notes
                * To whom correspondence should be addressed. E-mail: kbordin@ 123456medicine.psu.ac.th

                CONFLICT OF INTEREST:

                none declared

                Author information
                https://orcid.org/0000-0002-5436-8519
                https://orcid.org/0000-0002-8225-0630
                Article
                DOI: 10.3906/sag-1909-58
                PMC ID: 7379425
                PubMed ID: 32336075
                SO-VID: d490609b-6650-475c-952a-b27bce261d8e
                Copyright © Copyright © 2020 The Author(s)
                License:

                This article is distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use and redistribution provided that the original author and source are credited.

                History
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                Subject: Article

                Keywords: cardiac output,hemodynamic monitoring,pulse contour analysis,arterial waveform analysis,measurement technique
                Data availability:
                Keywords: cardiac output, hemodynamic monitoring, pulse contour analysis, arterial waveform analysis, measurement technique

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