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Accuracy, precision, and trending of 4 pulse wave analysis techniques in the postoperative period


Geisen, Martin; Ganter, Michael T; Hartnack, Sonja; Dzemali, Omer; Hofer, Christoph K; Zollinger, Andreas (2018). Accuracy, precision, and trending of 4 pulse wave analysis techniques in the postoperative period. Journal of Cardiothoracic and Vascular Anesthesia, 32(2):715-722.

Abstract

Objective: The aim of this study was to analyze the accuracy, precision, and trending ability of the following 4 pulse wave analysis devices to measure continuous cardiac output: PiCCO2 ([PCCO]; Pulsion Medical System, Munich, Germany); LiDCORapid ([LCCO]; LiDCO Ltd, London, UK); FloTrac/Vigileo ([FCCO]; Edwards Lifesciences, Irvine, CA); and Nexfin ([NCCO]; BMEYE, Amsterdam, The Netherlands).
Design: Prospective, observational clinical study.
Setting: Intensive care unit of a single-center, teaching hospital.
Participants: The study comprised 22 adult patients after elective coronary artery bypass surgery.
Interventions; Three measurement cycles were performed in all patient durings their immediate postoperative intensive care stay before and after fluid loading. Hemodynamic measurements were performed 5 minutes before and immediately after the administration of 500 mL colloidal fluid over 20 minutes.
Measurements and Main Results: PCCO, LCCO, FCCO, and NCCO were assessed and compared with cardiac output derived from intermittent transpulmonary thermodilution (ICO). One hundred thirty-two matched sets of data were available for analysis. Bland-Altman analysis using linear mixed effects models with random effects for patient and trial revealed a mean bias ±2 standard deviation (%error) of –0.86 ± 1.41 L/min (34.9%) for PCCO-ICO, –0.26 ± 2.81 L/min (46.3%) for LCCO-ICO, –0.28 ± 2.39 L/min (43.7%) for FCCO-ICO, and –0.93 ± 2.25 L/min (34.6%) for NCCO-ICO. Bland-Altman plots without adjustment for repeated measurements and replicates yielded considerably larger limits of agreement. Trend analysis for all techniques did not meet criteria for acceptable performance.
Conclusions: All 4 tested devices using pulse wave analysis for measuring cardiac output failed to meet current criteria for meaningful and adequate accuracy, precision, and trending ability in cardiac output monitoring.

Abstract

Objective: The aim of this study was to analyze the accuracy, precision, and trending ability of the following 4 pulse wave analysis devices to measure continuous cardiac output: PiCCO2 ([PCCO]; Pulsion Medical System, Munich, Germany); LiDCORapid ([LCCO]; LiDCO Ltd, London, UK); FloTrac/Vigileo ([FCCO]; Edwards Lifesciences, Irvine, CA); and Nexfin ([NCCO]; BMEYE, Amsterdam, The Netherlands).
Design: Prospective, observational clinical study.
Setting: Intensive care unit of a single-center, teaching hospital.
Participants: The study comprised 22 adult patients after elective coronary artery bypass surgery.
Interventions; Three measurement cycles were performed in all patient durings their immediate postoperative intensive care stay before and after fluid loading. Hemodynamic measurements were performed 5 minutes before and immediately after the administration of 500 mL colloidal fluid over 20 minutes.
Measurements and Main Results: PCCO, LCCO, FCCO, and NCCO were assessed and compared with cardiac output derived from intermittent transpulmonary thermodilution (ICO). One hundred thirty-two matched sets of data were available for analysis. Bland-Altman analysis using linear mixed effects models with random effects for patient and trial revealed a mean bias ±2 standard deviation (%error) of –0.86 ± 1.41 L/min (34.9%) for PCCO-ICO, –0.26 ± 2.81 L/min (46.3%) for LCCO-ICO, –0.28 ± 2.39 L/min (43.7%) for FCCO-ICO, and –0.93 ± 2.25 L/min (34.6%) for NCCO-ICO. Bland-Altman plots without adjustment for repeated measurements and replicates yielded considerably larger limits of agreement. Trend analysis for all techniques did not meet criteria for acceptable performance.
Conclusions: All 4 tested devices using pulse wave analysis for measuring cardiac output failed to meet current criteria for meaningful and adequate accuracy, precision, and trending ability in cardiac output monitoring.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:05 Vetsuisse Faculty > Chair in Veterinary Epidemiology
Dewey Decimal Classification:570 Life sciences; biology
610 Medicine & health
Uncontrolled Keywords:Anesthesiology and Pain Medicine, Cardiology and Cardiovascular Medicine, cardiac output measurement; pulse wave analysis; stroke volume measurement; transpulmonary thermodilution
Language:English
Date:1 April 2018
Deposited On:19 Feb 2019 12:30
Last Modified:19 Feb 2019 12:30
Publisher:Elsevier
ISSN:1053-0770
OA Status:Closed
Publisher DOI:https://doi.org/10.1053/j.jvca.2017.09.006
PubMed ID:29217236

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