Comparison of PulsioFlex® Uncalibrated Pulse Contour Method and a Modified Fick Principle with Transpulmonary Thermodilution Measurements in Critically Ill Patients
| Autor: | C Wieland, J M Defosse, J Grensemann, Samir G. Sakka, Frank Wappler, U W Wild |
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| Rok vydání: | 2016 |
| Předmět: |
Adult
Male Critical Illness Haemodynamic monitoring Thermodilution Cardiac index Fick method Critical Care and Intensive Care Medicine Fick principle Young Adult 03 medical and health sciences 0302 clinical medicine 030202 anesthesiology Humans Medicine Aged Monitoring Physiologic Aged 80 and over business.industry Pulse (signal processing) Critically ill Limits of agreement 030208 emergency & critical care medicine Middle Aged Anesthesiology and Pain Medicine Calibration Female Nuclear medicine business |
| Zdroj: | Anaesthesia and Intensive Care. 44:484-490 |
| ISSN: | 1448-0271 0310-057X |
| DOI: | 10.1177/0310057x1604400407 |
| Popis: | Monitoring of cardiac index (CI) by uncalibrated pulse contour (PC) methods has been shown to be inaccurate in critically ill patients. We tested accuracy and trending of a new pulse contour method and a modified Fick method using central venous oxygen saturation. We studied 21 critically ill and mechanically ventilated patients (age 20–86 years) monitored by PC (PulsioFlex®) and transpulmonary thermodilution (TPTD, PiCCO2®) as reference. At baseline, reference and PC–derived CI (CIPC) were recorded and CI obtained by Fick's method (FM, CIFICK). After four hours, measurements were performed analogously for trending analysis. CI are given in l/min/m2as mean ± standard deviation. At baseline CITPTDwas 3.7 ± 0.7, CIPC3.8 ± 0.7 and CIFICK5.2 ± 1.8. After 4 hours, CITPTDwas 3.5 ± 0.6, CIPC3.8 ± 1.2 and CIFICK4.8 ± 1.7. Mean bias for PC at baseline was −0.1 (limits of agreement [LOA] −1.4 to 1.2) and −0.4 (LOA −2.6 to 1.9) after four hours. Percentage errors (PE) were 34% and 60% respectively. FM revealed a bias of −1.5 (LOA −4.8 to 1.8, PE 74%) at baseline and −1.5 (LOA −4.5 to 1.4, PE 68%) at four hours. With an exclusion window of 10% of mean cardiac index, trending analysis by polar plots showed an angular bias of 5° (radial LOA ± 57°) for PC and 16° (radial LOA ± 51°) for FM. Although PC values at baseline were marginally acceptable, both methods fail to yield clinically acceptable absolute values. Likewise, trending ability is not adequate for both methods to be used in critically ill patients. |
| Databáze: | OpenAIRE |
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