Accuracy and trending ability of the fourth-generation FloTrac/Vigileo System™ in patients undergoing abdominal aortic aneurysm surgery

Maeda, Takuma; Hattori, Kohshi; Sumiyoshi, Miho; Kanazawa, Hiroko; Ohnishi, Yoshihiko

doi:10.1007/s00540-018-2491-y

Cited by 14 publications

(8 citation statements)

References 23 publications

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“…When compared to other minimally or non-invasive techniques used in clinical practice, most devices show a MPE of more than 30% [10,12,[68][69][70][71][72][73][74][75][76]. Therefore, Peyton and Chong have suggested to change the acceptable MPE to 45%, ensuring a higher rate of agreement in new methods [12].…”

Section: Summary Of Evidencementioning

confidence: 99%

Accuracy and precision of non-invasive cardiac output monitoring by electrical cardiometry: a systematic review and meta-analysis

Sanders

Servaas

Slagt

2019

J Clin Monit Comput

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Cardiac output monitoring is used in critically ill and high-risk surgical patients. Intermittent pulmonary artery thermodilution and transpulmonary thermodilution, considered the gold standard, are invasive and linked to complications. Therefore, many non-invasive cardiac output devices have been developed and studied. One of those is electrical cardiometry. The results of validation studies are conflicting, which emphasize the need for definitive validation of accuracy and precision. We performed a database search of PubMed, Embase, Web of Science and the Cochrane Library of Clinical Trials to identify studies comparing cardiac output measurement by electrical cardiometry and a reference method. Pooled bias, limits of agreement (LoA) and mean percentage error (MPE) were calculated using a random-effects model. A pooled MPE of less than 30% was considered clinically acceptable. A total of 13 studies in adults (620 patients) and 11 studies in pediatrics (603 patients) were included. For adults, pooled bias was 0.03 L min −1 [95% CI − 0.23; 0.29], LoA − 2.78 to 2.84 L min −1 and MPE 48.0%. For pediatrics, pooled bias was − 0.02 L min −1 [95% CI − 0.09; 0.05], LoA − 1.22 to 1.18 L min −1 and MPE 42.0%. Inter-study heterogeneity was high for both adults (I 2 = 93%, p < 0.0001) and pediatrics (I 2 = 86%, p < 0.0001). Despite the low bias for both adults and pediatrics, the MPE was not clinically acceptable. Electrical cardiometry cannot replace thermodilution and transthoracic echocardiography for the measurement of absolute cardiac output values. Future research should explore it's clinical use and indications.

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Section: Summary Of Evidencementioning

confidence: 99%

Accuracy and precision of non-invasive cardiac output monitoring by electrical cardiometry: a systematic review and meta-analysis

Sanders

Servaas

Slagt

2019

J Clin Monit Comput

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“…Another study tested the fourth-generation FloTrac™ algorithm in patients undergoing abdominal aortic aneurysm surgery and also found a low bias and high percentage error (bias 0.4 L min −1 ; percentage error 46.7%) of CO measurements [25]. The concordance rate for trending ability was 26.9% before and after aortic clamping and 47.3% before and after first unclamping of the iliac artery.…”

Section: Discussionmentioning

confidence: 99%

Disagreement in cardiac output measurements between fourth-generation FloTrac and critical care ultrasonography in patients with circulatory shock: a prospective observational study

et al. 2019

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Background Cardiac output measurements may inform diagnosis and provide guidance of therapeutic interventions in patients with hemodynamic instability. The FloTrac™ algorithm uses uncalibrated arterial pressure waveform analysis to estimate cardiac output. Recently, a new version of the algorithm has been developed. The aim was to assess the agreement between FloTrac™ and routinely performed cardiac output measurements obtained by critical care ultrasonography in patients with circulatory shock. Methods A prospective observational study was performed in a tertiary hospital from June 2016 to January 2017. Adult critically ill patients with circulatory shock were eligible for inclusion. Cardiac output was measured simultaneously using FloTrac™ with a fourth-generation algorithm (CO AP ) and critical care ultrasonography (CO CCUS ). The strength of linear correlation of both methods was determined by the Pearson coefficient. Bland-Altman plot and four-quadrant plot were used to track agreement and trending ability. Result Eighty-nine paired cardiac output measurements were performed in 17 patients during their first 24 h of admittance. CO AP and CO CCUS had strong positive linear correlation ( r 2 = 0.60, p < 0.001). Bias of CO AP and CO CCUS was 0.2 L min −1 (95% CI − 0.2 to 0.6) with limits of agreement of − 3.6 L min −1 (95% CI − 4.3 to − 2.9) to 4.0 L min −1 (95% CI 3.3 to 4.7). The percentage error was 65.6% (95% CI 53.2 to 77.3). Concordance rate was 64.4%. Conclusions In critically ill patients with circulatory shock, there was disagreement and clinically unacceptable trending ability between values of cardiac output obtained by uncalibrated arterial pressure waveform analysis and critical care ultrasonography. Trial registration Clinicaltrials.gov, NCT02912624 , registered on September 23, 2016 Electronic supplementary material The online version of this article (10.1186/s40560-019-0373-5) contains supplementary material, which is available to authorized users.

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“…The device has been proven to accurately track changes in cardiac output when preload changes [41]. On the other hand, current evidence still shows conflicting results on the FloTrac technology: the system still lacks optimal accuracy and trending ability in cardiac and vascular surgery, and the discrepancy in cardiac output measurement depends on the peripheral vascular tone [42,43]. The FloTrac 4-th generation software used in our study is both more accurate and more precise even when phenylephrine in low-moderate doses are administered [44].…”

Section: Discussionmentioning

confidence: 99%

The value of a superior vena cava collapsibility index measured with a miniaturized transoesophageal monoplane continuous echocardiography probe to predict fluid responsiveness compared to stroke volume variations in open major vascular surgery: a prospective cohort study

Bubenek-Turconi

Hendy

Băilă

et al. 2019

J Clin Monit Comput

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Superior vena cava collapsibility index (SVC-CI) and stroke volume variation (SVV) have been shown to predict fluid responsiveness. SVC-CI has been validated only with conventional transoesophageal echocardiography (TEE) in the SVC long axis, on the basis of SVC diameter variations, but not in the SVC short axis or by SVC area variations. SVV was not previously tested in vascular surgery patients. Forty consecutive adult patients undergoing open major vascular surgical procedures received 266 intraoperative volume loading tests (VLTs), with 500 ml of gelatine over 10 min. The hSVC-CI was measured using a miniaturized transoesophageal echocardiography probe (hTEE). The SVV and cardiac index (CI) were measured using Vigileo-FloTrac technology. VLTs were considered 'positive' (≥ 11% increase in CI) or 'negative' (< 11% increase in CI). We compared SVV and hSVC-CI measurements in the SVC short axis to predict fluid responsiveness. Areas under the receiver operating characteristic curves for hSVC-CI and SVV were not significantly different (P = 0.56), and both showed good predictivity at values of 0.92 (P < 0.001) and 0.89 (P < 0.001), respectively. The cutoff values for hSVC-CI and SVV were 37% (sensitivity 90%, specificity of 83%) and 15% (sensitivity 78%, specificity of 100%), respectively. Our study validated the value of the SVC-CI measured as area variations in the SVC short axis to predict fluid responsiveness in anesthetized patients. An hTEE probe was used to monitor and measure the hSVC-CI but conventional TEE may also offer this new dynamic parameter. In our cohort of significant preoperative hypovolemic patients undergoing major open vascular surgery, hSVC-CI and SVV cutoff values of 37% and 15%, respectively, predicted fluid responsiveness with good accuracy. Keywords Fluid responsiveness • Open major vascular surgery • Superior vena cava collapsibility index • Miniaturized transoesophageal echocardiography probe • Stroke volume variations Şerban-Ion Bubenek-Turconi and Adham Hendy are equal contributors.

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Accuracy and trending ability of the fourth-generation FloTrac/Vigileo System™ in patients undergoing abdominal aortic aneurysm surgery

Abstract: The degree of accuracy of the fourth-generation FloTrac/Vigileo™ in patients with AAA surgery was not acceptable. The tracking ability of the fourth-generation FloTrac/Vigileo™ after aortic clamp was below the acceptable limit.

Cited by 14 publications

References 23 publications

Accuracy and precision of non-invasive cardiac output monitoring by electrical cardiometry: a systematic review and meta-analysis

Accuracy and precision of non-invasive cardiac output monitoring by electrical cardiometry: a systematic review and meta-analysis

Disagreement in cardiac output measurements between fourth-generation FloTrac and critical care ultrasonography in patients with circulatory shock: a prospective observational study

The value of a superior vena cava collapsibility index measured with a miniaturized transoesophageal monoplane continuous echocardiography probe to predict fluid responsiveness compared to stroke volume variations in open major vascular surgery: a prospective cohort study

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