Accuracy of Vigileo/Flotrac monitoring system in morbidly obese patients

Tejedor, Ana Viana; Rivas, Eva; Ríos, José; Arismendi, Ebymar; Martínez-Pallí, Graciela; Delgado, Salvadora; Balust, Jaume

doi:10.1016/j.jcrc.2015.01.015

Cited by 11 publications

(8 citation statements)

References 47 publications

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“…While the one study did not demonstrate interchangeability between the Nexfin® system and Riva-Rocci/Korotkoff-derived blood pressure measurements in 33 patients [36], the other three studies could show clinically useful trend ability of the arterial pressure values [37][38][39]. Thus far, evidence on non-or semi-invasive CI measurements in the perioperative setting of bariatric surgery is limited to one case series and one prospective observational study [10,40]. In the one case series of only 8 morbidly obese patients, CO measurements by the FloTrac/Vigileo™ system were compared to the thermodilution method using a pulmonary artery catheter [40].…”

Section: Discussionmentioning

confidence: 97%

“…Thus far, evidence on non-or semi-invasive CI measurements in the perioperative setting of bariatric surgery is limited to one case series and one prospective observational study [10,40]. In the one case series of only 8 morbidly obese patients, CO measurements by the FloTrac/Vigileo™ system were compared to the thermodilution method using a pulmonary artery catheter [40]. No valid agreement but a systematic overestimation of the semi-invasively measured CO values could be shown.…”

Section: Discussionmentioning

confidence: 99%

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Perioperative non-invasive versus semi-invasive cardiac index monitoring in patients with bariatric surgery – a prospective observational study

Lorenzen¹,

Pohlmann²,

Hansen³

et al. 2020

BMC Anesthesiol

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Background: In morbidly obese patients undergoing laparoscopic bariatric surgery, the combination of obesityrelated comorbidities, pneumoperitoneum and extreme posture changes constitutes a high risk of perioperative hemodynamic complications. Thus, an advanced hemodynamic monitoring including continuous cardiac index (CI) assessment is desirable. While invasive catheterization may bear technical difficulties, transesophageal echocardiography is contraindicated due to the surgical procedure. Evidence on the clinical reliability of alternative semi-or non-invasive cardiac monitoring devices is limited. The aim was to compare the non-invasive vascular unloading to a semi-invasive pulse contour analysis reference technique for continuous CI measurements in bariatric surgical patients. Methods: This prospective observational study included adult patients scheduled for elective, laparoscopic bariatric surgery after obtained institutional ethics approval and written informed consent. CI measurements were performed using the vascular unloading technique (Nexfin®) and semi-invasive reference method (FloTrac™). At 10 defined measurement time points, the influence of clinically indicated body posture changes, passive leg raising, fluid bolus administration and pneumoperitoneum was evaluated pre-and intraoperatively. Correlation, Bland-Altman and concordance analyses were performed.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Perioperative non-invasive versus semi-invasive cardiac index monitoring in patients with bariatric surgery – a prospective observational study

Lorenzen¹,

Pohlmann²,

Hansen³

et al. 2020

BMC Anesthesiol

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“…Although blood pressure measurements by this device seem reliable in the perioperative setting [ 18 , 19 ] studies show variable results regarding agreement of cardiac output with thermodilution and trending capability [ 12 , 20 – 23 ]. In the morbidly obese population, other devices using pulse contour analysis to estimate cardiac output have shown to be unreliable compared to thermodilution [ 24 , 25 ], and our group demonstrated unacceptable agreement with thermodilution and insufficient trending in morbidly obese patients undergoing bariatric surgery [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

Pulse-contour derived cardiac output measurements in morbid obesity: influence of actual, ideal and adjusted bodyweight

Boly

Schraverus

Raalten

et al. 2017

J Clin Monit Comput

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The non-invasive Nexfin cardiac output (CO) monitor shows a low level of agreement with the gold standard thermodilution method in morbidly obese patients. Here we investigate whether this disagreement is related to excessive bodyweight, and can be improved when bodyweight derivatives are used instead. We performed offline analyses of cardiac output recordings of patient data previously used and partly published in an earlier study by our group. In 30 morbidly obese patients (BMI > 35 kg/m2) undergoing laparoscopic gastric bypass, cardiac output was simultaneously determined with PiCCO thermodilution and Nexfin pulse-contour method. We investigated if agreement of Nexfin-derived CO with thermodilution CO improved when ideal and adjusted—instead of actual- bodyweight were used as input to the Nexfin. Bodyweight correlated with the difference between Nexfin-derived and thermodilution-derived CO (r = −0.56; p = 0.001). Bland Altman analysis of agreement between Nexfin and thermodilution-derived CO revealed a bias of 0.4 ± 1.6 with limits of agreement (LOA) from −2.6 to 3.5 L min when actual bodyweight was used. Bias was −0.6 ± 1.4 and LOA ranged from −3.4 to 2.3 L min when ideal bodyweight was used. With adjusted bodyweight, bias improved to 0.04 ± 1.4 with LOA from −2.8 to 2.9 L min. Our study shows that agreement of the Nexfin-derived with invasive CO measurements in morbidly obese patients is influenced by body weight, suggesting that Nexfin CO measurements in patients with a BMI above 35 kg/m2 should be interpreted with caution. Using adjusted body weight in the Nexfin CO-trek algorithm reduced the bias.

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“…Another limitation was the use of a single method for cardiac evaluation, which is calculated from the radial arterial waveform and the rest of the parameters derived from these approximations, without the resource of a pulmonary artery catheter for corroboration of the measurements from the minimally invasive monitor. Moreover, studies in obese patients with FloTrac indicate a moderate correlation between the derived cardiac output and results from the thermodilution technique through pulmonary artery catheterization and poor agreement during very high or low cardiac activity [46,47].…”

Section: Study Limitationsmentioning

confidence: 99%

Minimally Invasive Hemodynamic Assessment during Obstetric Hysterectomy for Invasive Placentation with Epidural Anesthesia

Alvarado-Ramos

Díaz

López-Gutiérrez

et al. 2020

Anesthesiology Research and Practice

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Background. The present study aimed to describe the evolution of hemodynamic parameters over time of patients with invasive placentation during their third trimester who were delivered via cesarean section and subsequently underwent obstetric hysterectomy under epidural anesthesia. Methods. A prospective, descriptive, longitudinal, 11-month cohort study of 43 patients aged between 18 and 37 years who presented with invasive placentation. Minimal invasive monitoring was placed before the administration of epidural anesthesia for hemodynamic parameter tracking during the cesarean section. After delivery, the patients underwent an obstetric hysterectomy. Blood loss, hemodynamic parameters, and coagulation were managed via goal-directed therapy. Parameters were compared via repeated measures ANOVA and effect size estimation (Cohen’s d). Results. The mean age of the patients was 29.2 ± 3.4 years and was moderately overweight. They had minor cardiac index variance ( P = NS , no significance), vascular systemic resistance index (NS), heart rate ( P = NS ), and median arterial pressure ( P = NS ). Differences were observed in the stroke volume index ( P = 0.015 ) due to moderately higher values (d = 0.3, P = 0.016 ) in the middle of the surgery. Patients had lower cardiac index (d = −0.36, NS) and cardiac workload requirements (d = −0.29, P = 0.034 ) toward the completion of surgery. Conclusion. Patients who are in their third trimester and who subsequently underwent obstetric hysterectomy under epidural anesthesia had modest surgical hemodynamic variance and reduced cardiac workload requirements toward the end of the surgery.

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Accuracy of Vigileo/Flotrac monitoring system in morbidly obese patients

Cited by 11 publications

References 47 publications

Perioperative non-invasive versus semi-invasive cardiac index monitoring in patients with bariatric surgery – a prospective observational study

Perioperative non-invasive versus semi-invasive cardiac index monitoring in patients with bariatric surgery – a prospective observational study

Pulse-contour derived cardiac output measurements in morbid obesity: influence of actual, ideal and adjusted bodyweight

Minimally Invasive Hemodynamic Assessment during Obstetric Hysterectomy for Invasive Placentation with Epidural Anesthesia

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