Agreement between PiCCO pulse‐contour analysis, pulmonal artery thermodilution and transthoracic thermodilution during off‐pump coronary artery by‐pass surgery

Abstract

Background: Haemodynamic instability during off-pump coronary artery bypass surgery (OPCAB) may appear rapidly, and continuous monitoring of the cardiac index (CI) during the procedure is advisable. With the PiCCO monitor, CI can be measured continuously and almost real time with pulse-contour analysis and intermittently with transthoracic thermodilution. The agreement between pulmonal artery thermodilution CI (Tpa), transthoracic thermodilution CI (Tpc) and pulse-contour CI (PCCI) during OPCAB surgery has not been evaluated sufficiently. Methods: In 30 patients scheduled for OPCAB surgery, a pulmonary artery catheter and a PiCCO catheter were inserted. At different time points during surgery, Tpa, Tpc and PCCI were compared. Measurements were performed after induction of anesthesia (T1), after pericardiothomy (T2), after grafting on the anterior (T3), posterior (T4) and lateral (T5) walls and after chest closure (T6). The PCCI was recalibrated at time point T2-T6. Results: Mean difference and the limits of agreements (percentage error) between Tpa and Tpc were: -0.14 AE 0.60 (22.0%) l/min/m

Accuracy of cardiac output measurements with pulse contour analysis (PulseCOTM) and Doppler echocardiography during off-pump coronary artery bypass grafting

“…PCA analysis from a peripheral arterial pressure signal is traditionally considered less accurate because curve damping and wave reflection can induce important errors. Nevertheless, data from the present study compare well to published data on accuracy with the PiCCO system and suggest that the PulseCo algorithm may be relatively insensitive to such artifacts [7,17,18]. We need to emphasize that our results were obtained in patients undergoing OPCAB surgery, a peculiar type of cardiac surgery for which extracorporeal circulation is not used.…”

Minimally- and non-invasive assessment of maternal cardiac output: go with the flow!

“…[74][75][76] Inaccuracies when compared to PAC-derived thermodilution resulted in the original algorithms when there were variations in systemic vascular resistance but these have been modified subsequently so that some of these devices now appear more robust in rapidly changing haemodynamic situations. There have been recent suggestions of a requirement for studies to specifically observe the validity of changes in pulse contour CO. [77][78][79][80] A recent study performed a cross-comparison of the trending accuracy of the PAC, FloTrac Ò , LiDCO Ò and PiCCO Ò and showed that although the different devices displayed similar mean CO values, they often trended differently in response to therapy and showed different inter-device agreement. 81 In the clinically relevant low CO range (<5 L/min), agreement improved slightly.…”

Continuous arterial pressure waveform monitoring in pediatric cardiac transplant, cardiomyopathy and pulmonary hypertension patients

“…Other methods of pulse wave analysis have been extensively evaluated in adults [13][14][15][16][17][18] and in children [19][20][21]. However, there are no validation studies specifically on the use of the FloTrac technology in children.…”