Assessment of changes in cardiac index and fluid responsiveness: a comparison of <scp>N</scp>exfin and transpulmonary thermodilution

Fischer, Marc-Olivier; Coucoravas, J.; Truong, J.; Zhu, Lan; Gérard, Jean-Louis; Hanouz, Jean‐Luc; Fellahi, Jean-Luc

doi:10.1111/aas.12108

Cited by 55 publications

(28 citation statements)

References 32 publications

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“…Other studies have also reported favourably on the Nexfin's ability to measure cardiac output accurately, e.g., compared with rebreathing methods, 111 or with transthoracic Doppler. 112 These results contrast with other studies that reported far inferior performance of the Nexfin device when comparing the noninvasively derived cardiac output measurements with thermodilution in critically ill patients 113,114 and cardiac ultrasound. 115 It is important to point out that, relative to other noninvasive cardiac output devices (e.g., over 3,000 patients in 16 studies comparing the FloTrac [uncalibrated] with thermodilution, over 1,400 patients in nine studies comparing the PiCCO [calibrated] with thermodilution, and almost 400 patients in three studies comparing the LiDCO [calibrated] with thermodilution), 107 there are very few data comparing volume-clamp-based estimates of SV or cardiac output with gold standards.…”

Section: Technologic Principlescontrasting

confidence: 58%

Advances in photoplethysmography: beyond arterial oxygen saturation

Bartels

Thiele

2015

Can J Anesth/J Can Anesth

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Purpose Photoplethysmography permits continuous measurement of heart rate and peripheral oxygen saturation and has been widely used to inform clinical decisions. Recently, a myriad of noninvasive hemodynamic monitoring devices using this same technology have been increasingly available. This narrative review aims to summarize the principles that form the basis for the function of these devices as well as to comment on trials evaluating their accuracy and clinical application. Principal findings Advanced monitoring devices extend photoplethysmography technology beyond measuring oxygen concentration and heart rate. Quantification of respiratory variation of the photoplethysmographic waveform reflects respiratory variation of the arterial pressure waveform and can be used to gauge volume responsiveness. Both the volume-clamp and physiocal techniques are extensions of conventional photoplethysmography and permit continuous measurement of finger arterial blood pressure. Finger arterial pressure waveforms can subsequently inform estimations of cardiac output. Conclusions Although respiratory variations of the plethysmographic waveform correlate only modestly with the arterial blood pressure waveform, fluid responsiveness can be relatively consistently assessed using both approaches. Continuous blood pressure measurements obtained using the volume-clamp technique may be as accurate as conventional brachial noninvasive blood pressure measurements. Most importantly, clinical comparative effectiveness studies are still needed in order to determine if these technologies can be translated into improvement of relevant patient outcomes. RésuméObjectif La photopléthysmographie permet la mesure continue de la fréquence cardiaque et de la saturation en oxygène périphérique, et elle est largement utilisée pour les prises de décisions cliniques. Depuis peu, un très grand nombre de dispositifs non invasifs de surveillance hémodynamique utilisant la même technologie envahit le marché. Cette synthèse narrative vise à résumer les principes à la base du fonctionnement de ces dispositifs et à commenter les essais évaluant leur exactitude ainsi que leurs applications cliniques. Constatations principales Les dispositifs de surveillance avancée étendent la technologie de photopléthysmographie au-delà de la mesure de la concentration en oxygène et de la fréquence cardiaque. La quantification de la variation respiratoire du tracé photopléthysmographique reflète la variation respiratoire du tracé de pression artérielle et peut servir à jauger la réactivité au volume. Les deux techniques de compression volumique (volume-clamp) au doigt et la technique physiocal sont des prolongements de Author contributions Karsten Bartels wrote approximately 50% of the manuscript and critically edited the remainder. Robert H. Thiele wrote approximately 50% of the manuscript and critically edited the remainder.

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Section: Technologic Principlescontrasting

confidence: 58%

Advances in photoplethysmography: beyond arterial oxygen saturation

Bartels

Thiele

2015

Can J Anesth/J Can Anesth

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“…While the present study is the first validation study for CNCO, another technology for the noninvasive assessment of CO based on the volume clamp method [i.e., ClearSight system (Edwards Lifesciences, Irvine, CA, USA); formerly known as Nexfin system (BMEye, Amsterdam, The Netherlands)] has been evaluated in clinical studies before-with inconsistent results. While Broch et al [22] demonstrated that the Nexfin system allows CO estimation in cardiac surgery patients with a percentage error of \30 % when compared with transpulmonary thermodilution, higher percentage errors between 38 % and 58 % were reported in other clinical studies evaluating the system in cardiac surgery patients in comparison with pulmonary artery or transpulmonary thermodilution [23][24][25][26]. In 45 mixed ICU patients, Ameloot and colleagues [27] revealed a percentage error of 36 % between Nexfin-CO and CO determined by transpulmonary thermodilution.…”

Section: Discussionmentioning

confidence: 99%

Continuous noninvasive cardiac output determination using the CNAP system: evaluation of a cardiac output algorithm for the analysis of volume clamp method-derived pulse contour

Wagner

Grond²,

Fortin³

et al. 2015

J Clin Monit Comput

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The CNAP system (CNSystems Medizintechnik AG, Graz, Austria) provides noninvasive continuous arterial pressure measurements by using the volume clamp method. Recently, an algorithm for the determination of cardiac output by pulse contour analysis of the arterial waveform recorded with the CNAP system became available. We evaluated the agreement of the continuous noninvasive cardiac output (CNCO) measurements by CNAP in comparison with cardiac output measurements invasively obtained using transpulmonary thermodilution (TDCO). In this proof-of-concept analysis we studied 38 intensive care unit patients from a previously set up database containing CNAP-derived arterial pressure data and TDCO values obtained with the PiCCO system (Pulsion Medical Systems SE, Feldkirchen, Germany). We applied the new CNCO algorithm retrospectively to the arterial pressure waveforms recorded with CNAP and compared CNCO with the corresponding TDCO values (criterion standard). Analyses were performed separately for (1) CNCO calibrated to the first TDCO (CNCO-cal) and (2) CNCO autocalibrated to biometric patient data (CNCO-auto). We did not perform an analysis of trending capabilities because the patients were hemodynamically stable. The median age and APACHE II score of the 22 male and 16 female patients was 63 years and 18 points, respectively. 18 % were mechanically ventilated and in 29 % vasopressors were administered. Mean ± standard deviation for CNCO-cal, CNCO-auto, and TDCO was 8.1 ± 2.7, 6.4 ± 1.9, and 7.8 ± 2.4 L/min, respectively. For CNCO-cal versus TDCO, Bland-Altman analysis demonstrated a mean difference of +0.2 L/min (standard deviation 1.0 L/min; 95 % limits of agreement -1.7 to +2.2 L/min, percentage error 25 %). For CNCO-auto versus TDCO, the mean difference was -1.4 L/min (standard deviation 1.8 L/min; 95 % limits of agreement -4.9 to +2.1 L/min, percentage error 45 %). This pilot analysis shows that CNCO determination is feasible in critically ill patients. A percentage error of 25 % indicates acceptable agreement between CNCO-cal and TDCO. The mean difference, the standard deviation, and the percentage error between CNCO-auto and TDCO were higher than between CNCO-cal and TDCO. A hyperdynamic cardiocirculatory state in a substantial number of patients and the hemodynamic stability making trending analysis impossible are main limitations of our study.

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“…The technique is not applicable in low flow in the finger arteries, hypothermia, or peripheral oedema. ClearSight CO has been studied in cardiac surgical patients against PAC and PiCCO and has demonstrated a limited accuracy and precision and a high percentage error (weighted average of 41%) [83][84][85][86][87][88][89][90][91], but reliably track preload-induced changes in CO [92][93][94]. ClearSight was less accurate in patients with low CO, hypothermia and high SVR but performed better in patients with high CO [95].…”

Section: Clearsight System (Edwards Lifesciences® -Usa)mentioning

confidence: 99%

Pulse waveform hemodynamic monitoring devices: recent advances and the place in goal-directed therapy in cardiac surgical patients

Hendy

Bubenek

2016

Rom J Anaesth Int Care

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Hemodynamic monitoring has evolved and improved greatly during the past decades as the medical approach has shifted from a static to a functional approach. The technological advances have led to innovating calibrated or not, but minimally invasive and noninvasive devices based on arterial pressure waveform (APW) analysis. This systematic clinical review outlines the physiologic rationale behind these recent technologies. We describe the strengths and the limitations of each method in terms of accuracy and precision of measuring the flow parameters (stroke volume, cardiac output) and dynamic parameters which predict the fluid responsiveness. We also analyzed the place of the APW monitoring devices in goaldirected therapy (GDT) protocols in cardiac surgical patients. According to the data from the three GDTrandomized control trials performed in cardiac surgery (using two types of APW techniques PiCCO and FloTrac/Vigileo), these devices did not demonstrate that they played a role in decreasing mortality, but only decreasing the ventilation time and the ICU and hospital length of stay.

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Assessment of changes in cardiac index and fluid responsiveness: a comparison of Nexfin and transpulmonary thermodilution

Abstract: The Nexfin cannot be used to measure rapid changes in cardiac index following fluid challenge and to predict fluid responsiveness after cardiac surgery.

Cited by 55 publications

References 32 publications

Advances in photoplethysmography: beyond arterial oxygen saturation

Advances in photoplethysmography: beyond arterial oxygen saturation

Continuous noninvasive cardiac output determination using the CNAP system: evaluation of a cardiac output algorithm for the analysis of volume clamp method-derived pulse contour

Pulse waveform hemodynamic monitoring devices: recent advances and the place in goal-directed therapy in cardiac surgical patients

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