Cardiac Output by Flotrac/VigileoTM Validation Trials: Are there Reliable Conclusions?

Giustiniano, Enrico; Morenghi, Emanuela; Ruggieri, Nadia; Pellegrino, Francesco; Balazova, Jana; Dominoni, Cristina; Marinelli, Gian Luca

doi:10.2174/157488712802281367

Cited by 5 publications

(2 citation statements)

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“…If a CO is measured at 8 L/min, the true value can be between 5.7 and 10.3 L/min. Of note; however, is that the obtained correlation coefficients and LA are comparable to previous validation studies with PiCCO against PAC [ 6 – 11 ] and better than results obtained with other noncalibrated, more invasive monitoring devices such as the Vigileo [ 13 , 28 ], NiCO [ 13 , 29 ], and PrAM [ 30 ]. Also, in a recent meta-analysis, none of the four tested methods achieved satisfactory agreement with bolus thermodilution within the expected 30% PE limits [ 31 ].…”

Section: Discussionsupporting

confidence: 79%

Nexfin Noninvasive Continuous Hemodynamic Monitoring: Validation against Continuous Pulse Contour and Intermittent Transpulmonary Thermodilution Derived Cardiac Output in Critically Ill Patients

Ameloot

Vijver

Broch

et al. 2013

The Scientific World Journal

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Introduction. Nexfin (Bmeye, Amsterdam, Netherlands) is a noninvasive cardiac output (CO) monitor based on finger arterial pulse contour analysis. The aim of this study was to validate Nexfin CO (NexCO) against thermodilution (TDCO) and pulse contour CO (CCO) by PiCCO (Pulsion Medical Systems, Munich, Germany). Patients and Methods. In a mix of critically ill patients (n = 45), NexCO and CCO were measured continuously and recorded at 2-hour intervals during the 8-hour study period. TDCO was measured at 0–4–8 hrs. Results. NexCO showed a moderate to good (significant) correlation with TDCO (R 2 0.68, P < 0.001) and CCO (R 2 0.71, P < 0.001). Bland and Altman analysis comparing NexCO with TDCO revealed a bias (± limits of agreement, LA) of 0.4 ± 2.32 L/min (with 36% error) while analysis comparing NexCO with CCO showed a bias (±LA) of 0.2 ± 2.32 L/min (37% error). NexCO is able to follow changes in TDCO and CCO during the same time interval (level of concordance 89.3% and 81%). Finally, polar plot analysis showed that trending capabilities were acceptable when changes in NexCO (ΔNexCO) were compared to ΔTDCO and ΔCCO (resp., 89% and 88.9% of changes were within the level of 10% limits of agreement). Conclusion. we found a moderate to good correlation between CO measurements obtained with Nexfin and PiCCO.

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Section: Discussionsupporting

confidence: 79%

Nexfin Noninvasive Continuous Hemodynamic Monitoring: Validation against Continuous Pulse Contour and Intermittent Transpulmonary Thermodilution Derived Cardiac Output in Critically Ill Patients

Ameloot

Vijver

Broch

et al. 2013

The Scientific World Journal

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“…Aortic valve abnormalities are still likely to cause discrepancy [45] through distortion of the pulse contour, although they were not actively screened for in our analysis. Importantly, despite the growing use of pulse contour cardiac output analysis in clinical practice, its use in general intensive care remains controversial [46] and must be recognized as a limiting factor in this analysis.…”

Section: Discussionmentioning

confidence: 99%

Augmented renal clearance in septic and traumatized patients with normal plasma creatinine concentrations: identifying at-risk patients

et al. 2013

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IntroductionImproved methods to optimize drug dosing in the critically ill are urgently needed. Traditional prescribing culture involves recognition of factors that mandate dose reduction (such as renal impairment), although optimizing drug exposure, through more frequent or augmented dosing, represents an evolving strategy. Elevated creatinine clearance (CLCR) has been associated with sub-therapeutic antibacterial concentrations in the critically ill, a concept termed augmented renal clearance (ARC). We aimed to determine the prevalence of ARC in a cohort of septic and traumatized critically ill patients, while also examining demographic, physiological and illness severity characteristics that may help identify this phenomenon.MethodsThis prospective observational study was performed in a 30-bed tertiary level, university affiliated, adult intensive care unit. Consecutive traumatized and septic critically ill patients, receiving antibacterial therapy, with a plasma creatinine concentration ≤110 μmol/L, were eligible for enrolment. Pulse contour analysis (Vigileo / Flo Trac® system, Edwards Lifesciences, Irvine, CA, USA), was used to provide continuous cardiac index (CI) assessment over a single six-hour dosing interval. Urinary CLCR measures were obtained concurrently.ResultsSeventy-one patients contributed data (sepsis n = 43, multi-trauma n = 28). Overall, 57.7% of the cohort manifested ARC, although there was a greater prevalence in trauma (85.7% versus 39.5%, P <0.001). In all patients, a weak correlation was noted between CI and CLCR (r = 0.346, P = 0.003). This was mostly driven by septic patients (r = 0.508, P = 0.001), as no correlation (r = -0.012, P = 0.951) was identified in trauma. Those manifesting ARC were younger (P <0.001), male (P = 0.012), with lower acute physiology and chronic health evaluation (APACHE) II (P= 0.008) and modified sequential organ failure assessment (SOFA) scores (P = 0.013), and higher cardiac indices (P = 0.013). In multivariate analysis, age ≤50 years, trauma, and a modified SOFA score ≤4, were identified as significant risk factors. These had greater utility in predicting ARC, compared with CI assessment alone.ConclusionsDiagnosis, illness severity and age, are likely to significantly influence renal drug elimination in the critically ill, and must be regularly considered in future study design and daily prescribing practice.See related commentary by De Waele and Carlier, http://ccforum.com/content/17/2/130

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Comparing Changes in Carotid Flow Time and Stroke Volume Induced by Passive Leg Raising

Jalil

Thompson

Cavallazzi

et al. 2018

The American Journal of the Medical Sciences

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Cardiac Output by Flotrac/VigileoTM Validation Trials: Are there Reliable Conclusions?

Cited by 5 publications

References 0 publications

Nexfin Noninvasive Continuous Hemodynamic Monitoring: Validation against Continuous Pulse Contour and Intermittent Transpulmonary Thermodilution Derived Cardiac Output in Critically Ill Patients

Nexfin Noninvasive Continuous Hemodynamic Monitoring: Validation against Continuous Pulse Contour and Intermittent Transpulmonary Thermodilution Derived Cardiac Output in Critically Ill Patients

Augmented renal clearance in septic and traumatized patients with normal plasma creatinine concentrations: identifying at-risk patients

Comparing Changes in Carotid Flow Time and Stroke Volume Induced by Passive Leg Raising

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