Four different methods of measuring cardiac index during cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

Abstract

BackgroundCytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are high-risk extensive abdominal surgery. During high-risk surgery, less invasive methods for cardiac index (CI) measurement have been widely used in operating theater. We investigated the accuracy of CI derived from different methods (FroTrac, ProAQT, ClearSight, and arterial pressure waveform analysis [APWA], from PICCO) and compared them to transpulmonary thermodilution (TPTD) during CRS and HIPEC in the operative room and intensive care unit (ICU).MethodsTwenty-five patients scheduled for CRS-HIPEC were enrolled. During nine predefined time-points, simultaneous hemodynamic measurements were performed in the operating room and ICU. Absolute and relative changes of CI were analyzed using a Bland-Altman plot, four-quadrant plot, and interchangeability.ResultsThe mean bias was −0.1 L/min/m2 for ClearSight, ProAQT, and APWA and was −0.2 L/min/m2 for FloTrac compared with TPTD. All devices had large limits of agreement (LoA). The percentage of errors and interchangeabilities for ClearSight, FloTrac, ProAQT, and APWA were 50%, 50%, 54%, 36% and 36%, 47%, 40%, 72%, respectively. Trending capabilities expressed as concordance using clinically significant CI changes were −7º ± 39º, −19º ± 38º, −13º ± 41º, and −15º ± 39º. Interchangeability in trending showed low percentages of interchangeable and gray zone data pairs for all devices.ConclusionsDuring CRS-HIPEC, ClearSight, FloTrac and ProAQT systems were not able to reliably measure CI compared to TPTD. Reproducibility of changes over time using concordance, angular bias, radial LoA, and interchangeability in trending of all devices was unsatisfactory.

Comparison between Fourth-Generation FloTrac/Vigileo System and Continuous Thermodilution Technique for Cardiac Output Estimation after Time Adjustment during Off-Pump Coronary Artery Bypass Graft Surgery: A Retrospective Cohort Study

“…It is obvious that metrics such as concordance rate can differ by the selection of time scale. However, the time scales used in previous studies were too broad (e.g., interval between the administration of protamine and the start of sternal closure) [ 2 , 22 ] or not explicitly described (e.g., simply before and after a certain maneuver) [ 3 , 11 ]. To properly interpret and apply the results to actual clinical practice, the time scale should be considered in detail.…”

Non-Invasive Continuous Measurement of Haemodynamic Parameters—Clinical Utility

“…It can be easily used for both femoral and radial accesses. Nevertheless, when compared with other methods, its inaccuracy and inferiority to thermodilution-based CO and SI measurements is noteworthy [ 7 , 8 ]. Additionally, ProAQT is recognised as inequivalent to the esophageal Doppler system for haemodynamic monitoring during non-vascular, intermediate-risk abdominal surgeries [ 9 ].…”

Comparison of parameter types for the calibration of noninvasive continuous cardiac output monitoring of patients undergoing lumbar spinal surgery in the prone position

“…Many noninvasive hemodynamic monitoring techniques, such as impedance cardiography, arterial pressure-based CO (APCO), volume clamp method, and pulse wave transit time (PWTT) method, have been developed and studied recently [7][8][9]. Among these methods, the estimated continuous cardiac output (esCCO) system, a technique based on the PWTT method, can noninvasively and continuously monitor CO.…”