Improved Performance of the Fourth-Generation FloTrac/Vigileo System for Tracking Cardiac Output Changes

Suehiro, Koichi; Tanaka, Katsuaki; Mikawa, Mika; Uchihara, Yuriko; Matsuyama, Taiki; Matsuura, Tadashi; Funao, Tomoharu; Yamada, Tokuhiro; Mori, Takashi; Nishikawa, Kiyonobu

doi:10.1053/j.jvca.2014.07.022

Cited by 50 publications

(54 citation statements)

References 24 publications

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“…When compared to other minimally or non-invasive techniques used in clinical practice, most devices show a MPE of more than 30% [10,12,[68][69][70][71][72][73][74][75][76]. Therefore, Peyton and Chong have suggested to change the acceptable MPE to 45%, ensuring a higher rate of agreement in new methods [12].…”

Section: Summary Of Evidencementioning

confidence: 99%

“…The lowest bias and MPE are found in validation studies during cardiac surgery [68,77,78]. The worst results are found during sepsis and septic shock as the bias of most non-invasive devices is negatively influenced by a low systemic vascular resistance (SVR) [68,74,75,[79][80][81]. Which device should be the reference method and under which clinical condition the validation needs to be performed, remains subject of discussion.…”

Section: Summary Of Evidencementioning

confidence: 99%

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Accuracy and precision of non-invasive cardiac output monitoring by electrical cardiometry: a systematic review and meta-analysis

Sanders

Servaas

Slagt

2019

J Clin Monit Comput

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Cardiac output monitoring is used in critically ill and high-risk surgical patients. Intermittent pulmonary artery thermodilution and transpulmonary thermodilution, considered the gold standard, are invasive and linked to complications. Therefore, many non-invasive cardiac output devices have been developed and studied. One of those is electrical cardiometry. The results of validation studies are conflicting, which emphasize the need for definitive validation of accuracy and precision. We performed a database search of PubMed, Embase, Web of Science and the Cochrane Library of Clinical Trials to identify studies comparing cardiac output measurement by electrical cardiometry and a reference method. Pooled bias, limits of agreement (LoA) and mean percentage error (MPE) were calculated using a random-effects model. A pooled MPE of less than 30% was considered clinically acceptable. A total of 13 studies in adults (620 patients) and 11 studies in pediatrics (603 patients) were included. For adults, pooled bias was 0.03 L min −1 [95% CI − 0.23; 0.29], LoA − 2.78 to 2.84 L min −1 and MPE 48.0%. For pediatrics, pooled bias was − 0.02 L min −1 [95% CI − 0.09; 0.05], LoA − 1.22 to 1.18 L min −1 and MPE 42.0%. Inter-study heterogeneity was high for both adults (I 2 = 93%, p < 0.0001) and pediatrics (I 2 = 86%, p < 0.0001). Despite the low bias for both adults and pediatrics, the MPE was not clinically acceptable. Electrical cardiometry cannot replace thermodilution and transthoracic echocardiography for the measurement of absolute cardiac output values. Future research should explore it's clinical use and indications.

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Section: Summary Of Evidencementioning

confidence: 99%

Section: Summary Of Evidencementioning

confidence: 99%

Accuracy and precision of non-invasive cardiac output monitoring by electrical cardiometry: a systematic review and meta-analysis

Sanders

Servaas

Slagt

2019

J Clin Monit Comput

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“…Because of the unreliability of the third generation software to track the changes in CI with vasopressors administration [51] the fourth generation software (version 4.00) was developed based on a new correction factor for acute changes in SVR. Despite these developments a recent study [52] performed in cardiac surgical patients demonstrated that the CO values measured by the fourth-generation software still evidenced an unacceptable discrepancy in comparison with PAC-CO values. In contrast, the trending ability of tracking the CO after vasopressor administration was greatly improved [52].…”

Section: Flotrac/vigileo (Edwards Lifesciences -Usa)mentioning

confidence: 99%

“…Despite these developments a recent study [52] performed in cardiac surgical patients demonstrated that the CO values measured by the fourth-generation software still evidenced an unacceptable discrepancy in comparison with PAC-CO values. In contrast, the trending ability of tracking the CO after vasopressor administration was greatly improved [52]. Being easy to use and measuring also the SVV the system was widely used with mixed results in terms of accuracy and precision in different patient populations.…”

Section: Flotrac/vigileo (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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“…The FloTrac/ Vigileo (Edwards Lifesciences, Irvine, CA, USA) is a less invasive monitor and measures pulse pressure (PP)-derived CI without external calibration. The accuracy is validated in many studies [1][2][3].…”

Section: Introductionmentioning

confidence: 95%

Estimation of Cardiac Index: Validation of the Mobil-O-Graph NG in Comparison with the FloTrac/Vigileo

Cho

Park

et al. 2018

Soonchunhyang Med Sci

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Objective: Although the reference value of cardiac index (CI) is derived by pulmonary arterial pressure, the use of pulmonary arterial catheterization is limited by low cost effectiveness and many concerns regarding complications. Therefore, relatively noninvasive indirect measurement is used widely perioperatively. The goal of this study was to determine the accuracy of the CI derived by Mobil-O-Graph NG (cCI) noninvasively in patients undergoing general anesthesia by comparing that measured by FloTrac/Vigileo (fCI), the minimal invasive method. Methods: The Bland-Altman method was used to quantify agreement. Bias (mean difference between fCI-cCI) represents the systematic error between methods and precision (standard deviation of the bias) represents the random error or variability between techniques. The percentage error was considered clinically acceptable, and the tested method (Mobil-O-Graph NG) was regarded as interchangeable with the reference method (FloTrac/Vigileo), if it was below 30%. Results: One hundred and ninety-five patients were included in this study, and CI, measured in the 121 patients. The Bland-Altman analysis revealed a bias-0.01 and the percentage error of 32.4%. And the difference is inversely increased according the mean CI. Conclusion: Results showed that CI measured by Mobil-O-Graph NG had a wide limit of agreement with that measured by FloTrac/ Vigileo, therefore regarded as not interchangeable.

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Improved Performance of the Fourth-Generation FloTrac/Vigileo System for Tracking Cardiac Output Changes

Cited by 50 publications

References 24 publications

Accuracy and precision of non-invasive cardiac output monitoring by electrical cardiometry: a systematic review and meta-analysis

Accuracy and precision of non-invasive cardiac output monitoring by electrical cardiometry: a systematic review and meta-analysis

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

Estimation of Cardiac Index: Validation of the Mobil-O-Graph NG in Comparison with the FloTrac/Vigileo

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