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

Ameloot, Koen; Vijver, K. Van de; Broch, Ole Jacob; Regenmortel, N. Van; Laet, I. De; Schoonheydt, K.; Dits, H.; Bein, Berthold; Malbrain, Manu L N G

doi:10.1155/2013/519080

Cited by 67 publications

(53 citation statements)

References 31 publications

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“…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. In another study in medical ICU patients, Monnet et al [28] however observed a percentage error of 57 % when comparing Nexfin-derived cardiac index with transpulmonary thermodilution measurements.…”

Section: Discussionmentioning

confidence: 98%

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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Section: Discussionmentioning

confidence: 98%

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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“…Research on new risk factors for hypotension and bradycardia is on going, using low-invasive methods of haemodynamic monitoring [21]. Easily measurable risk factors for adverse circulatory consequences of spinal anaesthesia are individual patient characteristics, e.g., age, gender, body mass or its index (BMI).…”

Section: Discussionmentioning

confidence: 99%

“…The opinions regarding the device are positive regarding the reliability of arterial pressure measurements [25−27]; however, the agreement of the Nexfin-based CO and SVR measurements is assessed cautiously, although the majority of authors rate it as quite good or good [21,28,29]. Another limitation is the arbitrarily assumed central venous pressure value and the basing of SVRI calculations on it.…”

Section: Study Limitationsmentioning

confidence: 99%

Nieinwazyjna ocena układu krążenia przy użyciu urządzenia Nexfin pozwala na ocenę ryzyka wystąpienia hipotensji spowodowanej znieczuleniem podpajęczynówkowym

Ławicka¹,

Małek²,

Antczak³

et al. 2015

Anaesthesiol Intensive Ther

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Background: Unfavourable circulatory system conditions have been observed in many patients with spinal anaesthesia. The most frequent symptoms include a decrease in blood pressure and, less frequently, bradycardia. The appearance of unfavourable consequences of spinal anaesthesia might be related to the initial status of the patient's circulatory system. The aim of this study was to establish the possibility of predicting unfavourable circulatory consequences (hypotension, bradycardia) following spinal anaesthesia, based on non-invasive haemodynamic assessment with a Nexfin device. Methods: This prospective study included 100 18-60-year-old ASA I or II planned spinal anaesthesia patients. The initial hemodynamic parameters were assessed with a Nexfin monitor. Anaesthesia was performed with 3−3.5 mL of a 0,5% hyperbaric bupivacaine solution. Within 20 min after the administration of anaesthesia, the arterial blood pressure values, heart rate, sensory blockade level, and motoric blockade level were recorded in 5-min intervals. Hypotension was classified by a decrease of SAP < 90 mm Hg and/or the decrease of the SAP ≥ 20% initial value. Logistic regression was used to determine the independent predictors of hypotension resulting from a spinal blockade. Results: The development of hypotension and bradycardia was observed in 39 and 2%, respectively, of the patients. The patients who developed hypotension differed significantly from those who did not develop this symptom, with the main difference being the body mass and the assessment on the ASA scale. The patients who developed hypotension after spinal anaesthesia differed significantly in the initial hemodynamic parameters (SAP, MAP, SVRI). The following two independent risk factors for hypotension were isolated: the mean arterial pressure (OR 1.04; 95% CI: 1.005-1.076) and the systemic vascular resistance index (OR 1.109; 95% CI: 1.021-1.204). Conclusions: Nexfin-based non-invasive haemodynamic monitoring might be helpful in the identification of individuals with a high risk of hypotension following spinal blockade.

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

Cited by 67 publications

References 31 publications

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

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

Nieinwazyjna ocena układu krążenia przy użyciu urządzenia Nexfin pozwala na ocenę ryzyka wystąpienia hipotensji spowodowanej znieczuleniem podpajęczynówkowym

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

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