Performance of Third-generation FloTrac/Vigileo system during hyperdynamic therapy for delayed cerebral ischemia after subarachnoid hemorrhage

Abstract

Background:Monitoring of cardiac output (CO) is important for promising safe approach to goal-directed hemodynamic therapy for delayed cerebral ischemia (DCI) after subarachnoid hemorrhage (SAH), but is often precluded by the invasiveness and complexity of ongoing monitoring modalities. We examined the clinical utility of less-invasive management using an uncalibrated arterial pressure waveform-derived cardiac output (APCO) monitor with refined algorithm (Third-generation FloTrac/Vigileo, Edwards, Irvine, CA, USA) during hyperdynamic therapy for post-SAH DCI, compared with transpulmonary thermodilution (PiCCO, Pulsion, Munich, Germany) as a reference technique.Methods:Forty-five patients who underwent surgical clipping within 24 h of SAH onset and subsequently developed clinical deterioration attributable to DCI were investigated. Validation of the APCO-derived cardiac index (CI) during dobutamine-induced hyperdynamic therapy was compared with a reference CI analyzed by transpulmonary thermodilution in 20 patients. In a subsequent trial of 48 cases, the overall clinical results from patients managed with each device were compared.Results:The APCO underestimated CI with an overall bias ± SD of 0.33 ± 0.26 L/min/m2 compared with transpulmonary thermodilution, resulting in an error of 14.9%. The trends of CI for both techniques at each dobutamine dose were similar (r2= 0.77; P < 0.0001). No statistically significant differences were observed between the device groups for frequencies of neurological improvement, cerebral infarction, cardiopulmonary complications, or functional outcomes at 3 months.Conclusions:These data suggest that the refined APCO tends to underestimate CI compared with reference transpulmonary thermodilution during hyperdynamic therapy with dobutamine for reversing DCI, but may be acceptable in this select category of patients to obtain comparable clinical results.

Calibrated versus uncalibrated arterial pressure waveform analysis in monitoring cardiac output with transpulmonary thermodilution in patients with severe sepsis and septic shock

“…The FloTrac/Vigile has proven accuracy in stable haemodynamic conditions 3,[19][20][21][22] but not in severe sepsis, septic shock 2,3,11,23 -25 or liver surgery 3,[26][27][28][29][30][31]. Our results are consistent with the data in the literature.…”

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

“…[17][18][19][20] Meng and colleagues 17 examined the ability of the third-generation FloTrac TM /Vigileo TM system to track CO changes after hemodynamic interventions (phenylephrine or ephedrine administration, preload increase) using four-quadrant plot analysis. The concordance rate after phenylephrine or ephedrine boluses was poor (phenylephrine: 23%, ephedrine: 69%), while it was good after preload increase (96%).…”

Early Intensive Versus Minimally Invasive Approach to Postoperative Hemodynamic Management After Subarachnoid Hemorrhage

“…34,35 In the control group, intravenous fluid administration was adjusted according to the fluid balance, calculated every 8 hours by subtracting the urinary volume from the total oral and intravenous fluid volume, to achieve a positive fluid balance of 750 to 1500 mL ( Figure II1B in the online-only Data Supplement). If a central venous line was available, normovolemia (central venous pressure 5-8 mm Hg) was achieved by supplemental fluid administration.…”

“…[36][37][38] In patients requiring hyperdynamic therapy, a radial arterial line was placed to guide inotropic therapy, using a 20-or 22-gauge catheter connected to the FloTrac/Vigileo system (version 3.01; Edwards Lifesciences, Irvine, CA) for uncalibrated measurement of the CI by arterial pressure waveform-based pulse contour analysis ( Figure II2B in the online-only Data Supplement). 15,34,39 Digital subtraction angiography and endovascular treatment were considered when patients did not respond to medical treatment.…”