Validation of non-invasive hemodynamic monitoring with Nexfin in critically ill patients

Vijver, K. Van de; Verstraeten, A; Gillebert, Carl; Maniewski, Ula; Gabrovska, Maria; Viskens, D.; Regenmortel, N. Van; Laet, I. De; Schoonheydt, K.; Dits, H.; Malbrain, Manu

doi:10.1186/cc9495

Cited by 7 publications

(4 citation statements)

References 2 publications

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“…Especially, since there have been concerns about the use of the Penaz techniques in general critical care patients with poor peripheral perfusion. 28 Nevertheless, in recent years, this technique has significantly been improved and appears also applicable in the critically ill. 29 In conclusion, PPV and SPV can be measured reliably in a non-invasive manner using a non-invasive finger AP measurement in ICU patients on controlled mechanical ventilation after CABG surgery.…”

Section: Discussionmentioning

confidence: 87%

Non-invasive measurement of pulse pressure variation and systolic pressure variation using a finger cuff corresponds with intra-arterial measurement

Lansdorp

Ouweneel

Keijzer

et al. 2011

British Journal of Anaesthesia

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Section: Discussionmentioning

confidence: 87%

Non-invasive measurement of pulse pressure variation and systolic pressure variation using a finger cuff corresponds with intra-arterial measurement

Lansdorp

Ouweneel

Keijzer

et al. 2011

British Journal of Anaesthesia

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“…The accuracy and precision of hemodynamic data from Nexfin-based devices have been evaluated relative to invasive A-line and thermodilution monitoring strategies in multiple small-scale studies across various clinical settings (Table) [Stover 2009;Bogert 2010;Martina 2010;Van de Vijver 2011;Broch 2012;Fischer 2012;Kalmar 2012;Martina 2012;Monnet 2012;Ameloot 2013;Bubenek-Turconi 2013;Hohn 2013;Ameloot 2014;Hofhuizen 2014;Maass 2014;Vos 2014;Weiss 2014;Balzer 2016;de Wilde 2016;Heusdens 2016;Schraverus 2016;Berkelmans 2018;Sperna Weiland 2018]. In general, studies appear to report acceptable mean arterial pressure (MAP) biases when compared to the gold standard arterial catheter method [Stover 2009;Martina 2010;Fischer 2012;Martina 2012;Ameloot 2014;Hofhuizen 2014;de Wilde 2016;Heusdens 2016;Berkelmans 2018].…”

Section: Accuracy and Precision Compared To Invasive Hemodynamic Moni...mentioning

confidence: 99%

“…The ClearSight system from Edwards Lifesciences (Irvine, CA, US) is based on the latter principle and allows real-time beat-to-beat monitoring of multiple cardiac parameters [Kalmar 2013]. The Nexfin® technology underlying the ClearSight system has been evaluated in a number of clinical settings [Stover 2009;Bogert 2010;Martina 2010;Van de Vijver 2011;Broch 2012;Fischer 2012;Kalmar 2012;Martina 2012;Monnet 2012;Ameloot 2013;Bubenek-Turconi 2013;Hohn 2013;Ameloot 2014;Hofhuizen 2014;Maass 2014;Vos 2014;Weiss 2014;Balzer 2016;de Wilde 2016;Heusdens 2016;Schraverus 2016;Berkelmans 2018;Sperna Weiland 2018]; however, its specific impact on valve procedures remains to be determined. Herein, we present insights from the Banner -University Medical Center Phoenix (Phoenix, AZ, USA), an experienced site performing valve interventions, and contextualize our observations within the existing literature.…”

Section: Introductionmentioning

confidence: 99%

Use of the ClearSight® System for Continuous Noninvasive Hemodynamic Monitoring during Heart Valve Interventions: Review of the Literature and Single-Site Experience

Gellert

Bramlage

2018

HSF

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During interventional and structural cardiology procedures, such as mitral valve (MitraClip, BMV), aortic valve (TAVR, BAV), tricuspid valve (MitraClip), left atrial appendage (Watchman, Lariat), atrial septum (ASD/PFO closure), and coronary artery intervention (high-risk PCI), among others, patients are at a high risk of hemodynamic instability and require continuous monitoring. This is conventionally achieved through arterial catheterization and transpulmonary thermodilution. However, such invasive techniques are time-consuming and have been associated with steep learning curves, vascular complications, and increased risk of infection. In line with the ongoing simplification and improvement of the catheter-based valve intervention, it is logical to investigate the effectiveness of continuous noninvasive hemodynamic monitoring in this setting. Over the last 2 years, our team has performed over 400 valve procedures with continuous hemodynamic monitoring via the noninvasive ClearSight system. This system is based on a finger-cuff and automated volume-clamp technology integrated into a simplified clinical platform (EV1000 NI). Although current evidence suggests that the technology results in slight differences in arterial pressure (AP) and cardiac output (CO) relative to the current, commercially available, invasive approaches, we have found the bias to be acceptable. Both the noninvasive and the invasive approaches have the same percentage of error when compared to the true CO and provide beat-by-beat detection of acute changes facilitating shorter response times. In addition to AP and CO, the system provides up-to-date information on stroke volume (SV), stroke volume variation (SVV), and systemic vascular resistance, which can be useful in aiding decision-making and provide better postoperative outcomes, such as shorter length of stay (LOS), decreased postoperative infection, decreased postoperative arrhythmia, decreased postoperative renal failure, decreased postoperative congestive heart failure (CHF), and decreased readmission. Additionally, the simplicity of the system setup has translated into a time saving of up to 3 hours per day, allowing one team to perform an additional 2 to 3 valve interventions without moving rooms. Moving forward, a formal study comparing patient outcomes and cost-effectiveness between invasive and noninvasive hemodynamic monitoring techniques in valve replacement would be insightful.

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“…Part of this paper has been presented previously in abstract and poster form at the 31st International Symposium on Intensive Care and Emergency Medicine (ISICEM) held in Brussels in 2011 [ 34 ]. The authors are indebted to Bert Ferdinande, Nelie Desie, and Annelies Gerits for their excellent input and feedback.…”

Section: Acknowledgmentsmentioning

confidence: 99%

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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Validation of non-invasive hemodynamic monitoring with Nexfin in critically ill patients

Cited by 7 publications

References 2 publications

Non-invasive measurement of pulse pressure variation and systolic pressure variation using a finger cuff corresponds with intra-arterial measurement

Non-invasive measurement of pulse pressure variation and systolic pressure variation using a finger cuff corresponds with intra-arterial measurement

Use of the ClearSight® System for Continuous Noninvasive Hemodynamic Monitoring during Heart Valve Interventions: Review of the Literature and Single-Site Experience

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

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