Abstract
FloTrac/Vigileo™ system is based on arterial pressure waveform analysis arterial pressure-based CO (APCO). Therefore, systemic vascular resistance (SVR) can influence the accuracy of APCO. The purpose of this study is to evaluate the relationship between SVR and the accuracy of APCO. We managed 50 consecutive patients in the perioperative period of cardiac surgery with FloTrac/Vigileo™ system (v. 3.02) and Swan–Ganz catheter/Vigilance™ system pulmonary artery catheter-based CO (PAC-CO) simultaneously. Continuous hemodynamic measurement using both methods was performed every 20 s from the induction of anesthesia to PAC removal 4 h after extubation. A total of 11,092 (intraoperative), 38,455 (postoperative, pre-extubation), and 44,235 (postoperative, post-extubation) data pairs were finally analyzed. Bland–Altman analysis revealed that in the intraoperative [postoperative pre-extubation, post-extubation] period, the bias was 0.5 [0.1, 0.0] L/min and the limits of agreement ranged from −2.4 to 3.3 [−2.2 to 2.4, −2.4 to 2.3] L/min. The percentage error was 60.3 [54.5, 48.5] %. Regression analysis of the systemic vascular resistance index (SVRI) and the bias between APCO and PAC-CO showed that the bias was positively correlated to the SVRI. Subanalysis based on SVR with Lin’s concordance correlation coefficient revealed that relatively satisfactory concordance was found in the normal-SVR group (concordance correlation coefficient ρ c = 0.51–0.56) regardless of vasoactive agent use. The accuracy of the FloTrac/Vigileo™ System (v. 3.02) is relatively satisfactory in the condition with normal SVR regardless of vasoactive agent use. Positive correlation between the bias and SVR can be the clue to the more effective use of FloTrac/Vigileo™ system.
Similar content being viewed by others
References
Didier P, Gayat E. Which general intensive care unit patients can benefit from placement of the pulmonary artery catheter? Crit Care. 2006;10:S7.
Peters SG, Afessa B, Decker PA, Schroeder DR, Offord KP, Scott JP. Increase risk associated with pulmonary artery catheterization in the medical intensive care unit. J Crit Care. 2003;18:166–71.
Manecke GR. Edwards FloTrac sensor and Vigileo monitor: easy, accurate, reliable cardiac output assessment using the arterial pulse wave. Expert Rev Med Devices. 2005;2:523–7.
Headley JM. Arterial pressure-based technologies: a new trend in cardiac output monitoring. Crit Care Nurs Clin North Am. 2006;18:179–87.
Gödje O, Friedl R, Hannekum A. Accuracy of beat-to-beat cardiac output monitoring by pulse contour analysis in hemodynamical unstable patients. Med Sci Monit. 2001;7:1344–50.
Slagt C, Beute J, Hoeksema M, Malagon I, Mulder JW, Groeneveld JA. Cardiac output derived from arterial pressure waveform analysis without calibration versus thermodilution in septic shock: evolving accuracy of software versions. Eur J Anaesthesiol. 2010;27:550–4.
Mutoh T, Ishikawa T, Nishino K, Yasui N. Evaluation of the FloTrac uncalibrated continuous cardiac output system for perioperative hemodynamic monitoring after subarachnoid hemorrhage. J Neurosurg Anesthesiol. 2009;21:218–25.
Hofer CK, Button D, Weibel L, Genoni M, Zollinger A. Uncalibrated radial and femoral arterial pressure waveform analysis for continuous cardiac output measurement: an evaluation in cardiac surgery patients. J Cardiothorac Vasc Anesth. 2010;24:257–64.
De Backer D, Marx G, Tan A, Junker C, Van Nuffelen M, Hüter L, Ching W, Michard F, Vincent JL. Arterial pressure-based cardiac output monitoring: a multicenter validation of the third-generation software in septic patients. Intensive Care Med. 2011;37:233–40.
Zimmermann A, Steinwendner J, Hofbauer S, Kirnbauer M, Schneider J, Moser L, Pauser G. The accuracy of the Vigileo/FloTrac system has been improved follow-up after a software update: a blinded comparative study of 30 cardiosurgical patients. J Cardiothorac Vasc Anesth. 2009;23:929–31.
Mayer J, Suttner S. Cardiac output derived from arterial pressure waveform. Curr Opin Anaesthesiol. 2009;22:804–8.
Saraceni E, Rossi S, Persona P, Dan M, Rizzi S, Meroni M, Ori C. Comparison of two methods for cardiac output measurement in critically ill patients. Br J Anaesth. 2011;106:690–4.
Opdam HI, Wan L, Bellomo R. A pilot assessment of the FloTrac cardiac output monitoring system. Intensive Care Med. 2007;33:344–9.
Sander M, Spies CD, Grubitzsch H, Foer A, Müller M, von Heymann C. Comparison of uncalibrated arterial waveform analysis in cardiac surgery patients with thermodilution cardiac output measurements. Crit Care. 2006;21:R164.
Lin LI. A concordance correlation coefficient to evaluate reproducibility. Biometrics. 1989;45:255–68.
Bland JM, Altman DG. Measuring agreement in method comparison studies. Stat Methods Med Res. 1999;8:135–60.
Myles PS, Cui J. Using the Bland–Altman method to measure agreement with repeated measures. Br J Anaesth. 2007;99:309–11.
Peyton PJ, Chong SW. Minimally invasive measurement of cardiac output during surgery and critical care: a meta-analysis of accuracy and precision. Anesthesiology. 2010;113:1220–35.
Levett JM, Replogle RL. Thermodilution cardiac output: acritical analysis and review of the literature. J Surg Res. 1979;27:392–404.
Sotomi Y, Nishiyama C, Shimizu T, Kita T, Maki N, Sasaki S. Reliability of a less-invasive cardiac output monitor in the perioperative period of a patient with severe dilated cardiomyopathy. Masui. 2011;60:203–7.
Biancofiore G, Critchley LA, Lee A, Bindi L, Bisà M, Esposito M, Meacci L, Mozzo R, DeSimone P, Urbani L, Filipponi F. Evaluation of an uncalibrated arterial pulse contour cardiac output monitoring system in cirrhotic patients undergoing liver surgery. Br J Anaesth. 2009;102:47–54.
Junttila EK, Koskenkari JK, Ohtonen PP, Ala-Kokko TI. Uncalibrated arterial pressure waveform analysis for cardiac output monitoring is biased by low peripheral resistance in patients with intracranial haemorrhage. Br J Anaesth. 2011;107:581–6.
Biais M, Nouette-Gaulain K, Cottenceau V, Vallet A, Cochard JF, Revel P, Sztark F. Cardiac output measurement in patients undergoing liver transplantation: pulmonary artery catheter versus uncalibrated arterial pressure waveform analysis. Anesth Analg. 2008;106:1480–6.
Eleftheriadis S, Galatoudis Z, Didilis V, Bougioukas I, Schön J, Heinze H, Berger KU, Heringlake M. Variations in arterial blood pressure are associated with parallel changes in FlowTrac/Vigileo®-derived cardiac output measurements: a prospective comparison study. Crit Care. 2009;13:R179.
Sakka SG, Kozieras J, Thuemer O, van Hout N. Measurement of cardiac output: a comparison between transpulmonary thermodilution and uncalibrated pulse contour analysis. Br J Anaesth. 2007;99:337–42.
Compton FD, Zukunft B, Hoffmann C, Zidek W, Schaefer JH. Performance of a minimally invasive uncalibrated cardiac output monitoring system (Flotrac/Vigileo) in haemodynamically unstable patients. Br J Anaesth. 2008;100:451–6.
Lorsomradee S, Cromheecke S, De Hert SG. Uncalibrated arterial pulse contour analysis versus continuous thermodilution technique: effects of alterations in arterial waveform. J Cardiothorac Vasc Anesth. 2007;21:636–43.
Monnet X, Anguel N, Jozwiak M, Richard C, Teboul JL. Third-generation FloTrac/Vigileo does not reliably track changes in cardiac output induced by norepinephrine in critically ill patients. Br J Anaesth. 2012;108:615–22.
Meng L, Tran NP, Alexander BS, Laning K, Chen G, Kain ZN, Cannesson M. The impact of phenylephrine, ephedrine, and increased preload on third-generation Vigileo-FloTrac and esophageal doppler cardiac output measurements. Anesth Analg. 2011;113:751–7.
Su BC, Tsai YF, Chen CY, Yu HP, Yang MW, Lee WC, Lin CC. Cardiac output derived from arterial pressure waveform analysis in patients undergoing liver transplantation: validity of a third-generation device. Transplant Proc. 2012;44:424–8.
Acknowledgments
We acknowledge the nursing staff, clinical engineers, office administrators of Sakurabashi-Watanabe hospital for their kind support in performing this study.
Conflict of interest
The authors declare that they have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Sotomi, Y., Iwakura, K., Higuchi, Y. et al. The impact of systemic vascular resistance on the accuracy of the FloTrac/Vigileo™ system in the perioperative period of cardiac surgery: a prospective observational comparison study. J Clin Monit Comput 27, 639–646 (2013). https://doi.org/10.1007/s10877-013-9481-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10877-013-9481-2