Abstract
Objective
The clinical use of less invasive devices that calculate cardiac output from arterial
pressure waveform is increasing. We aimed to evaluate the accuracy and characteristics
of the systemic vascular resistance index (SVRI) of the cardiac index measured by
two less invasive devices, fourth-generation FloTrac (CIFT) and LiDCOrapid (CILR), compared with the intermittent thermodilution technique using a pulmonary artery
catheter (CITD).
Design
Prospective observational study.
Setting
Single University Hospital.
Participants
Twenty-nine adult patients undergoing elective cardiac surgery.
Interventions
Elective cardiac surgery.
Measurements and Main Results
Hemodynamic parameters, CIFT, CILR, and CITD were measured after the induction of general anesthesia, at the start of cardiopulmonary
bypass, after completion of weaning from cardiopulmonary bypass, 30 min after weaning,
and at sternal closure (135 measurements in total). CIFT and CILR had moderate correlations with CITD (r = 0.62 and 0.58, respectively). Compared with CITD, CIFT and CILR had a bias of −0.73 and −0.61 L/min/m2, limit of agreement of −2.14 to 0.68 L/min/m2 and −2.42 to 1.20 L/min/m2, and percentage error of 39.9% and 51.2%, respectively. Subgroup analysis for evaluating
SVRI characteristics showed that the percentage errors of CIFT and CILR were 33.9% and 54.5% in low-SVRI (<1200 dyne•s/cm5/m2), 37.6% and 47.9% in moderate-SVRI (1200–1800 dyne•s/cm5/m2), 49.3% and 50.6% in high-SVRI (>1800 dyne•s/cm5/m2), respectively.
Conclusions
The accuracy of CIFT or CILR is not clinically acceptable for cardiac surgery. Fourth-generation Flotrac was unreliable
in high-SVRI. LiDCOrapid was inaccurate across a broad range of SVRI and minimally
affected by SVRI.
Keywords
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Article info
Publication history
Publication stage
In Press Accepted ManuscriptFootnotes
Funding: This work was supported by Grants-in-Aid for Scientific Research (20K17882 Y. Takei) from the Japan Society for the Promotion of Science (JPSS).
Acknowledgements: We acknowledge the Heart Team at Tohoku University Hospital. We would like to thank Editage (www.editage.com) for English language editing.
Identification
Copyright
© 2023 Elsevier Inc. All rights reserved.
