Comparison between Flotrac-Vigileo and Bioreactance, a totally noninvasive method for cardiac output monitoring

Sophie Marqué, Alain Cariou, Jean-Daniel Chiche, Pierre Squara, Sophie Marqué, Alain Cariou, Jean-Daniel Chiche, Pierre Squara

Abstract

Introduction: This study was designed to compare the clinical acceptability of two cardiac output (CO) monitoring systems: a pulse wave contour-based system (FloTrac-Vigileo) and a bioreactance-based system (NICOM), using continuous thermodilution (PAC-CCO) as a reference method.

Methods: Consecutive patients, requiring PAC-CCO monitoring following cardiac surgery, were also monitored by the two other devices. CO values obtained simultaneously by the three systems were recorded continuously on a minute-by-minute basis.

Results: Continuous recording was performed on 29 patients, providing 12,099 simultaneous measurements for each device (417 +/- 107 per patient). In stable conditions, correlations of NICOM and Vigileo with PAC-CCO were 0.77 and 0.69, respectively. The bias was -0.01 +/- 0.84 for NICOM and -0.01 +/- 0.81 for Vigileo (NS). NICOM relative error was less than 30% in 94% of the patients and less than 20% in 79% vs. 91% and 79% for the Vigileo, respectively (NS). The variability of measurements around the trend line (precision) was not different between the three methods: 8 +/- 3%, 8 +/- 4% and 8 +/- 3% for PAC-CCO, NICOM and Vigileo, respectively. CO changes were 7.2 minutes faster with Vigileo and 6.9 minutes faster with NICOM (P < 0.05 both systems vs. PAC-CCO, NS). Amplitude of changes was not significantly different than thermodilution. Finally, the sensitivity and specificity for predicting significant CO changes were 0.91 and 0.95 respectively for the NICOM and 0.86 and 0.92 respectively for the Vigileo.

Conclusion: This study showed that the NICOM and Vigileo devices have similar monitoring capabilities in post-operative cardiac surgery patients.

Figures

Figure 1
Figure 1
Comparison between NICOM™ and Vigileo™. (Left panel) Relationship between averaged values of NICOM™ (in red, r = 0.77, not significant (NS) from identity line) and Vigileo™ (in black, r = 0,69, P < 0.05 from identity line) with PAC-CCO during periods of very stable cardiac output (CO). (Right panel) Corresponding Bland and Altman representation: NICOM™ bias = -0.01 L/min with limits of agreements (2 standard deviations) = 1.68 L/min; Vigileo™ bias = -0.01 L/min with limits of agreements (2 standard deviations) = 1.62 L/min.

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