Cross-comparison of cardiac output trending accuracy of LiDCO, PiCCO, FloTrac and pulmonary artery catheters

Mehrnaz Hadian, Hyung Kook Kim, Donald A Severyn, Michael R Pinsky, Mehrnaz Hadian, Hyung Kook Kim, Donald A Severyn, Michael R Pinsky

Abstract

Introduction: Although less invasive than pulmonary artery catheters (PACs), arterial pulse pressure analysis techniques for estimating cardiac output (CO) have not been simultaneously compared to PAC bolus thermodilution CO (COtd) or continuous CO (CCO) devices.

Methods: We compared the accuracy, bias and trending ability of LiDCO™, PiCCO™ and FloTrac™ with PACs (COtd, CCO) to simultaneously track CO in a prospective observational study in 17 postoperative cardiac surgery patients for the first 4 hours following intensive care unit admission. Fifty-five paired simultaneous quadruple CO measurements were made before and after therapeutic interventions (volume, vasopressor/dilator, and inotrope).

Results: Mean CO values for PAC, LiDCO, PiCCO and FloTrac were similar (5.6 ± 1.5, 5.4 ± 1.6, 5.4 ± 1.5 and 6.1 ± 1.9 L/min, respectively). The mean CO bias by each paired method was -0.18 (PAC-LiDCO), 0.24 (PAC-PiCCO), -0.43 (PAC-FloTrac), 0.06 (LiDCO-PiCCO), -0.63 (LiDCO-FloTrac) and -0.67 L/min (PiCCO-FloTrac), with limits of agreement (1.96 standard deviation, 95% confidence interval) of ± 1.56, ± 2.22, ± 3.37, ± 2.03, ± 2.97 and ± 3.44 L/min, respectively. The instantaneous directional changes between any paired CO measurements displayed 74% (PAC-LiDCO), 72% (PAC-PiCCO), 59% (PAC-FloTrac), 70% (LiDCO-PiCCO), 71% (LiDCO-FloTrac) and 63% (PiCCO-FloTrac) concordance, but poor correlation (r(2) = 0.36, 0.11, 0.08, 0.20, 0.23 and 0.11, respectively). For mean CO < 5 L/min measured by each paired devices, the bias decreased slightly.

Conclusions: Although PAC (COTD/CCO), FloTrac, LiDCO and PiCCO display similar mean CO values, they often trend differently in response to therapy and show different interdevice agreement. In the clinically relevant low CO range (< 5 L/min), agreement improved slightly. Thus, utility and validation studies using only one CO device may potentially not be extrapolated to equivalency of using another similar device.

Figures

Figure 1
Figure 1
Bland-Altman analysis of each set of paired devices' cardiac output (CO). Solid line, mean difference (bias); dotted lines, limit of agreement (bias ± 1.96 standard deviation (SD)).
Figure 2
Figure 2
Bland-Altman analysis of each set of paired devices' cardiac output (CO) ≤5 L/min. Solid line, mean difference (bias); dotted lines, limits of agreement (bias ± 1.96 SD).
Figure 3
Figure 3
Bland-Altman analysis of each device against the mean of all devices across all patients, wherein pulmonary arterial catheter (PAC) thermodilution CO (COtd) and continuous CO (CCO) are pooled to be one variable (Z-statistic). Solid line, mean difference (bias); dotted line, limits of agreement (bias ± 1.96 SD).
Figure 4
Figure 4
Bland-Altman analysis of subgroups of patients with either thermodilution cardiac output (COTD) or CCO PAC (Z-statistic). Solid line, mean difference (bias); dotted lines, limits of agreement (bias ± 1.96 SD).
Figure 5
Figure 5
Pearson product-moment analysis of change in cardiac output (∆CO; in L/min) by each set of paired devices. Dotted lines, CO of ± 0.5 L/min.

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