Arterial pressure-based cardiac output in septic patients: different accuracy of pulse contour and uncalibrated pressure waveform devices

Xavier Monnet, Nadia Anguel, Brice Naudin, Julien Jabot, Christian Richard, Jean-Louis Teboul, Xavier Monnet, Nadia Anguel, Brice Naudin, Julien Jabot, Christian Richard, Jean-Louis Teboul

Abstract

Introduction: We compared the ability of two devices estimating cardiac output from arterial pressure-curve analysis to track the changes in cardiac output measured with transpulmonary thermodilution induced by volume expansion and norepinephrine in sepsis patients.

Methods: In 80 patients with septic circulatory failure, we administered volume expansion (40 patients) or introduced/increased norepinephrine (40 patients). We measured the pulse contour-derived cardiac index (CI) provided by the PiCCO device (CIpc), the arterial pressure waveform-derived CI provided by the Vigileo device (CIpw), and the transpulmonary thermodilution CI (CItd) before and after therapeutic interventions.

Results: The changes in CIpc accurately tracked the changes in CItd induced by volume expansion (bias, -0.20 +/- 0.63 L/min/m2) as well as by norepinephrine (bias, -0.05 +/- 0.74 L/min/m2). The changes in CIpc accurately detected an increase in CItd >or= 15% induced by volume expansion and norepinephrine introduction/increase (area under ROC curves, 0.878 (0.736 to 0.960) and 0.924 (0.795 to 0.983), respectively; P < 0.05 versus 0.500 for both). The changes in CIpw were less reliable for tracking the volume-induced changes in CItd (bias, -0.23 +/- 0.95 L/min/m2) and norepinephrine-induced changes in CItd (bias, -0.01 +/- 1.75 L/min/m2). The changes in CIpw were unable to detect an increase in CItd >or= 15% induced by volume expansion and norepinephrine introduction/increase (area under ROC curves, 0.564 (0.398 to 0.720) and 0.541 (0.377 to 0.700, respectively, both not significantly different from versus 0.500).

Conclusions: The CIpc was reliable and accurate for assessing the CI changes induced by volume expansion and norepinephrine. By contrast, the CIpw poorly tracked the trends in CI induced by those therapeutic interventions.

Figures

Figure 1
Figure 1
Bland-Altman plots. (a, b) Bland-Altman plot for the changes (in absolute values) and correlation (for the percentage changes) induced by volume expansion on cardiac index obtained by transpulmonary thermodilution (CItd) and cardiac index obtained by the pulse-contour analysis (CIpc). (c, d) Bland-Altman plot for the changes (in absolute values) and correlation (for the percentage changes) induced by volume expansion on cardiac index obtained by transpulmonary thermodilution (CItd) and cardiac index obtained by the arterial pressure waveform analysis (CIpw). Bland-Altman plots: straight line, bias; dashed line: +2 SD/-2 SD limits of agreement); dashed line, correlation line.
Figure 2
Figure 2
Receiver operating characteristic (ROC) curves. (a) ROC curves constructed for testing the ability of the changes in cardiac index obtained by the pulse-contour analysis (CIpc) (straight line) and of the changes in cardiac index obtained by the arterial-pressure waveform analysis (CIpw) (dashed line) to detect an increase in cardiac index obtained by transpulmonary thermodilution (CItd) ≥15% induced by me expansion. (b) ROC curves constructed for testing the ability of the changes in cardiac index obtained by the pulse-contour analysis (CIpc) (straight line) and of the changes in cardiac index obtained by the arterial-pressure waveform analysis (CIpw) (dashed line) to detect an increase in cardiac index obtained by transpulmonary thermodilution (CItd) ≥15% induced by the introduction/increase in norepinephrine.
Figure 3
Figure 3
Bland-Altman plots. (a, b) Bland-Altman plot for the changes (in absolute values) and correlation (for the percentage changes) induced by the introduction/increase in norepinephrine on cardiac index obtained by transpulmonary thermodilution (CItd) and cardiac index obtained by the pulse-contour analysis (CIpc). (c, d) Bland-Altman plot for the changes (in absolute values) and correlation (for the percentage changes) induced by the introduction/increase in norepinephrine on cardiac index obtained by transpulmonary thermodilution (CItd) and cardiac index obtained by the arterial-pressure waveform analysis (CIpw). Plots: straight line, bias; dashed line: +2SD/-2SD limits of agreement); dashed line, correlation line.

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