Comparison of monitoring performance of Bioreactance vs. pulse contour during lung recruitment maneuvers

Pierre Squara, Dominique Rotcajg, Dominique Denjean, Philippe Estagnasie, Alain Brusset, Pierre Squara, Dominique Rotcajg, Dominique Denjean, Philippe Estagnasie, Alain Brusset

Abstract

Introduction: This study was designed to test the hypothesis of equivalence in cardiac output (CO) and stroke volume (SV) monitoring capabilities of two devices: non invasive transthoracic bioreactance (NICOM), and a pulse contour analysis (PICCO PC) coupled to transpulmonary thermodilution (PICCO TD).

Methods: We included consecutive patients of a single ICU following cardiac surgery. Continuous minute-by-minute hemodynamic variables obtained from NICOM and PICCO PC were recorded and compared in 20 patients at baseline, during a lung recruitment maneuver (20 cmH2O of PEEP) and following withdrawal of PEEP. PICCO TD measurements were also determined. We evaluated the accuracy of these two technologies at baseline using PICCO TD as reference and we estimated the precision by the fluctuation around the mean value (2SD/mean). Then, we assessed time response, amplitude response and reliability for detecting expected decreases when PEEP was applied. Type I and type II errors were analyzed.

Results: CO values (PICCO TD) ranged from 1.6 to 8.0 L.min-1. At baseline, CO values were comparable for NICOM, PICCO PC and PICCO TD: 5.0 +/- 1.2, 4.7 +/- 1.4 and 4.6 +/- 1.3 L.min.-1, respectively (NS). Limits of agreements with PICCO TD were 1.52 L.min.-1 for NICOM and 1.77 L.min.-1 for PICCO PC, NS. The 95% statistical power gives an equivalence with a threshold of 0.52 L.min.-1 for NICOM vs. PICCO PC. The CO precision was 6 +/- 3% and 6 +/- 5% for NICOM and PICCO PC, respectively, NS. When PEEP was applied, CO was reduced by 33 +/- 12%, 31 +/- 14% and 32 +/- 13%, for NICOM, PICCO PC and PICCO TD, respectively (NS). Time response was 3.2 +/- 0.7 minute for NICOM vs. 2 +/- 0.5 minute for PICCO PC (NS). SV results were comparable to those for CO.

Conclusions: Although limited to 20 patients, this study has enough power to show comparable CO and SV monitoring capabilities of Bioreactance and pulse contour analysis calibrated by transpulmonary thermodilution.

Figures

Figure 1
Figure 1
Typical original recordings of PICCO PC, PICCO TD and NICOM during the 30-minute study protocol. Recordings included the baseline period (minutes 0 to 10), during positive end expiratory pressure (PEEP; minutes 10 to 20), and following PEEP removal (minutes 20 to 30). CO = cardiac output.
Figure 2
Figure 2
Comparison of cardiac output measured by NICOM and PICCO PC in comparison of PICCO TD. The three different colours represent baseline, positive end expiratory pressure (PEEP) application, and return to baseline. The regression lines did not differ significantly from the line of identity (PICCO TD vs. NICOM: y = 1.2 + 0.77x, r = 0.77; PICCO TD vs. PICCO PC: y = -0.5 + 0.9x, r = 0.79).
Figure 3
Figure 3
Bland-Altman plots comparing NICOM and PICCO PC to PICCO TD. The three different colours represent baseline, positive end expiratory pressure application, and return to baseline. Mean bias and limits of agreements are given in Table 1. Mean bias and limits of agreements are 0.22 ± 1.67 L/min/m for NICOM and 0.01 ± 1.86 L/min/m for PICCO PC.

References

    1. Swan HJ, Ganz W, Forrester J, Marcus H, Diamond G, Chonette D. Catheterization of the heart in man with used of a flow directed balloon-tipped catheter. N Engl J Med. 1970;283:447–451.
    1. Ganz W, Donoso R, Marcus H, Forrester J, Swan H. A new technique for measurement of cardiac output by thermodilution in man. Am J Cardiol. 1971;27:392–396. doi: 10.1016/0002-9149(71)90436-X.
    1. Biais M, Nouette-Gaulain K, Cottenceau V, Revel P, Sztark F. Uncalibrated pulse contour-derived stroke volume variation predicts fluid responsiveness in mechanically ventilated patients undergoing liver transplantation. Br J Anaesth. 2008;101:761–768. doi: 10.1093/bja/aen277.
    1. Lamia B, Ochagavia A, Monnet X, Chemla D, Richard C, Teboul JL. Echocardiographic prediction of volume responsiveness in critically ill patients with spontaneously breathing activity. Intensive Care Med. 2007;33:1125–1132. doi: 10.1007/s00134-007-0646-7.
    1. Hofer C, Senn A, Weibel L, Zollinger A. Assessment of stroke volume variation for prediction of fluid responsiveness using the modified FloTrac and PiCCO plus system. Crit Care. 2008;12:R82. doi: 10.1186/cc6933.
    1. Squara P, Cecconi C, Singer M, Rhodes A, Chiche J. Tracking changes in cardiac output; Methodological considerations for the validation of monitoring devices. Intensive Care Med. 2009. in press .
    1. Cecconi M, Rhodes A, Poloniecki J, Della Rocca G, Grounds R. Bench-to-bedside review: The importance of the precision of the reference technique in method comparison studies – with specific reference to the measurement of cardiac output. Crit Care. 2009;13:201. doi: 10.1186/cc7129.
    1. Squara P, Denjean D, Estagnasie P, Brusset A, Dib JC, Dubois C. Noninvasive cardiac output monitoring (NICOM): a clinical validation. Intensive Care Med. 2007;33:1191–1194. doi: 10.1007/s00134-007-0640-0.
    1. Keren H, Burkhoff D, Squara P. Evaluation of a noninvasive continuous cardiac output monitoring system based on thoracic bioreactance. Am J Physiol Heart Circ Physiol. 2007;293:H583–589. doi: 10.1152/ajpheart.00195.2007.
    1. Raval N, Squara P, Cleman M, Yalamanchili K, Winklmaier M, Burkhoff D. Multicenter evaluation of noninvasive cardiac output measurement by bioreactance technique. J Clin Monit Comput. 2008;22:113–119.
    1. Marqué S, Cariou A, Chiche J, Squara P. Non Invasive Cardiac Output Monitoring (NICOM) Compared to Minimally Invasive Monitoring (VIGILEO) Crit Care. 2009;13:R73. doi: 10.1186/cc7884.
    1. de Wilde R, Breukers R, Berg P van den, Jansen J. Monitoring cardiac output using the femoral and radial arterial pressure waveform. Anaesthesia. 2006;61:743–746. doi: 10.1111/j.1365-2044.2006.04712.x.
    1. Squara P. In: Year book of Intensive Care And Emergency Medicine. Vincent J, editor. Paris: Springer; 2008. Bioreactance, A new method for non invasive cardiac output monitoring; pp. 619–630.
    1. Claxton B, Morgan P, McKeague H, Mulpur A, Berridge J. Alveolar recruitment strategy improves arterial oxygenation after cardiopulmonary bypass. Anaesthesia. 2003;58:111–116. doi: 10.1046/j.1365-2044.2003.02892.x.
    1. Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986;1:307–310.
    1. Critchley LA, Critchley JA. A meta-analysis of studies using bias and precision statistics to compare cardiac output measurement techniques. J Clin Monit Comput. 1999;15:85–91. doi: 10.1023/A:1009982611386.
    1. Altman D, Bland J. Absence of evidence is not evidence of absence. Aust Vet J. 1996;74:311. doi: 10.1111/j.1751-0813.1996.tb13786.x.
    1. Sagan C. The Demon-Haunted World: Science as a Candle in the Dark. New York: Random House Publishing Group; 1995.
    1. Henning R. Effects of positive end-expiratory pressure on the right ventricle. J Appl Physiol. 1986;61:819–826.
    1. Lim S, Adams A, Simonson D, Dries D, Broccard A, Hotchkiss J, Marini J. Transient hemodynamic effects of recruitment maneuvers in three experimental models of acute lung injury. Crit Care Med. 2004;32:2378–2384. doi: 10.1097/01.CCM.0000147444.58070.72.
    1. Della Rocca G, Costa MG, Coccia C, Pompei L, Di Marco P, Vilardi V, Pietropaoli P. Cardiac output monitoring: aortic transpulmonary thermodilution and pulse contour analysis agree with standard thermodilution methods in patients undergoing lung transplantation. Can J Anaesth. 2003;50:707–711. doi: 10.1007/BF03018714.
    1. Combes A, Berneau JB, Luyt CE, Trouillet JL. Estimation of left ventricular systolic function by single transpulmonary thermodilution. Intensive Care Med. 2004;30:1377–1383.
    1. Hüter L, Schwarzkopf K, Preussler N, Schubert H, Schreiber T. The level of cardiac output affects the relationship and agreement between pulmonary artery and transpulmonary aortic thermodilution measurements in an animal model. J Cardiothorac Vasc Anesth. 2007;21:659–663. doi: 10.1053/j.jvca.2007.01.005.

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