Evaluation of an uncalibrated arterial pulse contour cardiac output monitoring system in cirrhotic patients undergoing liver surgery
1 Liver Transplant Anaesthesia and Critical Care Medicine, Azienda Ospedaliera Universitaria Pisana, Ospedale Cisanello, Pisa, Italy
2 Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, P.R. China
3 Liver Transplant Unit, University School of Medicine, Pisa, Italy
* Corresponding author: UTI Trapianti, Ospedale Cisanello, Via Paradisa 2, 56100 Pisa, Italy. Email: g.biancofiore{at}med.unipi.it
Background: The pulmonary artery catheter is invasive and may cause serious complications. A safe method of cardiac output (CO) measurement is needed. We have assessed the accuracy and reliability of a recently marketed self-calibrating arterial pulse contour CO monitoring system (FloTrac/VigileoTM) in end-stage liver failure patients undergoing liver transplant. The pattern of alterations known as cirrhotic cardiomyopathy, and the transplant procedure itself, provided an evaluation under varying clinical conditions.
Methods: The cardiac index was measured simultaneously by thermodilution (CITD: mean of four readings) using a pulmonary artery catheter and pulse contour analysis (CIV: mean value computed by the FloTrac/VigileoTM over the same time period). Readings were made at 10 time-points during liver transplant surgery (T1–T5) and on the intensive care unit (T6–T10). CIV was computed using the latest Vigileo software version 01.10.
Results: A total of 290 paired readings from 29 patients were collected. Mean (SD) CITD was 5.2 (1.3) and CIV was 3.9 (0.9) litre min–1 m–2, with a corrected for repeated measures bias between readings of 1.3 (0.2) litre min–1 m–2 and 95% limits of agreement of –1.5 (0.2) to 4.1 (0.3) litre min–1 m–2. The percentage error (2SDBias/meanCITD) was 54%, which exceeded a 30% limit of acceptance. Low peripheral resistance and increasing bias were related (r=0.69; P<0.001). The Vigileo system failed to reliably trend CI data, with a concordance compared with thermodilution below an acceptable level (at best 68% of sequential readings).
Conclusions: In cirrhotic patients with hyperdynamic circulation, the Vigileo system showed a degree of error and unreliability higher than that considered acceptable for clinical purposes.
Keywords: heart, cardiac output; liver, transplantation; measurement techniques, thermodilution; monitoring, intensive care; monitoring, intraoperative
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- Evaluation of FloTrac/VigileoTM in patients undergoing liver transplantation
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