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BJA Advance Access published online on February 6, 2008
British Journal of Anaesthesia, doi:10.1093/bja/aem409
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2008. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Performance of a minimally invasive uncalibrated cardiac output monitoring system (FlotracTM/VigileoTM) in haemodynamically unstable patients{dagger}

F. D. Compton*, B. Zukunft, C. Hoffmann, W. Zidek and J.-H. Schaefer

Department of Nephrology, Charité University Medicine Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, D-12200 Berlin, Germany

* Corresponding author: Charité Centrum 10, Medizinische Klinik für Nephrologie, Charité Campus Benjamin Franklin, Hindenburgdamm 30, D-12200 Berlin, Germany. E-mail: friederike.compton{at}charite.de

Background: Early haemodynamic assessment is of particular importance in the evaluation of haemodynamically compromised patients, but is often precluded by the invasiveness and complexity of the established cardiac output (CO) monitoring techniques. The FloTracTM/VigileoTM system allows minimally invasive CO determination based on the arterial pressure waveform derived from any standard arterial catheter, and the algorithm underlying CO calculation was recently modified to allow a more precise estimate of aortic compliance.

Methods: Using the new software, we studied 25 haemodynamically unstable patients who had a radial artery catheter and underwent invasive haemodynamic monitoring with the PiCCOTM system. PiCCOTM-derived transpulmonary thermodilution and pulse contour CO (reference-CO) were compared with the CO values obtained with the FloTracTM/VigileoTM system (AP-CO). Reported CO values are indexed to body surface area. Agreement between reference-CO and AP-CO recorded during routine clinical care was assessed using Bland–Altman statistics.

Results: Overall bias between the reference-CO and the AP-CO (n=324) was 0.68 litre min–1 m–2 with a high percentage error of ±58.8% (95% limits of agreement ±1.94 l min–1 m–2). There was a significant difference (P<0.001) between the radial and the femoral mean arterial pressures, and bias was significantly larger for a mean pressure difference of >5 mm Hg (0.93 vs 0.57 litre min–1 m–2, P=0.032). No connection was found between the norepinephrine dose and the CO agreement.

Conclusions: Despite the updated algorithm, AP-CO still showed a limited agreement with the reference-CO and systematically underestimated the CO so that the method is not suitable to replace invasive CO monitoring at present.

Keywords: arterial pressure, measurement; intensive care; measurement techniques, cardiac output

{dagger} This work was presented in part at the annual congress of the European Society of Intensive Care Medicine (ESICM) 2007 in Berlin, Germany.


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Performance of a minimally invasive cardiac output monitoring system (Flotrac/Vigileo)
Thomas W.L. Scheeren, et al.
British Journal of Anaesthesia, 4 May 2008 [Full text]
Performance of the FloTrac™/Vigileo™
Friederike D Compton, et al.
British Journal of Anaesthesia, 16 May 2008 [Full text]

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