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TECHNOLOGY, COMPUTING, AND SIMULATION

Cardiac Output Measurement in Patients Undergoing Liver Transplantation: Pulmonary Artery Catheter Versus Uncalibrated Arterial Pressure Waveform Analysis

From the Service d'Anesthésie Réanimation I, Hôpital Pellegrin, Centre Hospitalo-Universitaire de Bordeaux, Place Amélie Raba-Léon, Bordeaux Cedex, France.

Address correspondence and reprint requests to François Sztark, MD, PhD, Service d'Anesthésie Réanimation I, Hôpital Pellegrin, Place Amélie Raba-Léon, 33076 Bordeaux Cedex, France. Address e-mail to francois.sztark{at}chu-bordeaux.fr.

BACKGROUND: Cardiac output (CO) and invasive hemodynamic measurements are useful during liver transplantation. The pulmonary artery catheter (PAC) is commonly used for these patients, despite the potential complications. Recently, a less invasive device (Vigileo®/FloTrac^TM) became available, which estimates CO using arterial pressure waveform analysis without external calibration. In this study, we compared CO obtained with a PAC using automatic thermodilution, instantaneous CO stat-mode (ICO_SM), and CO obtained with the new device, arterial pressure waveform analysis (APCO) in patients undergoing liver transplantation.

METHODS: Twenty sets of simultaneous measurements of APCO and ICO_SM were determined in sedated and mechanically ventilated patients undergoing liver transplantation. Time points were as follows: after PAC insertion (T1–3), after portal clamping (T4–6), during anhepathy (T7–9), after graft reperfusion (T10–15), and in the postoperative period in the intensive care unit (T15–20).

RESULTS: We enrolled 20 patients and 400 measurements were obtained. No data were rejected. Bias between ICO_SM and APCO was 0.8 L/min, 95% limits of agreement were –1.8 to 3.5 L/min. The percentage error was 43%. Bias between ICO_SM and APCO was correlated with systemic vascular resistance [r² = 0.55, P < 0.0001, y = 15.8–2.2 ln(x)] and subgroup analysis revealed an increase in the bias and in the percentage error in patients with low systemic vascular resistance (Child-Pugh grade B and C patients). There was no difference between the different surgical periods.

CONCLUSIONS: Our results suggest that Vigileo/FloTrac CO monitoring data do not agree well with those of automatic thermodilution in patients undergoing liver transplantation, especially in Child-Pugh grade B and C patients with low systemic vascular resistance.

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