JOURNAL HOME CME HOME THIS MONTH PAST ISSUES ETOC COLLECTIONS
AUTHORS REVIEWERS EDITORIAL BOARD FEEDBACK RSS HELP
A&A International Anesthesia Research Society
QUICK SEARCH:   [advanced]


     

Anesth Analg 2008; 106:1480-1486
© 2008 International Anesthesia Research Society
doi: 10.1213/ane.0b013e318168b309
This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a colleague
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Matthieu, B.
Right arrow Articles by François, S.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Matthieu, B.
Right arrow Articles by François, S.
Related Collections
Right arrow Cardiovascular
Right arrow Heart
Right arrow Monitoring (Cardiac)
Right arrow Technology

TECHNOLOGY, COMPUTING, AND SIMULATION

Section Editor:
Jeffrey M. Feldman

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

Biais Matthieu, MD, Nouette-Gaulain Karine, MD, PhD, Cottenceau Vincent, MD, Vallet Alain, MD, Cochard Jean François, MD, Revel Philippe, MD, and Sztark François, MD, PhD

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.


   Abstract
Top
 Abstract
Introduction
 METHODS
 RESULTS
 DISCUSSION
 REFERENCES
 
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®/FloTracTM) 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 (ICOSM), 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 ICOSM 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 ICOSM 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 ICOSM 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.


   Introduction
Top
 Abstract
 Introduction
METHODS
 RESULTS
 DISCUSSION
 REFERENCES
 
Cardiac output (CO) and invasive hemodynamic measurements are useful during liver transplantation, especially when hemodynamic instability occurs and massive transfusion of blood products is anticipated.1,2 The standard clinical method for intraoperative measurements of CO is intermittent pulmonary artery thermodilution (ICOTD). STAT-Mode (ICOSM) is an alternative to ICOTD and is obtained using automatic thermodilution.3 Good correlation, high levels of accuracy and precision are found between ICOTD and ICOSM.3–5 However, pulmonary artery catheterization may cause rare but serious complications and misinterpretations.6–9 For several years, less invasive methods to monitor CO continuously have been developed, including monitors using arterial pressure waveform analysis. Recently, a new device for monitoring CO continuously that does not require external calibration or a pulmonary artery catheter (PAC) has been introduced (Vigileo®/FloTracTM; Edwards Lifesciences, Irvine, CA). It calculates CO by using arterial pressure waveform analysis (APCO) in conjunction with patient demographic data (height, weight, age, and gender) to estimate arterial compliance.10 Previous studies evaluated the agreement between APCO and ICOTD and between APCO and transpulmonary thermodilution CO (COTPT) with contradictory results.11–14 To our knowledge, the Vigileo/FloTrac system has not been evaluated in a specific population of liver transplant patients.

In this clinical study, we evaluated the agreement between APCO and ICOSM during steady-state periods in patients undergoing orthotopic liver transplantation.


   METHODS
Top
 Abstract
 Introduction
 METHODS
RESULTS
 DISCUSSION
 REFERENCES
 
Patients
After obtaining approval from the ethics committee and informed consent, 20 consecutive patients scheduled to undergo liver transplantation for acute or chronic liver failure were enrolled. Child-Pugh grade was defined for each patient.15,16

Exclusion criteria were the following: patients younger than 18 yr, arrhythmias, body mass index >40 kg/m2 or <15 kg/m2, valvular heart disease, in particular tricuspid regurgitation and intracardiac shunt. No change was required from established protocols for monitoring and critical care management used at our institution. Vasopressive drugs and fluid administration was guided by patients' hemodynamic data.

Perioperative Management
Patients were anesthetized with sufentanil and propofol. Cisatracurium was used for muscle relaxation. Sufentanil and isoflurane were used for maintenance of anesthesia. After the induction of anesthesia, the patient's trachea was intubated and mechanical ventilation was instituted using volume-controlled ventilation. All patients' lungs were ventilated with an oxygen-air mixture to maintain an arterial oxygen partial pressure above 13.3 kPa, and ventilation parameters were adjusted to ensure an arterial carbon dioxide partial pressure between 4.7 and 5.4 kPa.

Liver transplantation was accomplished without venovenous bypass using the three-phase piggy-back.17 First, the attachments of the diseased liver were resected, and the vascular structures were prepared for resection. The second or anhepatic phase extends from the time when the host liver was removed until the donor liver was revascularized. Finally, the graft was reperfused.

After liver transplantation, patients were admitted to the intensive care unit (ICU). Patients were sedated with propofol and sufentanil, and mechanical volume-controlled ventilation was continued for a minimum 4 h period.

Cardiopulmonary Monitoring
After the induction of anesthesia and just before the beginning of surgery, a PAC (CCOmbo, 744HF75, 7.5 Fr, Edwards Lifesciences) was inserted via the left subclavian vein through an introducer (M3L9FHSI, 9 Fr, Edwards Lifesciences) and was connected to the Vigilance monitor (Edwards Lifesciences) for CO monitoring. The position of the catheter was confirmed by pressure curves, {Delta}-pulmonary artery occlusion pressure/{Delta}-pulmonary artery pressure (PAP) ratio as previously described18 and postoperatively by chest radiograph. Intracardiac pressure and PAP were monitored continuously. A safe level of heat was transferred to the blood by a computer-controlled thermal filament mounted on the PAC.3 To eliminate the natural temperature variations in the pulmonary artery, which could constitute background "thermal noise," heat was transferred to the blood in a pseudorandom on–off fashion.3,19 The observed changes in pulmonary artery temperature were recorded by the distal rapid-response thermistor in the pulmonary artery. There was no need for user calibration because the Vigilance monitor automatically computed a cross-correlation between the filament input sequence, the power, and the distal thermistor response to blood warming.19 From this cross-correlation, CO was calculated using a modified Stewart-Hamilton equation.19,20 STAT-Mode displayed the actual CO values determined within the past 60 s (ICOSM) and continuous cardiac output (CCO), which was an average of the previous 3–6 min ICOSM. Heart rate, central venous pressure, and PAP were displayed on a bedside monitor, and pressures were recorded at the end of the expiration with the zero level set at midthorax.

APCO Monitoring
A 3 Fr, 8-cm-long arterial catheter (115.09, Vygon, Ecouen, France) was inserted in the left radial artery. A dedicated transducer was connected to the radial arterial line for APCO evaluation (Vigileo System, FloTracTM, Edwards Lifesciences). This system needs no external calibration and provides CCO measurements from the arterial pressure wave. The Vigileo (Software version 1.07) records hemodynamic variables at 20-s intervals, performing its calculations on the most recent 20 s data. The system calculates the stroke volume (SV) using arterial pulsatility (standard deviation of the pulse pressure over a 20-s interval), resistance, and compliance (Eq. 1). The CO is calculated as follows: CO = heart rate x SV.



Formula 1

where K is a constant quantifying arterial compliance and vascular resistance, derived from a multivariate regression model including (i) Langewouter's aortic compliance,21 (ii) mean arterial blood pressure (MAP), (iii) variance, (iv) skewness, and (v) kurtosis of the pressure curve. The rate of adjustment of K was 1 min (Software 1.07). Pulsatility is proportional to the standard deviation of the arterial pressure wave over a 20-s interval.

Study Protocol
Fifteen sets of measurements were performed in the operating room after the induction of anesthesia: 5, 15, and 25 min after PAC insertion (T1–3); 5, 15, and 25 min after portal clamping (T4–6); 15, 25, and 35 min after the hepatectomy (T7–9); and 10, 20, 30, 40, 50, and 60 min after reperfusion (T10–15). Five sets of measurements were made in the ICU: 60, 90, 120, 150, and 180 min after the admission (T16–20). Each set of measurements was made with the patient in the supine position and during a steady-state period, i.e., at least 5 min after a change in infusion rate of catecholamine or sedative drugs, or ventilatory settings. At each time point, three consecutive measurements of ICOSM were performed and the plausibility of every temperature curve was judged visually on the Vigilance monitor. If ICOSM changed by more than 15% during the steady-state period, five measurements were performed and the highest and lowest were rejected. For each measurement of ICOSM, a corresponding simultaneous APCO was recorded. The average of the consecutive measurements of ICOSM and APCO was used for statistical analysis. CCO was not used for statistical analysis.

Hemodynamic data were grouped into five phases: after PAC insertion (3 measurements), after portal clamping (3 measurements), after hepatectomy (3 measurements), after reperfusion (6 measurements), and in the ICU (5 measurements).

ICOSM and APCO measurements were obtained by two operators who were blinded to the corresponding CO measurement of the other method.

Statistical Analysis
All results were expressed as mean ± standard deviation (sd) unless indicated otherwise. APCO and ICOSM were compared using the Bland and Altman method.22 Bias (mean difference between APCO and ICOSM) represents the systematic error between both methods. Precision (sd of the bias) is representative of the random error or variability between the different techniques. The limits of agreement were calculated as bias ±2sd, and defined the range in which 95% of the differences between the methods were expected to lie.

The percentage error was calculated as the ratio of 2sd of the bias to mean CO and was considered clinically acceptable if it was below 30%, as proposed by Critchley and Critchley.23

Bias, limits of agreements, and percentage error between ICOSM and APCO were calculated for all data, separately for the five phases (PAC insertion, after portal clamping, after hepatectomy, after reperfusion, and after arrival in ICU) and separately for different Child-Pugh grades (A, B, and C). The relation between systemic vascular resistance (SVR) and the bias between ICOSM and APCO were tested using a logarithmic regression. Changes in CO ({Delta}-CO) were calculated as the differences between consecutive measurements. The ability to detect {Delta}-CO was tested using the Bland–Altman method. Child-Pugh grade A, B, and C patient data were compared using a Student's t-test. All statistical analysis was computed with StatView (Version 5.0; SAS Institute Inc.). A P value ≤0.05 was considered significant.


   RESULTS
Top
 Abstract
 Introduction
 METHODS
 RESULTS
DISCUSSION
 REFERENCES
 
Twenty patients (6 women, 14 men) were enrolled. Their average age was 51 ± 9 yr, average weight was 63 ± 12 kg, and average height was 170 ± 9 cm. The average body surface area was 1.80 ± 0.16 m2. Surgical indications were hepatitis C virus cirrhosis (n = 6), hepatitis B virus cirrhosis (n = 1), alcoholic cirrhosis (n = 11), and others (n = 2). The Child-Pugh classification was A, B, and C, respectively, for 3, 10, and 7 patients. The average Model for End-Stage Liver Disease score was 16 ± 5, and the average packed red blood cell transfusion was 6 ± 4 U. Mean anesthesia time was 7.5 ± 2 h. Four-hundred comparative measurements performed between ICOSM and APCO were obtained. No data were rejected. ICOSM values ranged from 2.5 to 12.3 L/min (mean 6.4 ± 2.3 L/min) whereas the values for APCO ranged from 2.1 to 9.5 L/min (mean 5.5 ± 1.3 L/min). All patients received norepinephrine (0.36 ± 0.40 µg · kg–1 · min–1). Hemodynamic data are shown in Table 1. No adverse effect related to PAC was observed.


View this table:
[in this window]
[in a new window]

  		Table 1. Hemodynamic Data in Patients Classified as Child-Pugh Grade A, B, and C

 

Global Analysis
The bias between ICOSM and APCO was 0.8 L/min, and 95% limits of agreement were –1.8 to 3.5 L/min (Fig. 1). The percentage error between all ICOSM and APCO measurements was 43%. Bias between ICOSM and APCO was correlated with SVR [r2 = 0.55; P < 0.0001; y = 15.8–2.2 ln(x)] (Fig. 2). Delta-CO was calculated separately for each method and data comparison revealed a bias of 0.1 L/min; 95% limits of agreement were –2.4 to 2.7 L/min.


Figure 125
View larger version (13K):
[in this window]
[in a new window]

  		Figure 1. Bland–Altman plot between ICOSM-APCO. The unbroken lines show the mean difference and the dotted lines show the 2sd limits of agreement. ICOSM= Instantaneous Cardiac Output Stat-Mode; APCO= Vigileo®/FloTracTM Cardiac Output.

 

Figure 225
View larger version (16K):
[in this window]
[in a new window]

  		Figure 2. Regression analysis between systemic vascular resistance (SVR) and ICOSM-APCO. ICOSM= Instantaneous Cardiac Output Stat-Mode; APCO= Vigileo®/FloTracTM Cardiac Output.

 

Subgroup Analysis
Bias, limits of agreements, and percentage error of the five phases are shown in Table 2. Bias between Delta-ICOSM and Delta-APCO were not different in the five phases.


View this table:
[in this window]
[in a new window]

  		Table 2. Bias, 95% Limits of Agreement, and Percentage Error Between ICOSM and APCO Measurements at Different Phases of Liver Transplantation

 

Bias, limits of agreements, and percentage error in different Child-Pugh grades are shown in Table 3. Child-Pugh A patients presented a percentage error <30% and a bias between ICOSM and APCO significantly lower than Child-Pugh B and C patients (Fig. 3).


View this table:
[in this window]
[in a new window]

  		Table 3. Bias, 95% Limits of Agreement, and Percentage Error Between ICOSM and APCO Measurements in Patients with Child-Pugh Grade A, B, and C

 

Figure 325
View larger version (10K):
[in this window]
[in a new window]

  		Figure 3. Bland–Altman plot between ICOSM and APCO obtained in patients classified as Child-Pugh A (A), B (B), and C (C). The unbroken lines show the mean difference and the dotted lines show the 2sd limits of agreement. ICOSM= Instantaneous Cardiac Output Stat-Mode; APCO= Vigileo®/FloTracTM Cardiac Output.

 

Bias between Delta-ICOSM and Delta-APCO in Child-Pugh A, B, and C patients was, respectively, –0.11, 0.5, and –0.1 L/min, and 95% limits of agreement were, respectively –1.09 to 0.86, –2.2 to 3.1, and –2.9 to 2.6 L/min.


   DISCUSSION
Top
 Abstract
 Introduction
 METHODS
 RESULTS
 DISCUSSION
REFERENCES
 
In the present study, APCO values differed significantly from ICOSM values in patients undergoing liver transplantation. We found a bias of 0.8 L/min, 95% limits of agreement of –1.8 to 3.5 L/min. The percentage error was 43%, exceeding a 30% limit of acceptability.

Recently published studies investigating the Vigileo/FloTrac showed discordant results (Table 4). Studies performed in patients undergoing cardiac surgery, liver transplantation, or in patients with septic shock found clinically unacceptable bias and limits of agreement between APCO and ICOTD, and between APCO and COTPT.12–14,24,25 However, three other cardiosurgical studies found clinically acceptable bias and limits of agreement between APCO and ICOTD or between APCO and COTPT.11,26,27 De Waal et al. reported a mean bias of 0.00 L/min (sd = 0.87) between APCO and COTPT in 22 patients studied after cardiac surgery.27 Button et al. showed that performance of the Vigileo/FloTrac, the PiCCOplusTM and the Vigilance CCO monitor for CO measurement were comparable when tested against ICOTD in 31 patients undergoing cardiac surgery.26 Manecke et al. studied 50 postoperative cardiac surgery patients and found that APCO algorithm provided CO assessments that agreed satisfactorily for clinical purposes with intermittent thermodilution.11 The bias and the precision were, respectively, 0.55 and 0.98 L/min between APCO and ICOTD. The authors did not calculate the percentage error as proposed by Critchley and Critchley and were unable to conclude whether the results were clinically acceptable.


View this table:
[in this window]
[in a new window]

  		Table 4. Studies Comparing Data Obtained with Vigileo®/FloTracTM to Those Obtained with PAC or Transpulmonary Thermodilution

 

The Vigileo/FloTrac calculates CO using arterial waveform characteristics and patients' demographic data. The relation between pressure pulse and SV depends on the characteristics of the arterial vascular tree (compliance and resistance). Mechanical arterial properties differ from patient to patient and can differ in the same patient, particularly during liver transplantation, with a large decrease in SVR after graft reperfusion. The extent of vasodilation has an impact on the arterial pressure waveform.28 The lack of external calibration could explain the value of the bias and the percentage error between APCO and ICOSM. Indeed, other techniques using the arterial wave (PulseCO system, LiDCO Group, London, UK; PiCCO system, Pulsion SG, Munich, Germany; Finapres Modelflow system, Finapres Medical System, Amsterdam, Netherlands) require calibration with another method of CO assessment (Lithium, transpulmonary thermodilution).29,30 The initial invasive calibration decreases the bias due to interindividual differences, and other calibrations are required in case of marked changes in SVR with the PiCCO system, for example.31 Our study was performed in patients with mainly a moderate or severe Child-Pugh grade (B and C). The patients' data revealed a high bias between APCO and ICOSM and a percentage error higher than 30%, whereas Child-Pugh grade A patient data showed a percentage error of 15%. Several reasons might explain these results. The cardiovascular system in cirrhotic patients is characterized by increased CO, decreased peripheral vascular resistance, and decreased MAP. Child-Pugh grade is directly related to central and nonsplanchnic hemodynamic alterations.32 In the present study, SVR and MAP were significantly lower and CO was significantly higher in patients classified as Child-Pugh B and C. We hypothesized that in these groups, vasodilation induced by cirrhosis could interfere with the arterial pressure waveform and with its analysis. This interpretation is supported by the result of the logarithmic regression between bias between ICOSM-APCO and SVR. Costa et al. demonstrated that during liver transplantation, the bias and the 95% limits of agreement between ICOTD-APCO increased significantly in hyperdynamic conditions (CO >8 L/min).24 Moreover, vasoactive treatments induce changes in vascular impedance and compliance with an impact on arterial pressure waveform. These may affect the accuracy of APCO to a greater extent than the accuracy of ICOSM. In the present study, all of the patients received norepinephrine (0.36 ± 0.40 µg · kg–1 · min–1), which may have impacted the level of bias between APCO and ICOSM. Furthermore, the Vigileo/FloTrac uses radial artery pressure waveforms. Systolic radial artery pressure is higher than systolic aortic pressure, whereas diastolic and mean pressures were found to be equal in both sites.33,34 In all pulse contour methods, the aortic pressure waveform should ideally be used as the input for the pulse contour method. Femoral artery pressure waveforms as well as the brachial artery waveform are probably more similar to the aortic pressure waveform than the radial artery waveform.

Our study had some limitations. APCO was compared with ICOSM and we did not use ICOTD. ICOTD is often referred to as the clinical standard, but it has well-known pitfalls related to operator variation, patient pathologies, and the indicator used.35 Although ICOSM has its own inherent limitations and is not a "gold standard" method, previous studies have shown acceptable limits of agreement.4,36–42 However, because of a time delay of the CO calculation, the STAT-Mode may miss rapid and transient hemodynamic changes.38,43,44 In the case of liver transplantation, accuracy between ICOTD and ICOSM may decrease when rapid changes in CO occur, when the thermal noise increases, when caval clamping is required, or when peripheral IV fluid infusion rates are high.36,37 To avoid these pitfalls, liver transplantation was done without caval clamping by using the piggy-back technique,17 and measurements were made during stable hemodynamic and thermal conditions defined in the protocol as the lack of change in infusion rate of catecholamine, of sedative drugs or ventilatory setting for 5 min. Despite these precautions, minimal CO variations may have occurred during these steady-state periods and influenced our results. This could explain the lower bias and percentage error in the ICU, with minimal hemodynamic variations. Finally, one of the hemodynamic specificities of liver transplant patients is low SVR and high CO. Many sources of error have been identified regarding the thermodilution method, including high CO levels, and these may contribute to low accuracy between ICOSM and APCO.35,45

In conclusion, CO values obtained with uncalibrated arterial pressure waveform analysis (Software 1.07) in patients undergoing liver transplantation do not agree with thermodilution data (percentage error of 43%), particularly in patients with low SVR as attested by Child-Pugh grade B and C. The extent of vasodilation observed in our patients may account for the poor correlation between both methods.


   ACKNOWLEDGMENTS
 
The authors thank Françoise Masson for statistical support and Ray Cooke for revising the English.


   Footnotes
 
Accepted for publication December 28, 2007.


   REFERENCES
Top
 Abstract
 Introduction
 METHODS
 RESULTS
 DISCUSSION
 REFERENCES
 

  1. Pirat A, Sargin D, Torgay A, Arslan G. Identification of preoperative predictors of intraoperative blood transfusion requirement in orthotopic liver transplantation. Transplant Proc 2002;34:2153–55[Web of Science][Medline]
  2. Schroeder R, Collins B, Tuttle-Newhall E, Robertson K, Plotkin J, Johnson L, Kuo P. Intraoperative fluid management during orthotopic liver transplantation. J Cardiothorac Vasc Anesth 2004;18:438–41[Web of Science][Medline]
  3. Yelderman M, Quinn MD, McKown RC. Thermal safety of a filamented pulmonary artery catheter. J Clin Monit 1992;8:147–9[Web of Science][Medline]
  4. Boldt J, Menges T, Wollbruck M, Hammermann H, Hempelmann G. Is continuous cardiac output measurement using thermodilution reliable in the critically ill patient? Crit Care Med 1994;22:1913–8[Web of Science][Medline]
  5. Bottiger BW, Soder M, Rauch H, Bohrer H, Motsch J, Bauer H, Martin E. Semi-continuous versus injectate cardiac output measurement in intensive care patients after cardiac surgery. Intensive Care Med 1996;22:312–8[Web of Science][Medline]
  6. Bowdle TA. Complications of invasive monitoring. Anesthesiol Clin North Am 2002;20:571–88[Medline]
  7. Gnaegi A, Feihl F, Perret C. Intensive care physicians' insufficient knowledge of right-heart catheterization at the bedside: time to act? Crit Care Med 1997;25:213–20[Web of Science][Medline]
  8. Iberti TJ, Fischer EP, Leibowitz AB, Panacek EA, Silverstein JH, Albertson TE. A multicenter study of physicians' knowledge of the pulmonary artery catheter. Pulmonary Artery Catheter Study Group. JAMA 1990;264:2928–32[Abstract/Free Full Text]
  9. Jain M, Canham M, Upadhyay D, Corbridge T. Variability in interventions with pulmonary artery catheter data. Intensive Care Med 2003;29:2059–62[Web of Science][Medline]
  10. Manecke GR. Edwards FloTrac sensor and Vigileo monitor: easy, accurate, reliable cardiac output assessment using the arterial pulse wave. Expert Rev Med Devices 2005;2:523–7[Web of Science][Medline]
  11. Manecke GR Jr, Auger WR. Cardiac output determination from the arterial pressure wave: clinical testing of a novel algorithm that does not require calibration. J Cardiothorac Vasc Anesth 2007;21:3–7[Web of Science][Medline]
  12. Mayer J, Boldt J, Schollhorn T, Rohm KD, Mengistu AM, Suttner S. Semi-invasive monitoring of cardiac output by a new device using arterial pressure waveform analysis: a comparison with intermittent pulmonary artery thermodilution in patients undergoing cardiac surgery. Br J Anaesth 2007;98:176–82[Abstract/Free Full Text]
  13. Opdam HI, Wan L, Bellomo R. A pilot assessment of the FloTrac cardiac output monitoring system. Intensive Care Med 2007;33:344–9[Web of Science][Medline]
  14. Sander M, Spies CD, Grubitzsch H, Foer A, Muller M, von Heymann C. Comparison of uncalibrated arterial waveform analysis in cardiac surgery patients with thermodilution cardiac output measurements. Crit Care 2006;10:R164[Medline]
  15. Child CG, Turcotte JG. Surgery and portal hypertension. Major Probl Clin Surg 1964;1:1–85[Medline]
  16. Pugh RN, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg 1973;60:646–9[Web of Science][Medline]
  17. Busque S, Esquivel CO, Concepcion W, So SK. Experience with the piggyback technique without caval occlusion in adult orthotopic liver transplantation. Transplantation 1998;65:77–82[Web of Science][Medline]
  18. Teboul J, Besbes M, Andrivet P, Axler O, Douguet D, Zelter M, Lemaire F, Brun-Buisson C. A bedside index assessing the reliability of pulmonary artery occlusion pressure measurements during mechanical ventilation with positive end-expiratory pressure. J Crit Care 1992;7:22–9[Web of Science]
  19. Yelderman M. Continuous measurement of cardiac output with the use of stochastic system identification techniques. J Clin Monit 1990;6:322–32[Web of Science][Medline]
  20. Yelderman M. Continuous cardiac output by thermodilution. Int Anesthesiol Clin 1993;31:127–40[Web of Science][Medline]
  21. Langewouters G, Wesseling K, Goedhard W. The pressure dependent dynamic elasticity of 35 thoracic and 16 abdominal human aortas in vitro described by a five component model. J Biomech 1985;18:613–20[Web of Science][Medline]
  22. Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986;327:307–10
  23. 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[Medline]
  24. Costa MG, Chiarandini P, Coccia C, Pompei L, Della Rocca G. Arterial pulse cardiac output agreement with thermodilution at different level of cardiac output. Anesthesiology 2006;105:A463
  25. Sakka SG, Kozieras J, Thuemer O, van Hout N. Measurement of cardiac output: a comparison between transpulmonary thermodilution and uncalibrated pulse contour analysis. Br J Anaesth 2007;99:337–42[Abstract/Free Full Text]
  26. Button D, Weibel L, Reuthebuch O, Genoni M, Zollinger A, Hofer CK. Clinical evaluation of the FloTrac/VigileoTM system and two established continuous cardiac output monitoring devices in patients undergoing cardiac surgery. Br J Anaesth 2007;99:329–36[Abstract/Free Full Text]
  27. de Waal EE, Kalkman CJ, Rex S, Buhre WF. Validation of a new arterial pulse contour-based cardiac output device. Crit Care Med 2007;35:1904–9[Web of Science][Medline]
  28. Watt TB Jr, Burrus CS. Arterial pressure contour analysis for estimating human vascular properties. J Appl Physiol 1976; 40:171–6[Abstract/Free Full Text]
  29. Della Rocca G, Costa MG, Pompei L, Coccia C, Pietropaoli P. Continuous and intermittent cardiac output measurement: pulmonary artery catheter versus aortic transpulmonary technique. Br J Anaesth 2002;88:350–6[Abstract/Free Full Text]
  30. Hamilton TT, Huber LM, Jessen ME. Pulse CO: a less-invasive method to monitor cardiac output from arterial pressure after cardiac surgery. Ann Thorac Surg 2002;74:S1408–12[Abstract/Free Full Text]
  31. Rodig G, Prasser C, Keyl C, Liebold A, Hobbhahn J. Continuous cardiac output measurement: pulse contour analysis vs thermodilution technique in cardiac surgical patients. Br J Anaesth 1999;82:525–30[Abstract/Free Full Text]
  32. Dincer D, Besisk F, Demirkol O, Demir K, Kaymakoglu S, Cakaloglu Y, Okten A. Relationships between hemodynamic alterations and Child-Pugh Score in patients with cirrhosis. Hepatogastroenterology 2005;52:1521–5[Medline]
  33. Kanazawa M, Fukuyama H, Kinefuchi Y, Takiguchi M, Suzuki T. Relationship between aortic-to-radial arterial pressure gradient after cardiopulmonary bypass and changes in arterial elasticity. Anesthesiology 2003;99:48–53[Web of Science][Medline]
  34. Soderstrom S, Nyberg G, O'Rourke MF, Sellgren J, Ponten J. Can a clinically useful aortic pressure wave be derived from a radial pressure wave? Br J Anaesth 2002;88:481–8[Abstract/Free Full Text]
  35. Nishikawa T, Dohi S. Errors in the measurement of cardiac output by thermodilution. Can J Anaesth 1993;40:142–53[Web of Science][Medline]
  36. Bottiger BW, Sinner B, Motsch J, Bach A, Bauer H, Martin E. Continuous versus intermittent thermodilution cardiac output measurement during orthotopic liver transplantation. Anaesthesia 1997;52:207–14[Web of Science][Medline]
  37. Greim CA, Roewer N, Thiel H, Laux G, Schulte am Esch J. Continuous cardiac output monitoring during adult liver transplantation: thermal filament technique versus bolus thermodilution. Anesth Analg 1997;85:483–8[Abstract]
  38. Lazor MA, Pierce ET, Stanley GD, Cass JL, Halpern EF, Bode RH Jr. Evaluation of the accuracy and response time of STAT-mode continuous cardiac output. J Cardiothorac Vasc Anesth 1997;11:432–6[Web of Science][Medline]
  39. Munro HM, Wood CE, Taylor BL, Smith GB. Continuous invasive cardiac output monitoring–the Baxter/Edwards Critical-Care Swan Ganz IntelliCath and Viligance system. Clin Intensive Care 1994;5:52–5[Medline]
  40. Neto EP, Piriou V, Durand PG, Du Gres B, Lehot JJ. Comparison of two semicontinuous cardiac output pulmonary artery catheters after valvular surgery. Crit Care Med 1999;27:2694–7[Web of Science][Medline]
  41. Singh A, Juneja R, Mehta Y, Trehan N. Comparison of continuous, stat, and intermittent cardiac output measurements in patients undergoing minimally invasive direct coronary artery bypass surgery. J Cardiothorac Vasc Anesth 2002;16:186–90[Web of Science][Medline]
  42. Sun Q, Rogiers P, Pauwels D, Vincent JL. Comparison of continuous thermodilution and bolus cardiac output measurements in septic shock. Intensive Care Med 2002;28:1276–80[Web of Science][Medline]
  43. Aranda M, Mihm FG, Garrett S, Mihm MN, Pearl RG. Continuous cardiac output catheters: delay in in vitro response time after controlled flow changes. Anesthesiology 1998;89:1592–5[Web of Science][Medline]
  44. Siegel LC, Hennessy MM, Pearl RG. Delayed time response of the continuous cardiac output pulmonary artery catheter. Anesth Analg 1996;83:1173–7[Abstract]
  45. Dhingra VK, Fenwick JC, Walley KR, Chittock DR, Ronco JJ. Lack of agreement between thermodilution and fick cardiac output in critically ill patients. Chest 2002;122:990–7[Web of Science][Medline]



This article has been cited by other articles:


Home page
 Anesth. Analg.Home page
M. R. Concha, V. F. Mertz, L. I. Cortinez, K. A. Gonzalez, and J. M. Butte
Pulse Contour Analysis and Transesophageal Echocardiography: A Comparison of Measurements of Cardiac Output During Laparoscopic Colon Surgery
Anesth. Analg., July 1, 2009; 109(1): 114 - 118.
[Abstract] [Full Text] [PDF]

Home page
 Br J AnaesthHome page
G. Gouvea, R. Diaz, L. Auler, R. Toledo, and J. M. Martinho
Evaluation of the pulse pressure variation index as a predictor of fluid responsiveness during orthotopic liver transplantation
Br. J. Anaesth., May 19, 2009; (2009) aep123v1.
[Abstract] [Full Text] [PDF]

Home page
 Br J AnaesthHome page
R. Chatti, S. de Rudniki, S. Marque, A. S. Dumenil, A. Descorps-Declere, A. Cariou, J. Duranteau, M. Aout, E. Vicaut, and B. P. Cholley
Comparison of two versions of the Vigileo-FloTracTM system (1.03 and 1.07) for stroke volume estimation: a multicentre, blinded comparison with oesophageal Doppler measurements
Br. J. Anaesth., April 1, 2009; 102(4): 463 - 469.
[Abstract] [Full Text] [PDF]

Home page
 SEMIN CARDIOTHORAC VASC ANESTHHome page
F. Compton and J.-H. Schafer
Noninvasive Cardiac Output Determination: Broadening the Applicability of Hemodynamic Monitoring
Seminars in Cardiothoracic and Vascular Anesthesia, March 1, 2009; 13(1): 44 - 55.
[Abstract] [PDF]

Home page
 Anesth. Analg.Home page
M. Cannesson, H. Musard, O. Desebbe, C. Boucau, R. Simon, R. Henaine, and J.-J. Lehot
The Ability of Stroke Volume Variations Obtained with Vigileo/FloTrac System to Monitor Fluid Responsiveness in Mechanically Ventilated Patients
Anesth. Analg., February 1, 2009; 108(2): 513 - 517.
[Abstract] [Full Text] [PDF]

This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a colleague
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Matthieu, B.
Right arrow Articles by François, S.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Matthieu, B.
Right arrow Articles by François, S.
Related Collections
Right arrow Cardiovascular
Right arrow Heart
Right arrow Monitoring (Cardiac)
Right arrow Technology

Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press