Abstract
Purpose
Bioreactance is a non-invasive technology for measuring stroke volume (SV) in the operating room and critical care setting. We evaluated how the NICOM® bioreactance device performed against the CardioQ® esophageal Doppler monitor in patients undergoing major abdominal–pelvic surgery, focusing on the effect of different hemodynamic interventions.
Methods
SVNICOM and SVODM were simultaneously measured intraoperatively, including before and after interventions including fluid challenge, vasopressor boluses, peritoneal gas insufflation/removal, and Trendelenburg/reverse Trendelenburg patient positioning.
Results
A total of 768 values were collected from 21 patients. Pre- and post-intervention measures were recorded on 155 occasions. Bland–Altman analysis revealed a bias of 8.6 ml and poor precision with wide limits of agreement (54 and −37 ml) and a percentage error of 50.6%. No improvement in precision was detected after taking into account repeated measurements for each patient (bias: 8 ml; limits of agreement: 74 and −59 ml). Concordance between changes in SVNICOM and SVODM before and after interventions was also poor: 78.7% (all measures), 82.4% (after vasopressor administration), and 74.3% (after fluid challenge). Using Doppler SV as the reference technique, the area under the receiver operating characteristic curve assessing the ability of the NICOM device to predict fluid responsiveness was 0.81 (0.7–0.9).
Conclusions
In patients undergoing major abdomino-pelvic surgery, SV values obtained by NICOM showed neither clinically or statistically acceptable agreement with those obtained by esophageal Doppler. Although, in the setting of this study, bioreactance technology cannot reliably replace esophageal Doppler monitoring, its accuracy for predicting fluid responsiveness was higher, up to approximately 80%.
Trial registration
Observational study.
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Dr. De Pascale takes responsibility for the content of the manuscript, including the data and analysis. Dr. De Pascale and Dr. Brealey contributed to conception and design, acquisition of data, or analysis and interpretation of data; drafted the submitted article, revised it critically for important intellectual content and provided final approval of the version to be published. Prof Singer contributed to the design of the study, critically revised the paper for important intellectual content and provided final approval of the version to be published.
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Funding
No funding was received from either Deltex (CardioQ manufacturer) or Cheetah (NICOM manufacturer) for this study. NICOM electrodes were provided free for this evaluation by Cheetah.
Conflict of interest
Mervyn Singer sits on an advisory board for Deltex; his academic fund at UCL receives an annual unrestricted donation from Deltex. UCL also hold shares in Deltex donated by the Pauline Thomas Charitable Trust. He was not involved in the collection of data for this study. The other authors declare no conflict of interests regarding this study.
Ethical approval
This article does not contain any studies with human participants performed by any of the authors. The monitoring, interventions and data collected were part of standard care. In addition, the analyzed data were fully anonymized and, as such, specific ethics committee permission was not required.
Informed consent
For this type of study formal consent was not required.
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De Pascale, G., Singer, M. & Brealey, D. Comparison of stroke volume measurement between non-invasive bioreactance and esophageal Doppler in patients undergoing major abdominal–pelvic surgery. J Anesth 31, 545–551 (2017). https://doi.org/10.1007/s00540-017-2351-1
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DOI: https://doi.org/10.1007/s00540-017-2351-1