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Continuous cardiac output measurement by un-calibrated pulse wave analysis and pulmonary artery catheter in patients with septic shock

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Abstract

Septic shock is a serious medical condition. With increased concerns about invasive techniques, a number of non-invasive and semi-invasive devices measuring cardiac output (CO) have become commercially available. The aim of the present study was to determine the accuracy, precision and trending abilities of the FloTrac and the continuous pulmonary artery catheter thermodilution technique determining CO in septic shock patients. Consecutive septic shock patients were included in two centres and CO was measured every 4 h up to 48 h by FloTrac (APCO) and by pulmonary artery catheter (PAC) using the continuous (CCO) and intermittent (ICO) technique. Forty-seven septic shock patients with 326 matched sets of APCO, CCO and ICO data were available for analysis. Bland and Altman analysis revealed a mean bias ±2 SD of 0.0 ± 2.14 L min−1 for APCO–ICO (%error = 34.5 %) and 0.23 ± 2.55 L min−1 for CCO–ICO (%error = 40.4 %). Trend analysis showed a concordance of 85 and 81 % for APCO and CCO, respectively. In contrast to CCO, APCO was influenced by systemic vascular resistance and by mean arterial pressure. In septic shock patients, APCO measurements assessed by FloTrac but also the established CCO measurements using the PAC did not meet the currently accepted statistical criteria indicating acceptable clinical performance.

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Acknowledgments

This study was supported by a grant of Edwards Lifesciences, Irvine, CA, USA.

Conflict of interest

In the past, CKH received lecturing fees and research grants from Edwards Lifesciences, Irvine, CA, USA. CKH has no other financial relationship with Edwards Lifesciences. MTG, JAA, AMA, UMS, PS, SAS, AMB and SH have no conflict of interests to declare and have no financial relationship with Edwards Lifesciences.

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Authors and Affiliations

  1. Institute of Anaesthesiology and Pain Medicine, Kantonsspital Winterthur, Brauerstr. 15, 8401, Winterthur, Switzerland

    Michael T. Ganter

  2. Department of Anaesthesia and Critical Care, King Abdulaziz University Jeddah, P.O. Box 80215, 21589, Jeddah, Saudi Arabia

    Jamal A. Alhashemi, Adel M. Al-Shabasy, Sanaa A. Shalabi & Ahmed M. Badri

  3. Section of Epidemiology, Vetsuisse Faculty, University of Zurich, Winterthurerstr. 270, 8057, Zurich, Switzerland

    Sonja Hartnack

  4. Institute of Anaesthesiology and Intensive Care Medicine, Triemli City Hospital Zurich, Birmensdorferstr. 497, 8063, Zurich, Switzerland

    Ursina M. Schmid, Peter Schott & Christoph K. Hofer

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  1. Michael T. Ganter
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  2. Jamal A. Alhashemi
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Correspondence to Christoph K. Hofer.

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Ganter, M.T., Alhashemi, J.A., Al-Shabasy, A.M. et al. Continuous cardiac output measurement by un-calibrated pulse wave analysis and pulmonary artery catheter in patients with septic shock. J Clin Monit Comput 30, 13–22 (2016). https://doi.org/10.1007/s10877-015-9672-0

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  • DOI: https://doi.org/10.1007/s10877-015-9672-0

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