Cardiac output monitoring in septic shock: evaluation of the third-generation Flotrac-Vigileo®
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Continuous cardiac index (CI) monitoring is frequently used in critically ill patients. Few studies have compared the pulse contour-based device FloTrac/Vigileo® to pulmonary artery thermodilution (PAC) in terms of accuracy for CI monitoring in septic shock. The aim of our study was to compare the third-generation FloTrac/Vigileo® to PAC in septic shock. Eighteen patients with septic shock requiring monitoring by PAC were included in this study. We monitored CI using both FloTrac/Vigileo® and continuous thermodilution (PAC-CI). Hemodynamic data were recorded every hour or every 2 min during fluid challenges. The primary endpoint was the global agreement of all CI-paired measurements determined using the Bland–Altman method adapted to replicated data. We tested the linearity of the bias by regression analysis, and compared the reactivity of the 2 techniques during fluid challenges. A receiver operating characteristic (ROC) curve analysis tested the ability of FloTrac/Vigileo® to detect concordant and significative CI changes, using PAC-CI as the reference method. Overall, 1,201 paired CI measurements were recorded. The Bland–Altman analysis for global agreement of the 2 techniques showed a bias of −0.1 ± 2.1 L min−1 m−2 and a percentage error of 64 %. The overall correlation coefficient between PAC-CI and FloTrac/Vigileo® CI was 0.47 (p < 0.01), with r2 = 0.22. The area under the curve of the ROC curve for detecting concordant and significant changes in CI was 0.72 (0.53; 0.87). In our study, third-generation Flowtrac-Vigileo® appears to be too inaccurate to be recommended for CI monitoring in septic shock.
KeywordsCardiac output Pulse contour analysis Septic shock Critically ill patients
Edwards Lifesciences SAS (France) provided the FloTrac® sensor kits and loaned the Vigileo® monitor used in the study.
Conflict of interest
The authors declare that they have no conflict of interest.
This clinical study complies with the French current laws. It was approved by the Ethical Committee of the French Society of Intensive Care Medicine (SRLF), which waived the need for informed patient consent (Ref 08/241).
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