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Reliability of a new 4th generation FloTrac algorithm to track cardiac output changes in patients receiving phenylephrine

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Abstract

Phenylephrine is often used to treat intra-operative hypotension. Previous studies have shown that the FloTrac cardiac monitor may overestimate cardiac output (CO) changes following phenylephrine administration. A new algorithm (4th generation) has been developed to improve performance in this setting. We performed a prospective observational study to assess the effects of phenylephrine administration on CO values measured by the 3rd and 4th generation FloTrac algorithms. 54 patients were enrolled in this study. We used the Nexfin, a pulse contour method shown to be insensitive to vasopressor administration, as the reference method. Radial arterial pressures were recorded continuously in patients undergoing surgery. Phenylephrine administration times were documented. Arterial pressure recordings were subsequently analyzed offline using three different pulse contour analysis algorithms: FloTrac 3rd generation (G3), FloTrac 4th generation (G4), and Nexfin (nf). One minute of hemodynamic measurements was analyzed immediately before phenylephrine administration and then repeated when the mean arterial pressure peaked. A total of 157 (4.6 ± 3.2 per patient, range 1–15) paired sets of hemodynamic recordings were analyzed. Phenylephrine induced a significant increase in stroke volume (SV) and CO with the FloTrac G3, but not with FloTrac G4 or Nexfin algorithms. Agreement between FloTrac G3 and Nexfin was: 0.23 ± 1.19 l/min and concordance was 51.1 %. In contrast, agreement between FloTrac G4 and Nexfin was: 0.19 ± 0.86 l/min and concordance was 87.2 %. In conclusion, the pulse contour method of measuring CO, as implemented in FloTrac 4th generation algorithm, has significantly improved its ability to track the changes in CO induced by phenylephrine.

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Acknowledgments

The authors thank Zhongping Jian, PhD of Edwards Lifesciences for assisting with the data analysis and members of the Department of Anesthesiology and Perioperative Care, University of California, Irvine for assisting with part of the data collection. This work was supported by the University of California Davis Health System Department of Anesthesiology and Pain Medicine, and NIH grant UL1 TR000002. This study was supported by a grant from Edwards Lifesciences, a grant from Jiangsu Province’s by Key Provincial Talents Program, China (Fuhai Ji), by Jiangsu province’s six major peak talents program, China (Fuhai Ji) and by Suzhou science and No. SYS201111 (Fuhai Ji) from Technology Bureau’s program, China.

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Authors and Affiliations

  1. Department of Anesthesiology and Pain Medicine, University of California Davis Health System, 4150 V Street, Suite 1200, Sacramento, CA, 95817, USA

    Fuhai Ji, Neal Fleming, David Rose & Hong Liu

  2. Department of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China

    Fuhai Ji & Jian Li

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  1. Fuhai Ji
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  2. Jian Li
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  3. Neal Fleming
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  4. David Rose
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  5. Hong Liu
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Correspondence to Hong Liu.

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Fuhai Ji and Jian Li have contributed equally to this paper.

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Ji, F., Li, J., Fleming, N. et al. Reliability of a new 4th generation FloTrac algorithm to track cardiac output changes in patients receiving phenylephrine. J Clin Monit Comput 29, 467–473 (2015). https://doi.org/10.1007/s10877-014-9624-0

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  • DOI: https://doi.org/10.1007/s10877-014-9624-0

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