Cardiac output by femoral arterial thermodilution-calibrated pulse contour analysis during liver transplantation: comparison with pulmonary artery thermodilution.
OBJECTIVE
The continuous monitoring of the cardiac output during liver transplantation (LT) is an essential part of the intraoperative management of the patient's hemodynamics. To verify the accuracy of a new method based on femoral artery thermodilution-calibrated pulse contour analysis (PCCO) during LT, we compared the technique with the results of an intermittent pulmonary artery thermodilution method (ICO).


METHODS
A prospective study included 314 paired cardiac output measurements at 10 sampling times in 35 patients undergoing LT. After initial calibration of the pulse contour analysis, no further recalibrations were performed. Bland and Altman's statistical method, one-way ANOVA, and one sample t tests were used for the analysis of the data. A P<.05 was considered significant.


RESULTS
There was a small bias 0.18 L x min(-1) (6.29% from the ICO) for the whole sample of paired measurements, associated with 95% limits of agreement of +/-4.72 (68.89%) L x min(-1). The additional analysis showed comparable biases and limits of agreement for any single time in the study period. The difference PCCO-ICO showed a negative sign for ICO >10 L x min(-1) (P<.001) and a positive sign for ICO <5 L x min(-1) (P<.001). It was greater during infusion of a vasoactive drug (P<.001).


CONCLUSIONS
The pulse contour analysis was found to be an unsatisfactory substitute for intermittent thermodilution measurement of cardiac output during the LT.
Grigorov Tzenkov
I
I
Department of Anesthesia, University General Hospital Gregorio Marañon, Madrid, Spain. ivaylotzenkov@fastmail.fm
Arnal Velasco
D
D
Perez Peña
J M
JM
Olmedilla Arnal
L
L
Garutti Martínez
I
I
Sanz Fernández
J
J
D000704:Analysis of Variance; D002138:Calibration; D002302:Cardiac Output / Q000502:physiology*; D005263:Femoral Artery; D006801:Humans; D016031:Liver Transplantation / Q000379:methods* / Q000502:physiology*; D016343:Monitoring, Intraoperative; D015588:Observer Variation; D011651:Pulmonary Artery; D015203:Reproducibility of Results; D013815:Thermodilution / Q000379:methods*