title: Noninvasive cardiac output monitoring (NICOM): a clinical validation.
abstract: OBJECTIVE
  To evaluate the clinical utility of a new device for continuous noninvasive cardiac output monitoring (NICOM) based on chest bio-reactance compared with cardiac output measured semi-continuously by thermodilution using a pulmonary artery catheter (PAC-CCO).
  
  
  METHODS
  Prospective, single-center study.
  
  
  METHODS
  Intensive care unit.
  
  
  METHODS
  Consecutive adult patients immediately after cardiac surgery.
  
  
  METHODS
  Cardiac output measurements obtained from NICOM and thermodilution were simultaneously recorded minute by minute and compared in 110 patients. We evaluated the accuracy, precision, responsiveness, and reliability of NICOM for detecting cardiac output changes. Tolerance for each of these parameters was specified prospectively.
  
  
  RESULTS
  A total of 65,888 pairs of cardiac output measurements were collected. Mean reference values for cardiac output ranged from 2.79 to 9.27 l/min. During periods of stable PAC-CCO (slope<+/-10%, 2SD/mean<20%), the correlation between NICOM and thermodilution was R=0.82; bias was +0.16+/-0.52 l/min (+4.0+/-11.3%), and relative error was 9.1%+/-7.8%. In 85% of patients the relative error was <20%. During periods of increasing output, slopes were similar with the two methods in 96% of patients and intra-class correlation was positive in 96%. Corresponding values during periods of decreasing output were 90% and 84%, respectively. Precision was always better with NICOM than with thermodilution. During hemodynamic challenges, changes were 3.1+/-3.8 min faster with NICOM (p<0.01) and amplitude of changes did not differ significantly. Finally, sensitivity of the NICOM for detecting significant directional changes was 93% and specificity was 93%.
  
  
  CONCLUSIONS
  Cardiac output measured by NICOM had most often acceptable accuracy, precision, and responsiveness in a wide range of circulatory situations.
authors: CERIC, Clinique Ambroise Paré, 27, boulevard Victor Hugo, 92200, Neuilly-sur-Seine, France. pierre.squara@wanadoo.fr.
authors: Pierre
authors: P
authors: Squara
authors: CERIC, Clinique Ambroise Paré, 27, boulevard Victor Hugo, 92200, Neuilly-sur-Seine, France.
authors: Dominique
authors: D
authors: Denjean
authors: CERIC, Clinique Ambroise Paré, 27, boulevard Victor Hugo, 92200, Neuilly-sur-Seine, France.
authors: Philippe
authors: P
authors: Estagnasie
authors: CERIC, Clinique Ambroise Paré, 27, boulevard Victor Hugo, 92200, Neuilly-sur-Seine, France.
authors: Alain
authors: A
authors: Brusset
authors: CERIC, Clinique Ambroise Paré, 27, boulevard Victor Hugo, 92200, Neuilly-sur-Seine, France.
authors: Jean Claude
authors: JC
authors: Dib
authors: CERIC, Clinique Ambroise Paré, 27, boulevard Victor Hugo, 92200, Neuilly-sur-Seine, France.
authors: Claude
authors: C
authors: Dubois
mesh_terms: D000368:Aged; D002302:Cardiac Output; D006348:Cardiac Surgical Procedures; D006801:Humans; D007362:Intensive Care Units; D008991:Monitoring, Physiologic / Q000295:instrumentation / Q000379:methods*; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013815:Thermodilution