Validation of a new arterial pulse contour-based cardiac output device.
OBJECTIVE
To evaluate the accuracy and precision of an arterial pulse contour-based continuous cardiac output device (Vigileo). Vigileo cardiac output (VigileoCO) was compared with intermittent transpulmonary thermodilution cardiac output (TPCO) and an established arterial pulse contour-based cardiac output (PCCO).


METHODS
Prospective clinical study.


METHODS
University hospital.


METHODS
Twenty-two patients undergoing coronary artery bypass graft surgery.


METHODS
Defined volume load during surgery and in the postoperative period.


RESULTS
We obtained 184 pairs of VigileoCO and TPCO, 140 pairs of VigileoCO and PCCO, and 140 pairs of PCCO and TPCO. Measurements were performed after induction of anesthesia (T1), after sternotomy (T2), immediately after (T3) and 20 mins after volume challenge with 10 mL.kg hydroxyethyl starch 6% (T4), 15 mins after coronary pulmonary bypass (T5), after retransfusion of autologous blood (T6), after arrival at the intensive care unit (T7), and immediately after (T8) and 20 mins after (T9) a second volume load with 10 mL.kg hydroxyethyl starch 6%. TPCO was used to calibrate PCCO. For pooled data, including uncalibrated PCCO data immediately after weaning from coronary pulmonary bypass (T5), the correlation coefficient of TPCO vs. VigileoCO, PCCO vs. VigileoCO, and TPCO vs. PCCO was 0.75, 0.60, and 0.75 respectively. Bland-Altman analysis showed a bias of 0.00, -0.01, and 0.02 L.min, the precision (=sd) was 0.87, 1.08, and 0.93 L.min, and the mean error was 33%, 40%, and 35%. When we compared calibrated PCCO values (T2-T4, T6, T7-9), the correlation coefficients of PCCO-VigileoCO and TPCO-PCCO were 0.72 and 0.85, bias was -0.16 and 0.19 L.min, and mean error was 33% and 27%, respectively. Best correlations and the least differences between TPCO and VigileoCO were observed in postbypass closed-chest conditions and in the intensive care unit.


CONCLUSIONS
Our results showed that VigileoCO enables clinically acceptable assessment of cardiac output in postbypass closed-chest conditions and during stable conditions in the intensive care unit.
de Waal
Eric E C
EE
Division of Perioperative and Emergency Care, University Medical Center, Utrecht, The Netherlands. e.e.c.dewaal@azu.nl
Kalkman
Cor J
CJ
Rex
Steffen
S
Buhre
Wolfgang F
WF
D000368:Aged; D000465:Algorithms; D002138:Calibration; D002302:Cardiac Output; D002407:Catheterization, Swan-Ganz; D001026:Coronary Artery Bypass; D005260:Female; D006334:Heart Function Tests / Q000295:instrumentation; D006801:Humans; D008297:Male; D008991:Monitoring, Physiologic / Q000295:instrumentation* / Q000379:methods; D019990:Perioperative Care; D012016:Reference Values; D015203:Reproducibility of Results; D013815:Thermodilution