title: Uncalibrated arterial pressure waveform analysis for less-invasive cardiac output determination in obese patients undergoing cardiac surgery.
abstract: BACKGROUND
  Uncalibrated arterial waveform analysis (FloTrac/Vigileo) uses standard arterial access to determine cardiac output (CO). Calculations are based on arterial waveform characteristics in combination with patient characteristic data to estimate individual arterial compliance. It has been shown that obesity is associated with altered arterial compliance independently of other risk factors. We conducted this study to assess the validity of measuring CO by the FloTrac/Vigileo device in obese patients undergoing cardiac surgery in comparison with bolus thermodilution technique.
  
  
  METHODS
  Fifteen obese patients with a BMI of > or = 30 and 23 non-obese patients (BMI 18-25) undergoing coronary artery bypass grafting (CABG) were included. Simultaneous CO measurements by bolus thermodilution and the FloTrac/Vigileo device (software version 1.10) were obtained intraoperatively after induction of anaesthesia, before cardiopulmonary bypass (CPB), after CPB, and after sternal closure. Measurements in the intensive care unit (ICU) were performed upon arrival in the ICU, after 4, 8, and 24 h after surgery. CO was indexed to the body surface area (cardiac index, CI).
  
  
  RESULTS
  The analysis of 262 data pairs revealed a bias and precision of 0.19 and +/-0.66 litre min(-1) m(-2), resulting in a percentage error of 26.6%. Thermodilution CI values ranged from 1.1 to 4.2 litre min(-1) m(-2) [mean 2.4 (0.52) litre min(-1) m(-2)]. Subgroup analysis resulted in a percentage error of 29.8% in obese patients and 24.4% in patients with normal BMI.
  
  
  CONCLUSIONS
  The semi-invasive FloTrac/Vigileo device was found to adequately agree with bolus pulmonary artery thermodilution in both obese and non-obese patients undergoing CABG.
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Klinikum Ludwigshafen, Bremserstr. 79, 67063 Ludwigshafen, Germany. j-mayer@gmx.de
authors.forename: J
authors.initials: J
authors.lastname: Mayer
authors.forename: J
authors.initials: J
authors.lastname: Boldt
authors.forename: R
authors.initials: R
authors.lastname: Beschmann
authors.forename: A
authors.initials: A
authors.lastname: Stephan
authors.forename: S
authors.initials: S
authors.lastname: Suttner
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000502:physiology; D015992:Body Mass Index; D002302:Cardiac Output / Q000502:physiology*; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D009765:Obesity / Q000503:physiopathology*; D017534:Radial Artery / Q000503:physiopathology; D015203:Reproducibility of Results; D013815:Thermodilution / Q000379:methods; D014655:Vascular Resistance / Q000502:physiology