Accuracy of arterial pressure waveform analysis for cardiac output measurement in comparison with thermodilution methods in patients undergoing living donor liver transplantation.
OBJECTIVE
The aim of this study was to assess the accuracy of the first and third versions of arterial pressure waveform cardiac output (APCO(v.1.0) and APCO(v.3.0)) measurements in comparison with thermodilution methods in patients undergoing living donor liver transplantation.


METHODS
Twenty patients were anesthetized and mechanically ventilated. A radial arterial line was connected to a dedicated transducer for the APCO evaluation (FloTrac™). A pulmonary artery catheter was placed and connected to a computer system (Vigilance™) to measure intermittent thermodilution cardiac output (CO(TD)) and continuous cardiac output (CCO).


RESULTS
A total of 138 measurements were analyzed. Bland-Altman analysis showed that the mean biases for CO(TD)-APCO(v.3.0), CO(TD)-APCO(v.1.0), and CO(TD)-CCO were 0.89, 1.73, and -0.79 L/min, and the adjusted percentage errors were 37.5, 30.3, and 43%, respectively. While the variance for CO(TD)-APCO(v3.0) was greater, the accuracy (bias) improved by 0.8 L/min as compared with CO(TD)-APCO(v1.0). The difference CO(TD)-APCO(v.3.0) became apparent when systemic vascular resistance was lower than 1000 dyne × s/cm(5), especially below 700 dyne × s/cm(5).


CONCLUSIONS
These data suggest that the accuracy of APCO(v.3.0) has improved compared to APCO(v.1.0) due to the updated algorithm, but additional improvements should be evaluated, especially in patients undergoing living donor liver transplantation with low systemic vascular resistance.
Department of Anesthesiology and Critical Care Medicine, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
Kozaburo
K
Akiyoshi
Tadashi
T
Kandabashi
Junko
J
Kaji
Ken
K
Yamaura
Hayashi
H
Yoshimura
Kazuo
K
Irita
Sumio
S
Hoka
D000368:Aged; D001794:Blood Pressure; D002302:Cardiac Output; D005260:Female; D006801:Humans; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D013815:Thermodilution; D014655:Vascular Resistance
Intensive Care Med. 2007 Feb;33(2):344-9
17063359
Intensive Care Med. 2011 Feb;37(2):233-40
21153399
Br J Anaesth. 2007 Sep;99(3):329-36
17631509
Br J Anaesth. 2007 Sep;99(3):337-42
17611251
Pharmacol Ther. 2001 Mar;89(3):221-31
11516477
J Cardiothorac Vasc Anesth. 2007 Feb;21(1):3-7
17289472
Hepatogastroenterology. 2005 Sep-Oct;52(65):1521-5
16201110
Anesth Analg. 2008 May;106(5):1480-6, table of contents
18420863
Br J Anaesth. 2007 Sep;99(3):309-11
17702826
Expert Rev Med Devices. 2005 Sep;2(5):523-7
16293062
Crit Care Med. 2007 Aug;35(8):1904-9
17581493
World J Gastroenterol. 2007 Nov 28;13(44):5918-25
17990357
Lancet. 1986 Feb 8;1(8476):307-10
2868172
J Clin Monit Comput. 1999 Feb;15(2):85-91
12578081
J Appl Physiol. 1976 Feb;40(2):171-6
1248996
Med Hypotheses. 2004;62(1):82-5
14729009
Br J Anaesth. 2007 Feb;98(2):176-82
17218375
Crit Care. 2006;10(6):R164
17118186