Effect of norepinephrine dosage and calibration frequency on accuracy of pulse contour-derived cardiac output.
BACKGROUND
Continuous cardiac output monitoring is used for early detection of hemodynamic instability and guidance of therapy in critically ill patients. Recently, the accuracy of pulse contour-derived cardiac output (PCCO) has been questioned in different clinical situations. In this study, we examined agreement between PCCO and transcardiopulmonary thermodilution cardiac output (COTCP) in critically ill patients, with special emphasis on norepinephrine (NE) administration and the time interval between calibrations.


METHODS
This prospective, observational study was performed with a sample of 73 patients (mean age, 63 ± 13 years) requiring invasive hemodynamic monitoring on a non-cardiac surgery intensive care unit. PCCO was recorded immediately before calibration by COTCP. Bland-Altman analysis was performed on data subsets comparing agreement between PCCO and COTCP according to NE dosage and the time interval between calibrations up to 24 hours. Further, central artery stiffness was calculated on the basis of the pulse pressure to stroke volume relationship.


RESULTS
A total of 330 data pairs were analyzed. For all data pairs, the mean COTCP (±SD) was 8.2 ± 2.0 L/min. PCCO had a mean bias of 0.16 L/min with limits of agreement of -2.81 to 3.15 L/min (percentage error, 38%) when compared to COTCP. Whereas the bias between PCCO and COTCP was not significantly different between NE dosage categories or categories of time elapsed between calibrations, interchangeability (percentage error <30%) between methods was present only in the high NE dosage subgroup (≥0.1 μg/kg/min), as the percentage errors were 40%, 47% and 28% in the no NE, NE < 0.1 and NE ≥ 0.1 μg/kg/min subgroups, respectively. PCCO was not interchangeable with COTCP in subgroups of different calibration intervals. The high NE dosage group showed significantly increased central artery stiffness.


CONCLUSIONS
This study shows that NE dosage, but not the time interval between calibrations, has an impact on the agreement between PCCO and COTCP. Only in the measurements with high NE dosage (representing the minority of measurements) was PCCO interchangeable with COTCP.
Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Schwanenweg 21, D-24105 Kiel, Germany. gruenewald@anaesthesie.uni-kiel.de
Matthias
M
Gruenewald
Patrick
P
Meybohm
Jochen
J
Renner
Ole
O
Broch
Amke
A
Caliebe
Norbert
N
Weiler
Markus
M
Steinfath
Jens
J
Scholz
Berthold
B
Bein
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002138:Calibration; D002302:Cardiac Output / Q000187:drug effects* / Q000502:physiology; D003422:Critical Care / Q000379:methods*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D009638:Norepinephrine / Q000494:pharmacology*; D011446:Prospective Studies; D015203:Reproducibility of Results; D013815:Thermodilution / Q000379:methods; D013997:Time Factors; D014662:Vasoconstrictor Agents / Q000494:pharmacology*; D055815:Young Adult
D014662:Vasoconstrictor Agents; D009638:Norepinephrine
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