Cardiac output monitoring in septic shock: evaluation of the third-generation Flotrac-Vigileo.
Continuous cardiac index (CI) monitoring is frequently used in critically ill patients. Few studies have compared the pulse contour-based device FloTrac/Vigileo to pulmonary artery thermodilution (PAC) in terms of accuracy for CI monitoring in septic shock. The aim of our study was to compare the third-generation FloTrac/Vigileo to PAC in septic shock. Eighteen patients with septic shock requiring monitoring by PAC were included in this study. We monitored CI using both FloTrac/Vigileo and continuous thermodilution (PAC-CI). Hemodynamic data were recorded every hour or every 2 min during fluid challenges. The primary endpoint was the global agreement of all CI-paired measurements determined using the Bland-Altman method adapted to replicated data. We tested the linearity of the bias by regression analysis, and compared the reactivity of the 2 techniques during fluid challenges. A receiver operating characteristic (ROC) curve analysis tested the ability of FloTrac/Vigileo to detect concordant and significative CI changes, using PAC-CI as the reference method. Overall, 1,201 paired CI measurements were recorded. The Bland-Altman analysis for global agreement of the 2 techniques showed a bias of -0.1 ± 2.1 L min(-1) m(-2) and a percentage error of 64 %. The overall correlation coefficient between PAC-CI and FloTrac/Vigileo CI was 0.47 (p < 0.01), with r(2) = 0.22. The area under the curve of the ROC curve for detecting concordant and significant changes in CI was 0.72 (0.53; 0.87). In our study, third-generation Flowtrac-Vigileo appears to be too inaccurate to be recommended for CI monitoring in septic shock.
Service de Réanimation Médico-Chirurgicale, Centre Hospitalier Sud Francilien, 116 boulevard Jean Jaurès, 91106 Corbeil Essonnes, France. sophie.marque@ch-sud-francilien.fr
Sophie
S
Marqué
Antoine
A
Gros
Loic
L
Chimot
Arnaud
A
Gacouin
Sylvain
S
Lavoué
Christophe
C
Camus
Yves
Y
Le Tulzo
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002302:Cardiac Output; D016638:Critical Illness; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000295:instrumentation* / Q000706:statistics & numerical data; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000503:physiopathology; D012772:Shock, Septic / Q000503:physiopathology*; D012984:Software; D013815:Thermodilution / Q000295:instrumentation / Q000706:statistics & numerical data