title: The impact of systemic vascular resistance on the accuracy of the FloTrac/Vigileo™ system in the perioperative period of cardiac surgery: a prospective observational comparison study.
abstract: FloTrac/Vigileo™ system is based on arterial pressure waveform analysis arterial pressure-based CO (APCO). Therefore, systemic vascular resistance (SVR) can influence the accuracy of APCO. The purpose of this study is to evaluate the relationship between SVR and the accuracy of APCO. We managed 50 consecutive patients in the perioperative period of cardiac surgery with FloTrac/Vigileo™ system (v. 3.02) and Swan-Ganz catheter/Vigilance™ system pulmonary artery catheter-based CO (PAC-CO) simultaneously. Continuous hemodynamic measurement using both methods was performed every 20 s from the induction of anesthesia to PAC removal 4 h after extubation. A total of 11,092 (intraoperative), 38,455 (postoperative, pre-extubation), and 44,235 (postoperative, post-extubation) data pairs were finally analyzed. Bland-Altman analysis revealed that in the intraoperative [postoperative pre-extubation, post-extubation] period, the bias was 0.5 [0.1, 0.0] L/min and the limits of agreement ranged from -2.4 to 3.3 [-2.2 to 2.4, -2.4 to 2.3] L/min. The percentage error was 60.3 [54.5, 48.5] %. Regression analysis of the systemic vascular resistance index (SVRI) and the bias between APCO and PAC-CO showed that the bias was positively correlated to the SVRI. Subanalysis based on SVR with Lin's concordance correlation coefficient revealed that relatively satisfactory concordance was found in the normal-SVR group (concordance correlation coefficient ρ c = 0.51-0.56) regardless of vasoactive agent use. The accuracy of the FloTrac/Vigileo™ System (v. 3.02) is relatively satisfactory in the condition with normal SVR regardless of vasoactive agent use. Positive correlation between the bias and SVR can be the clue to the more effective use of FloTrac/Vigileo™ system.
authors.affiliation: Cardiovascular Center, Sakurabashi-Watanabe Hospital, 2-4-32 Umeda, Kita-ku, Osaka, 530-0001, Japan, sotomiyohei@yahoo.co.jp.
authors.forename: Yohei
authors.initials: Y
authors.lastname: Sotomi
authors.forename: Katsuomi
authors.initials: K
authors.lastname: Iwakura
authors.forename: Yoshiharu
authors.initials: Y
authors.lastname: Higuchi
authors.forename: Kazuo
authors.initials: K
authors.lastname: Abe
authors.forename: Junko
authors.initials: J
authors.lastname: Yoshida
authors.forename: Takafumi
authors.initials: T
authors.lastname: Masai
authors.forename: Kenshi
authors.initials: K
authors.lastname: Fujii
mesh_terms: D000368:Aged; D062186:Arterial Pressure; D002302:Cardiac Output; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002407:Catheterization, Swan-Ganz / Q000379:methods; D016638:Critical Illness; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D059035:Perioperative Period; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000473:pathology; D012044:Regression Analysis; D015203:Reproducibility of Results; D013997:Time Factors; D014655:Vascular Resistance; D014662:Vasoconstrictor Agents / Q000737:chemistry
chemical_list: D014662:Vasoconstrictor Agents