title: Evaluation of cardiac output in intensive care using a non-invasive arterial pulse contour technique (Nexfin(®)) compared with echocardiography.
abstract: In this prospective study, cardiac output was measured in 38 intensive care unit patients before and after a fluid challenge, using both pulse contour analysis (Nexfin(®); BMEYE, Amsterdam, the Netherlands) and transthoracic echocardiography. The ability of the Nexfin device to detect significant changes in the velocity-time integral was evaluated. The pulse wave could not be detected by the Nexfin device in five patients (13%), leaving 33 patients for analysis. The Nexfin device adequately tracked changes in the velocity-time integral in 20 (61%) patients. Using a cut-off of a 10% increase in cardiac output estimated by the Nexfin or by echocardiography, the sensitivity of the Nexfin device to detect a response to fluid challenge was 47%, with specificity 81% and accuracy 64%. The percentage error between the Nexfin and echocardiography was 448%; lower limit of agreement -48% (95% CI -62 to -36%) and upper limit of agreement, 32% (95% CI 20-45%). We conclude that the Nexfin device does not adequately track changes in cardiac output in critically ill patients.
authors.affiliation: Department of Intensive Care, Erasme Hospital, Université libre de Bruxelles, Brussels, Belgium.
authors.forename: O
authors.initials: O
authors.lastname: Taton
authors.forename: D
authors.initials: D
authors.lastname: Fagnoul
authors.forename: D
authors.initials: D
authors.lastname: De Backer
authors.forename: J-L
authors.initials: JL
authors.lastname: Vincent
mesh_terms: D002302:Cardiac Output / Q000502:physiology*; D003102:Colloids / Q000008:administration & dosage; D003422:Critical Care / Q000379:methods*; D000077324:Crystalloid Solutions; D004452:Echocardiography / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007552:Isotonic Solutions / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D010991:Plethysmography / Q000295:instrumentation / Q000592:standards / Q000706:statistics & numerical data; D011446:Prospective Studies; D011674:Pulse; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
chemical_list: D003102:Colloids; D000077324:Crystalloid Solutions; D007552:Isotonic Solutions