title: Ability of the third-generation FloTrac/Vigileo software to track changes in cardiac output in cardiac surgery patients: a polar plot approach.
abstract: OBJECTIVE
  To evaluate the ability of the third-generation (3.01) of FloTrac/Vigileo monitor (Edwards Lifesciences, Irvine, CA) to follow variations in cardiac output (∆CO) using the new polar plot approach.
  
  
  METHODS
  Prospective interventional study.
  
  
  METHODS
  Single hospital university study.
  
  
  METHODS
  Twenty-five patients referred for cardiac surgery.
  
  
  METHODS
  CO was measured simultaneously by 3 to 5 bolus thermodilution (COtd measurements), using a pulmonary artery catheter and by arterial pulse contour analysis, using the FloTrac/Vigileo (COvi). Data were collected at eight time points: before incision, after sternotomy, before and after protamine sulfate infusion, at the start of sternal closure, at the end of surgery, on arrival to intensive care unit, and after a standardized volume expansion with 500 mL of hetastarch 6%.
  
  
  RESULTS
  One-hundred thirty-five pairs of CO data were collected; the mean bias of all CO measurements corrected for repeated measures was 0.2 L/min with limits of agreements of -3.3 L/min and +2.9 L/min. The percentage error was 66.5%. The polar plot analysis included 71 significant ∆CO and showed a mean polar angle of -3.4 degrees with 95% polar percentage error equivalent limits of -61 to 55; 69% of analysed data points fell within the 30-degree limits and provided a correct polar concordance rate.
  
  
  CONCLUSIONS
  Third-generation FloTrac/Vigileo software still lacks the accuracy to reliably detect changes in cardiac output (∆CO) in cardiac surgery. Improvements to FloTrac/Vigileo CO algorithm and software still are needed in this particular setting.
authors.affiliation: Department of Anesthesiology and Intensive Care, Louis Pradel Hospital; Laboratory EA4169, Claude Bernard Lyon 1 University, Lyon, France. Electronic address: oldesebbe@yahoo.com.
authors.forename: Olivier
authors.initials: O
authors.lastname: Desebbe
authors.forename: Roland
authors.initials: R
authors.lastname: Henaine
authors.forename: Geoffray
authors.initials: G
authors.lastname: Keller
authors.forename: Catherine
authors.initials: C
authors.lastname: Koffel
authors.forename: Hans
authors.initials: H
authors.lastname: Garcia
authors.forename: Pascal
authors.initials: P
authors.lastname: Rosamel
authors.forename: Jean-Francois
authors.initials: JF
authors.lastname: Obadia
authors.forename: Olivier
authors.initials: O
authors.lastname: Bastien
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Lehot
authors.forename: Marek
authors.initials: M
authors.lastname: Haftek
authors.forename: Lester A H
authors.initials: LA
authors.lastname: Critchley
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002302:Cardiac Output / Q000502:physiology*; D006348:Cardiac Surgical Procedures / Q000379:methods*; D003627:Data Interpretation, Statistical; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000295:instrumentation* / Q000379:methods*; D011446:Prospective Studies; D012372:ROC Curve; D012984:Software; D013815:Thermodilution / Q000379:methods
keywords: cardiac output; intraoperative monitoring; pulse-wave analysis; thermodilution; thoracic surgery