title: Two Methods of Hemodynamic and Volume Status Assessment in Critically Ill Patients: A Study of Disagreement.
abstract: BACKGROUND
  The invasive nature and potential complications associated with pulmonary artery (PA) catheters (PACs) have prompted the pursuit of less invasive monitoring options. Before implementing new hemodynamic monitoring technologies, it is important to determine the interchangeability of these modalities. This study examines monitoring concordance between the PAC and the arterial waveform analysis (AWA) hemodynamic monitoring system.
  
  
  METHODS
  Critically ill patients undergoing hemodynamic monitoring with PAC were simultaneously equipped with the FloTrac AWA system (both from Edwards Lifesciences, Irvine, California). Data were concomitantly obtained for hemodynamic variables. Bland-Altman methodology was used to assess CO measurement bias and κ coefficent to show discrepancies in intravascular volume.
  
  
  RESULTS
  Significant measurement bias was observed in both CO and intravascular volume status between the 2 techniques (mean bias, -1.055 ± 0.263 liter/min, r = 0.481). There was near-complete lack of agreement regarding the need for intravenous volume administration (κ = 0.019) or the need for vasoactive agent administration (κ = 0.015).
  
  
  CONCLUSIONS
  The lack of concordance between PAC and AWA in critically ill surgical patients undergoing active resuscitation raises doubts regarding the interchangeability and relative accuracy of these modalities in clinical use. Lack of awareness of these limitations can lead to errors in clinical decision making when managing critically ill patients.
authors.affiliation: Department of Surgery, Division of Trauma, Critical Care, and Burn, Ohio State University Wexner Medical Center, Columbus, OH, USA daniel.eiferman@osumc.edu.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Eiferman
authors.affiliation: Department of Surgery, Division of Trauma, Critical Care, and Burn, Ohio State University Wexner Medical Center, Columbus, OH, USA.
authors.forename: H Tracy
authors.initials: HT
authors.lastname: Davido
authors.affiliation: Department of Surgery, Division of Trauma, Critical Care, and Burn, Ohio State University Wexner Medical Center, Columbus, OH, USA.
authors.forename: James M
authors.initials: JM
authors.lastname: Howard
authors.affiliation: Department of Surgery, Division of Trauma, Critical Care, and Burn, Ohio State University Wexner Medical Center, Columbus, OH, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Gerckens
authors.affiliation: Department of Surgery, Division of Trauma, Critical Care, and Burn, Ohio State University Wexner Medical Center, Columbus, OH, USA.
authors.forename: David C
authors.initials: DC
authors.lastname: Evans
authors.affiliation: Department of Surgery, Division of Trauma, Critical Care, and Burn, Ohio State University Wexner Medical Center, Columbus, OH, USA.
authors.forename: Charles H
authors.initials: CH
authors.lastname: Cook
authors.affiliation: Department of Surgery, Division of Trauma, Critical Care, and Burn, Ohio State University Wexner Medical Center, Columbus, OH, USA.
authors.forename: S P A
authors.initials: SP
authors.lastname: Stawicki
mesh_terms: D000368:Aged; D003422:Critical Care / Q000379:methods*; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D011651:Pulmonary Artery / Q000502:physiology*; D015203:Reproducibility of Results
keywords: cardiac index; cardiac output; disagreement; hemodynamic monitoring; volume status