title: Oesophageal Doppler and calibrated pulse contour analysis are not interchangeable within a goal-directed haemodynamic algorithm in major gynaecological surgery.
abstract: BACKGROUND
  Evidence for the benefit of an intraoperative use of a goal-directed haemodynamic management has grown. We compared the oesophageal Doppler monitor (ODM, CardioQ-ODM™) with a calibrated pulse contour analysis (PCA, PiCCO2™) with regard to assessment of stroke volume (SV) changes after volume administration within a goal-directed haemodynamic algorithm during non-cardiac surgery.
  
  
  METHODS
  The data were obtained prospectively in patients with metastatic ovarian carcinoma undergoing cytoreductive surgery. During surgery, fluid challenges were performed as indicated by the goal-directed haemodynamic algorithm guided by the ODM. Monitors were compared regarding precision and trending. Clinical characteristics associated with trending were studied by extended regression analysis.
  
  
  RESULTS
  A total of 762 fluid challenges were performed in 41 patients resulting in 1524 paired measurements. The precision of ODM and PCA was 5.7% and 6.0% (P=0.80), respectively. Polar plot analysis revealed a poor trending between ODM and PCA with an angular bias of -7.1°, radial limits of agreement of -58.1° to 43.8°, and an angular concordance rate of 67.8%. Dose of norepinephrine (NE) (scaled 0.1 µg kg(-1) min(-1)) [adjusted odds ratio (OR) 0.606 (95% confidence interval, CI: 0.404-0.910); P=0.016] and changes in mean arterial pressure (MAP) to a fluid challenge (scaled 10%) [adjusted OR 0.733 (95% CI: 0.635-0.845); P<0.001] were associated with trending between ODM and PCA, whereas there was no relation to type of i.v. solution.
  
  
  CONCLUSIONS
  Despite a similar precision, ODM and PCA were not interchangeable with regard to measuring SV changes within a goal-directed haemodynamic algorithm. A decrease in interchangeability coincided with increasing NE levels and greater changes of MAP to a fluid challenge.
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-University Medicine Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Feldheiser
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-University Medicine Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
authors.forename: O
authors.initials: O
authors.lastname: Hunsicker
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-University Medicine Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Krebbel
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-University Medicine Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Weimann
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-University Medicine Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
authors.forename: L
authors.initials: L
authors.lastname: Kaufner
authors.affiliation: Charité-University Medicine Berlin and SOSTANA GmbH Berlin, Wildensteiner Straße 27, 10318 Berlin, Germany.
authors.forename: K-D
authors.initials: KD
authors.lastname: Wernecke
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-University Medicine Berlin, Augustenburger Platz 1, 13353 Berlin, Germany claudia.spies@charite.de.
authors.forename: C
authors.initials: C
authors.lastname: Spies
mesh_terms: D000465:Algorithms; D002138:Calibration; D017548:Echocardiography, Transesophageal / Q000379:methods*; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods* / Q000401:mortality; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000295:instrumentation / Q000379:methods*; D010051:Ovarian Neoplasms / Q000601:surgery; D011446:Prospective Studies; D011674:Pulse / Q000706:statistics & numerical data*; D013318:Stroke Volume / Q000502:physiology*
keywords: goal-directed therapy; haemodynamic monitoring; oesophageal Doppler; pulse contour analysis; trending