title: Inaccuracy of the FloTrac/Vigileo™ system in patients with low cardiac index.
abstract: OBJECTIVE
  The goal of this study was to compare cardiac output derived from the FloTrac/Vigileo™ system (CO(FT)) with cardiac output measured by 3-dimensional transesophageal echocardiography (CO3D) in patients with severe heart failure undergoing cardiac resynchronization therapy. The impact of preoperative systemic vascular resistance index on the accuracy of the FloTrac/Vigileo™ system also was investigated.
  
  
  METHODS
  Prospective clinical study.
  
  
  METHODS
  Cardiac surgery operating room of a single cardiovascular center.
  
  
  METHODS
  Forty-one patients undergoing elective cardiac resynchronization therapy lead implantation.
  
  
  METHODS
  CO3D as the reference method and CO(FT) were determined simultaneously after induction of anesthesia.
  
  
  RESULTS
  Linear regression analysis showed a poor correlation between CO3D and CO(FT) (R² = 0.16). Bland-Altman plots showed wide limits of agreement between CO3D and CO(FT.). Bias was 0.60 ± 0.63 L/min with a high percentage error of 58.2%. Subgroup analysis showed that the percentage error between CO3D and CO(FT) was 74.1% in patients with a cardiac index<2.2 L/min/m(2) and 17.2% in patients with a cardiac index ≥ 2.2 L/min/m(2). Systemic vascular resistance index was significantly higher in patients with a cardiac index<2.2 L/min/m(2) (3,037 ± 820 v 2,461 ± 878; p = 0.039).
  
  
  CONCLUSIONS
  The FloTrac/Vigileo™ system is not accurate in patients with low cardiac output, especially those with a cardiac index<2.2 L/min/m(2). A high systemic vascular resistance index in patients with low cardiac index may contribute to this inaccuracy.
authors.affiliation: Department of Anesthesiology, National Cerebral and Cardiovascular Center, Osaka, Japan. Electronic address: takuma@ncvc.go.jp.
authors.forename: Takuma
authors.initials: T
authors.lastname: Maeda
authors.affiliation: Department of Anesthesiology, National Cerebral and Cardiovascular Center, Osaka, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Yoshitani
authors.affiliation: Department of Anesthesiology, National Cerebral and Cardiovascular Center, Osaka, Japan.
authors.forename: Yuzuru
authors.initials: Y
authors.lastname: Inatomi
authors.affiliation: Department of Anesthesiology, National Cerebral and Cardiovascular Center, Osaka, Japan.
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Ohnishi
mesh_terms: D000328:Adult; D000368:Aged; D002302:Cardiac Output; D058406:Cardiac Resynchronization Therapy / Q000379:methods; D006348:Cardiac Surgical Procedures; D019560:Echocardiography, Three-Dimensional / Q000379:methods; D017548:Echocardiography, Transesophageal / Q000379:methods; D005260:Female; D006333:Heart Failure / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000295:instrumentation* / Q000379:methods / Q000592:standards*; D057234:Preoperative Period; D011446:Prospective Studies; D015203:Reproducibility of Results; D013815:Thermodilution / Q000379:methods; D014655:Vascular Resistance / Q000502:physiology; D055815:Young Adult
keywords: cardiac output; heart failure; intraoperative monitoring; low cardiac output syndrome; pulse-wave analysis; thermodilution