title: Continuous cardiac output measurement by un-calibrated pulse wave analysis and pulmonary artery catheter in patients with septic shock.
abstract: Septic shock is a serious medical condition. With increased concerns about invasive techniques, a number of non-invasive and semi-invasive devices measuring cardiac output (CO) have become commercially available. The aim of the present study was to determine the accuracy, precision and trending abilities of the FloTrac and the continuous pulmonary artery catheter thermodilution technique determining CO in septic shock patients. Consecutive septic shock patients were included in two centres and CO was measured every 4 h up to 48 h by FloTrac (APCO) and by pulmonary artery catheter (PAC) using the continuous (CCO) and intermittent (ICO) technique. Forty-seven septic shock patients with 326 matched sets of APCO, CCO and ICO data were available for analysis. Bland and Altman analysis revealed a mean bias ±2 SD of 0.0 ± 2.14 L min(-1) for APCO-ICO (%error = 34.5 %) and 0.23 ± 2.55 L min(-1) for CCO-ICO (%error = 40.4 %). Trend analysis showed a concordance of 85 and 81 % for APCO and CCO, respectively. In contrast to CCO, APCO was influenced by systemic vascular resistance and by mean arterial pressure. In septic shock patients, APCO measurements assessed by FloTrac but also the established CCO measurements using the PAC did not meet the currently accepted statistical criteria indicating acceptable clinical performance.
authors.affiliation: Institute of Anaesthesiology and Pain Medicine, Kantonsspital Winterthur, Brauerstr. 15, 8401, Winterthur, Switzerland.
authors.forename: Michael T
authors.initials: MT
authors.lastname: Ganter
authors.affiliation: Department of Anaesthesia and Critical Care, King Abdulaziz University Jeddah, P.O. Box 80215, 21589, Jeddah, Saudi Arabia.
authors.forename: Jamal A
authors.initials: JA
authors.lastname: Alhashemi
authors.affiliation: Department of Anaesthesia and Critical Care, King Abdulaziz University Jeddah, P.O. Box 80215, 21589, Jeddah, Saudi Arabia.
authors.forename: Adel M
authors.initials: AM
authors.lastname: Al-Shabasy
authors.affiliation: Institute of Anaesthesiology and Intensive Care Medicine, Triemli City Hospital Zurich, Birmensdorferstr. 497, 8063, Zurich, Switzerland.
authors.forename: Ursina M
authors.initials: UM
authors.lastname: Schmid
authors.affiliation: Institute of Anaesthesiology and Intensive Care Medicine, Triemli City Hospital Zurich, Birmensdorferstr. 497, 8063, Zurich, Switzerland.
authors.forename: Peter
authors.initials: P
authors.lastname: Schott
authors.affiliation: Department of Anaesthesia and Critical Care, King Abdulaziz University Jeddah, P.O. Box 80215, 21589, Jeddah, Saudi Arabia.
authors.forename: Sanaa A
authors.initials: SA
authors.lastname: Shalabi
authors.affiliation: Department of Anaesthesia and Critical Care, King Abdulaziz University Jeddah, P.O. Box 80215, 21589, Jeddah, Saudi Arabia.
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Badri
authors.affiliation: Section of Epidemiology, Vetsuisse Faculty, University of Zurich, Winterthurerstr. 270, 8057, Zurich, Switzerland.
authors.forename: Sonja
authors.initials: S
authors.lastname: Hartnack
authors.affiliation: Institute of Anaesthesiology and Intensive Care Medicine, Triemli City Hospital Zurich, Birmensdorferstr. 497, 8063, Zurich, Switzerland. hoferck@gmail.com.
authors.forename: Christoph K
authors.initials: CK
authors.lastname: Hofer
mesh_terms: D002138:Calibration; D002302:Cardiac Output; D002406:Catheterization, Peripheral / Q000295:instrumentation / Q000379:methods; D003936:Diagnosis, Computer-Assisted / Q000295:instrumentation / Q000379:methods*; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D006334:Heart Function Tests / Q000295:instrumentation / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D011669:Pulmonary Wedge Pressure; D063177:Pulse Wave Analysis / Q000295:instrumentation* / Q000379:methods; D015203:Reproducibility of Results; D012529:Saudi Arabia; D012680:Sensitivity and Specificity; D012772:Shock, Septic / Q000175:diagnosis*; D012984:Software; D013557:Switzerland; D013815:Thermodilution / Q000379:methods
keywords: Cardiac output, measurement; Pulmonary artery catheter; Pulse wave analysis; Sepsis; Stroke volume, measurement; Thermodilution