title: Comparison of an advanced minimally invasive cardiac output monitoring with a continuous invasive cardiac output monitoring during lung transplantation.
abstract: The aim of this study was to compare a continuous non-calibrated left heart cardiac index (CI) measurement by arterial waveform analysis (FloTrac(®)/Vigileo(®)) with a continuous calibrated right heart CI measurement by pulmonary artery thermodilution (CCOmbo-PAC(®)/Vigilance II(®)) for hemodynamic monitoring during lung transplantation. CI was measured simultaneously by both techniques in 13 consecutive lung transplants (n = 4 single-lung transplants, n = 9 sequential double-lung transplants) at distinct time points perioperatively. Linear regression analysis and Bland-Altman analysis with percentage error calculation were used for statistical comparison of CI measurements by both techniques. In this study the FloTrac(®) system underestimated the CI in comparison with the continuous pulmonary arterial thermodilution (p < 0.000). For all measurement pairs we calculated a bias of -0.55 l/min/m(2) with limits of agreement between -2.31 and 1.21 l/min/m(2) and a percentage error of 55 %. The overall correlations before clamping a branch oft the pulmonary artery (percentage error 41 %) and during the clamping periods of a branch oft the pulmonary artery (percentage error 66 %) failed to reached the required percentage error of less than 30 %. We found good agreement of both CI measurements techniques only during the measurement point "15 min after starting the second one-lung ventilation period" (percentage error 30 %). No agreement was found during all other measurement points. This pilot study shows for the first time that the CI of the FloTrac(®) system is not comparable with the continuous pulmonary-artery thermodilution during lung transplantation including the time periods without clamping a branch of the pulmonary artery. Arterial waveform and continuous pulmonary artery thermodilution are, therefore, not interchangeable during these complex operations.
authors.affiliation: Department of Anaesthesiology, University of Munich, Marchionistrasse 15, 81377, Munich, Germany.
authors.forename: Roland
authors.initials: R
authors.lastname: Tomasi
authors.affiliation: Institute for Emergency Medicine and Management in Medicine, University of Munich, Schillerstrasse 53, 80336, Munich, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Prueckner
authors.affiliation: Department of Anaesthesiology, University of Munich, Marchionistrasse 15, 81377, Munich, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Czerner
authors.affiliation: Clinic of Cardiac Surgery, University of Munich, Marchionistrasse 15, 81377, Munich, Germany.
authors.forename: Renè
authors.initials: R
authors.lastname: Schramm
authors.affiliation: Department of General Thoracic Surgery, University of Munich, Marchionistrasse 15, 81377, Munich, Germany.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Preissler
authors.affiliation: Department of Anaesthesiology, University of Munich, Marchionistrasse 15, 81377, Munich, Germany.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Zwißler
authors.affiliation: Department of Anaesthesiology, University of Munich, Marchionistrasse 15, 81377, Munich, Germany. vera.dossow@med.uni-muenchen.de.
authors.forename: Vera
authors.initials: V
authors.lastname: von Dossow-Hanfstingl
mesh_terms: D000328:Adult; D000368:Aged; D002302:Cardiac Output; D005260:Female; D006439:Hemodynamics; D006801:Humans; D016014:Linear Models; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods* / Q000706:statistics & numerical data; D010865:Pilot Projects; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000502:physiology; D063177:Pulse Wave Analysis / Q000379:methods / Q000706:statistics & numerical data; D013815:Thermodilution / Q000379:methods / Q000706:statistics & numerical data
keywords: Arterial waveform analysis; Cardiac index; Cardiac output; FloTrac® system; Lung transplantation; Pulmonary artery catheter