title: Assessment of changes in cardiac index with calibrated pulse contour analysis in cardiac surgery: A prospective observational study.
abstract: OBJECTIVE
  To assess the trending ability of calibrated pulse contour cardiac index (CIPC) monitoring during haemodynamic changes (passive leg raising [PLR] and fluid loading) compared with transpulmonary thermodilution CI (CITD).
  
  
  METHODS
  Seventy-eight mechanically-ventilated patients admitted to intensive care with calibrated pulse contour following cardiac surgery were prospectively included and investigated during PLR, and after fluid loading. Fluid responsiveness was defined as a≥15% CITD increase after a 500ml bolus. Areas under the empiric receiver operating characteristic curves (ROCAUC) for changes in CIPC (ΔCIPC) during PLR to predict fluid responsiveness and after fluid challenge to predict an increase at least 15% in CITD after fluid loading were calculated.
  
  
  RESULTS
  Fifty-five patients (71%) were classified as responders, 23 (29%) as non-responders. ROCAUC for ΔCIPC during PLR in predicting fluid responsiveness, its sensitivity, specificity, and percentage of patients within the inconclusive class of response were 0.67 (95% CI=0.55-0.77), 0.76 (95% CI=0.63-0.87), 0.57 (95% CI=0.34-0.77) and 68%, respectively. Bias, precision and limits of agreements and percentage error between CIPC and CITD after fluid challenge were 0.14 (95% CI: 0.08-0.20), 0.26, -0.37 to 0.64 l min(-1)m(-2), and 20%, respectively. The concordance rate was 97% and the polar concordance at 30° was 91%. ROCAUC for ΔCIPC in predicting an increase of at least 15% in CITD after fluid loading was 0.85 (95% CI: 0.76-0.92).
  
  
  CONCLUSIONS
  Although ΔCIPC after fluid loading could track the direction of changes of CITD and was interchangeable with bolus transpulmonary thermodilution, PLR could not predict fluid responsiveness in cardiac surgery patients.
authors.affiliation: Pôle réanimations anesthésie Samu/Smur, CHU de Caen, avenue de la Côte-de-Nacre, CS 30001, 14000 Caen, France; EA 4650, université de Caen Basse-Normandie, Esplanade de la Paix, CS 14032, 14000 Caen, France. Electronic address: marcolivierfischer@yahoo.fr.
authors.forename: Marc-Olivier
authors.initials: MO
authors.lastname: Fischer
authors.affiliation: Pôle réanimations anesthésie Samu/Smur, CHU de Caen, avenue de la Côte-de-Nacre, CS 30001, 14000 Caen, France. Electronic address: rebet-o@chu-caen.fr.
authors.forename: Olivier
authors.initials: O
authors.lastname: Rebet
authors.affiliation: Anesthesiology and Critical Care Department, Amiens University Hospital, avenue René-Laennec, 80054 Amiens, France; Inserm U 1088, Jules-Vernes University of Picardy, Centre Universitaire de Recherche en Santé (CURS), chemin du Thil, 80025 Amiens cedex, France. Electronic address: guinotpierregregoire@gmail.com.
authors.forename: Pierre-Grégoire
authors.initials: PG
authors.lastname: Guinot
authors.affiliation: Pôle réanimations anesthésie Samu/Smur, CHU de Caen, avenue de la Côte-de-Nacre, CS 30001, 14000 Caen, France. Electronic address: charlotte.lemetayer@gmail.com.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Lemétayer
authors.affiliation: Service de chirurgie cardiaque, CHU de Caen, avenue de la Côte-de-Nacre, CS 30001, 14000 Caen, France. Electronic address: saplacan-v@chu-caen.fr.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Saplacan
authors.affiliation: Pôle réanimations anesthésie Samu/Smur, CHU de Caen, avenue de la Côte-de-Nacre, CS 30001, 14000 Caen, France. Electronic address: gerard-jl@chu-caen.fr.
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Gérard
authors.affiliation: Service d'anesthésie-réanimation, hôpital cardiologique Louis-Pradel, avenue du Doyen-Lepine, 69677 Lyon, France; Faculty of Medicine, University of Lyon 1 Claude-Bernard, 69008 Lyon, France. Electronic address: jean-luc.fellahi@chu-lyon.fr.
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Fellahi
authors.affiliation: Pôle réanimations anesthésie Samu/Smur, CHU de Caen, avenue de la Côte-de-Nacre, CS 30001, 14000 Caen, France; EA 4650, université de Caen Basse-Normandie, Esplanade de la Paix, CS 14032, 14000 Caen, France. Electronic address: hanouz-jl@chu-caen.fr.
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Hanouz
authors.affiliation: Anesthesiology and Critical Care Department, Amiens University Hospital, avenue René-Laennec, 80054 Amiens, France; Inserm U 1088, Jules-Vernes University of Picardy, Centre Universitaire de Recherche en Santé (CURS), chemin du Thil, 80025 Amiens cedex, France. Electronic address: lorne.emmanuel@chu-amiens.fr.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Lorne
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D002138:Calibration; D002302:Cardiac Output; D006348:Cardiac Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D019990:Perioperative Care; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results; D013815:Thermodilution
keywords: Arterial pressure; Cardiac surgery; Fluid responsiveness; Passive leg raising; Pulse contour analysis