Effects of norepinephrine-driven change in arterial blood pressure on four different continuous cardiac output systems in critically ill patients

TY - JOUR

T1 - Effects of norepinephrine-driven change in arterial blood pressure on four different continuous cardiac output systems in critically ill patients

AU - Smith, John

AU - Scaramuzzi, Marco

AU - Charlton, Peter

AU - Brooks, John

AU - Arces, Daniele

AU - Wong, Guideon

AU - Camporota, Luigi

AU - Beale, Richard

PY - 2011/9

Y1 - 2011/9

N2 - INTRODUCTION. Pharmacological alterations of the arterial blood pressure waveform(ABPW) can affect arterial pressure-based cardiac output systems (APCOs) independently of stroke volume. We assessed the: 1) effect of the increase in ABP during a norepinephrine ‘double-pump’ manoeuvre (NEDP) on APCOs and trans-pulmonary thermo-dilution (TPTDCO); 2) agreement between TPTDCO and four APCOs (PiCCO, LiDCO, PRAM, Vigileo v03.02.pic).METHODS. TPTDCO was performed in fifteen ICU patients before, during and after NEDP. The same ABPW, was used by each APCOs to calculate CCO.RESULTS. During NEDP, TPTDCO did not change significantly from baseline [median%(IQR)], [4.5%(-0.9 to 13.4)]. Only Vigileo demonstrated a significant increase in CCO, [17.4% (6.7–34.0)]; p\0.001. Bland–Altmann analysis (TPTDCO-CCO) during NEDP showed a [bias (L/min), limits of agreement (LOA)] of [0.3 (-2.8 to +2.2)] for LiDCO; [0.3 (-2.9 to +3.6)] for PiCCO; [-0.3 (-5.3 to +4.8)] for PRAM; 0.4 (-2.3 to +3.2) for Vigileo. The percentage error was unacceptable for all systems: (35.1% LiDCO, 42.7% PiCCO, 75.4% PRAM, 37.7% Vigileo). Only PiCCO and LiDCO had low PE at baseline (16.3 and 14.5%, respectively) compared to PRAM (97.2%) and Vigileo (57.4%). CONCLUSIONS. ABPCOs fail to track TPTDCO during NEDP. This suggests that uncalibrated systems are unreliable during changes in vascular tone and reactivity and that calibrated systems need to be re-calibrated with significant changes in tone.

AB - INTRODUCTION. Pharmacological alterations of the arterial blood pressure waveform(ABPW) can affect arterial pressure-based cardiac output systems (APCOs) independently of stroke volume. We assessed the: 1) effect of the increase in ABP during a norepinephrine ‘double-pump’ manoeuvre (NEDP) on APCOs and trans-pulmonary thermo-dilution (TPTDCO); 2) agreement between TPTDCO and four APCOs (PiCCO, LiDCO, PRAM, Vigileo v03.02.pic).METHODS. TPTDCO was performed in fifteen ICU patients before, during and after NEDP. The same ABPW, was used by each APCOs to calculate CCO.RESULTS. During NEDP, TPTDCO did not change significantly from baseline [median%(IQR)], [4.5%(-0.9 to 13.4)]. Only Vigileo demonstrated a significant increase in CCO, [17.4% (6.7–34.0)]; p\0.001. Bland–Altmann analysis (TPTDCO-CCO) during NEDP showed a [bias (L/min), limits of agreement (LOA)] of [0.3 (-2.8 to +2.2)] for LiDCO; [0.3 (-2.9 to +3.6)] for PiCCO; [-0.3 (-5.3 to +4.8)] for PRAM; 0.4 (-2.3 to +3.2) for Vigileo. The percentage error was unacceptable for all systems: (35.1% LiDCO, 42.7% PiCCO, 75.4% PRAM, 37.7% Vigileo). Only PiCCO and LiDCO had low PE at baseline (16.3 and 14.5%, respectively) compared to PRAM (97.2%) and Vigileo (57.4%). CONCLUSIONS. ABPCOs fail to track TPTDCO during NEDP. This suggests that uncalibrated systems are unreliable during changes in vascular tone and reactivity and that calibrated systems need to be re-calibrated with significant changes in tone.

U2 - 10.1007/s00134-011-2322-1

DO - 10.1007/s00134-011-2322-1

M3 - Meeting abstract

SN - 0342-4642

VL - 37

SP - S280-S280

JO - Intensive Care Medicine

JF - Intensive Care Medicine

IS - S1

M1 - 1098

T2 - 24th ESICM Annual Congress

Y2 - 1 October 2011 through 5 October 2011

ER -