Effects of norepinephrine on four different continuous cardiac output systems using the femoral and radial arterial pressure waveform in critically ill patients

John Smith, Marco Scaramuzzi, Peter Charlton, John Brooks, Daniele Arces, Guideon Wong, Luigi Camporota, Richard Beale

Research output: Contribution to journalPoster abstract

244 Citations (Scopus)

Abstract

INTRODUCTION. Pharmacological alterations of the arterial blood pressure waveform (ABPW) can affect arterial pressure-based cardiac output systems (APCOs) independently of stroke volume. However, the morphology of the ABPW can vary between femoral or radial arteries especially in hypovolaemic patients or requiring high-dose vasopressors. We assessed the agreement between the CCO derived from the femoral vs radial artery during a 'double-pump' norepinephrine manoeuvre (NEDP) using four APCOs (PiCCO, LiDCO, PRAM, Vigileo v03.02.pic).
METHODS. Comparisons were performed in nine ICU patients before, during and after NEDP. The recorded both radial and femoral ABPW were played back in each APCOs to calculate CCO.
RESULTS. Bland-Altmann analysis of the ABPCOs (Femoral-Radial) before, during and after NEDP is shown as [bias (L/min), limits of agreement (LOA)].
LiDCO.
Before [-0.06 (-0.5 to +0.38]
During [0.13 (-0.94 to +0.67)]
After [0.25 (-1.1 to +1.6)]
PiCCO.
Before [-0.03 (-0.53 to +0.47)]
During [0.8 (-1.9 to +3.4)]
After [0.24 (-1.0 to +1.4)]
PRAM.
Before [-0.2 (-3.4 to +3.9)]
During [0.1 (-3.7 to +3.9)]
After [0.5 (-3.8 to +4.8)]
Vigileo.
Before [ -0.54 (-0.89 to +2.0)]
During [0.5 (-2.2 to +3.2)]
After [0.4 (-1.9 to +2.8)]
CONCLUSIONS. ABPCOs can give potentially large differences in CCO when ABPW is obtained from different arterial sites particularly during rapid changes in vasopressors and in uncalibrated systems.
Original languageEnglish
Article number0943
Pages (from-to)S241-S241
Number of pages1
JournalIntensive Care Medicine
Volume37
Issue numberS1
Publication statusPublished - Sept 2011

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