Continuous arterial pulse cardiac output validation in hyperdynamic conditions

Introduction

Assessment of continuous cardiac output using the arterial pulse cardiac index (APCI) is nowadays available also with only standard radial artery catheterization with a transducer (Vigileo System, FloTrac^™; Edwards Lifesciences, Irvine, CA, USA) [1][2]. It does not require calibration (thermodilution or any) but rather bases its calculations on arterial waveform characteristics in conjunction with patient demographic data. The aim of the study was to assess the level of agreement between a continuous APCI and continuous cardiac index (CCI) and intermittent cardiac index (ICI) obtained with a pulmonary artery catheter (Intellicath) in cirrhotic patients with hyperdynamic conditions.

Methods

Hemodynamic measurements were obtained in 14 liver-transplanted patients. ICI measurements were collected after ICU admission and every 8 hours until the 48th postoperative hour. Continuous data were collected every hour after ICU admission to the 48th postoperative hour. Statistical analysis was performed using the method described by Bland and Altman. Statistical significance was considered P < 0.05.

Results

Data are presented standardized by body surface area. The mean difference between APCI–ICI (bias ± 2SD) was 0.48 ± 1.40 l/min/m² together with 95% confidence intervals of -0.92 to 1.88 l/min/m². The mean difference between APCI–CCI (bias ± 2SD) was 0.90 ± 1.49 l/min/m² together with 95% confidence intervals of -0.59 to 2.39 l/min/m².

Conclusion

APCI obtained with the Vigileo System provided comparable measurements of cardiac output in hyperdynamic conditions. Larger population studies are needed to confirm these preliminary data.

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