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Uncalibrated arterial pulse contour analysis in major vascular surgery


Assessment of continuous cardiac output using the arterial pulse wave (APCO) is currently available only with standard radial artery catheterization (Vigileo System, FloTrac™, Edwards Lifesciences, Irvine, CA, USA) [1, 2]. Many of the studies available in the literature have compared APCO versus intermittent cardiac output (ICO) obtained with a pulmonary artery catheter (Intellicath, Edwards Lifesciences, Irvine, CA, USA) in patients undergoing cardiac surgery [3]. The aim of this study was to assess the bias and level of agreement between the APCO and ICO in patients undergoing major vascular surgery.


Twenty elective patients undergoing abdominal aortic aneurysm (AAA) repair were enrolled. Patients with a pre-operative history of valvular heart disease, preoperative dysrhythmias, or ejection fraction <40% were excluded from the study. APCO and ICO measurements were simultaneously collected at the following steps: Before anesthesia induction (T1), after anesthesia induction (T2), 30 min after anesthesia induction (T3), at aortic cross-clamping (T4), 30 min after aortic cross-clamping (T5), 5 (T6), 10 (T7), 30 (T8) min after aortic unclamping, and at the end of surgery (T9). Statistical evaluation was performed using the Bland and Altman analysis. The percentage error was calculated according to the method described by Critchley et al. [4].


A total of 360 pairs of APCO/ICO measurements were analyzed and the bias was 0.09 ± 1.93 l/min/m2 with a percentage error of 28%. Subgroup analysis revealed that the bias, calculated without the measurements obtained during the T4 and T5 aortic cross-clamping periods, was 0.06 ± 1.97 l/min/m2 with a percentage error of 29%, surprisingly similar to the all pairs results.


In patients undergoing major vascular surgery, APCO obtained with the Vigileo System provided a clinically acceptable bias and agreement with intermittent pulmonary thermodilution measurements, surprisingly also during the aortic cross-clamping period. Larger population studies are needed to confirm these very preliminary data.


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Vetrugno, L., Spagnesi, L., Centonze, C. et al. Uncalibrated arterial pulse contour analysis in major vascular surgery. Crit Care 12 (Suppl 2), P101 (2008).

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