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Validation of non-invasive hemodynamic monitoring with Nexfin in critically ill patients

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Critical Care201115 (Suppl 1) :P75

https://doi.org/10.1186/cc9495

  • Published:

Keywords

  • Cardiac Output
  • Hemodynamic Monitoring
  • Pulse Contour
  • Pulse Contour Analysis
  • Intermittent Bolus

Introduction

Thermodilution (TD) is a gold standard for cardiac output (CO) measurement in critically ill patients [1]. Although transpulmonary thermodiluation is less invasive than the Swan-Ganz catheter, it still requires an arterial and deep venous line. This study will compare intermittent bolus transpulmonary TDCO with continuous CO (CCO) obtained by pulse contour analysis (PiCCO2; Pulsion Medical Systems) and non-invasive CO (NexCO) measurement via finger cuff using Finapres technology (Nexfin BMEYE).

Methods

A prospective study in 45 patients (43 mechanically ventilated, 32 male). Age 57.6 ± 19.4, BMI 25.3 ± 4.4, SAPS II 51.5 ± 16.9, APACHE II 25.3 ± 10.3 and SOFA score 9.4 ± 3.3. In an 8-hour period, simultaneous CCO and NexCO measurements were obtained every 2 hours while simultaneous TDCO and NexCO were obtained every 4 hours. The CCO and NexCO values were recorded within 5 minutes before TDCO was determined. Statistical analysis was performed using Pearson correlation and Bland-Altman analysis.

Results

In total, 585 CO values were obtained: 225 paired CCO-NexCO; 135 paired CCO-TDCO and 135 NexCO-TDCO. Thirty-five patients received norepinephrine at a dose of 0.2 ± 0.2 μg/kg/minute (range 0.02 to 1). TDCO values ranged from 2.4 to 14.9 l/minute (mean 6.6 ± 2.2), CCO ranged from 1.8 to 15.6 l/minute (6.4 ± 2.3) and NexCO from 0.8 to 14.9 l/minute (6.1 ± 2.3). The Pearson correlation coefficient comparing NexCO with TDCO and CCO was similar with an R2 of 0.68 and 0.71 respectively. Bland-Altman analysis comparing NexCO with TDCO revealed a mean bias ± 2SD (limits of agreement (LA)) of 0.4 ± 2.32 l/minute (with 36.1% error) while analysis of NexCO versus CCO showed a bias (± LA) of 0.2 ± 2.32 l/minute (37% error). TDCO was highly correlated with CCO (R2 = 0.95) with bias 0.2 ± 0.86 (% error 13.3). The MAP values obtained ranged from 43 to 140 mmHg (83 ± 17) for PiCCO2 and from 44 to 131 (85 ± 17) for Nexfin. The MAP obtained with Nexfin correlated well with invasive MAP via PiCCO2 (R2 = 0.89) with a bias (± LA) of 2.3 ± 12.4 (% error 14.7).

Conclusions

These preliminary results indicate that in unstable critically ill patients CO and MAP can be reliably monitored non-invasively with Nexfin technology. Although TPTD remains a gold stand for the measurement of CO in ICU patients, Nexfin non-invasive monitoring may provide useful information in the emergency or operating room when an arterial or CVL is not available.

Authors’ Affiliations

(1)
ZNA Stuivenberg, Antwerp, Belgium

References

  1. Malbrain M, et al.: Cost-effectiveness of minimally invasive hemodynamic monitoring. In Yearbook of Intensive Care and Emergency Medicine. Edited by: Vincent J-L. Berlin: Springer-Verlag; 2005:603-631.Google Scholar

Copyright

© Van de Vijver et al. 2011

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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