Skip to main content
  • Poster presentation
  • Open access
  • Published:

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

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.

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 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Cite this article

Van de Vijver, K., Verstraeten, A., Gillebert, C. et al. Validation of non-invasive hemodynamic monitoring with Nexfin in critically ill patients. Crit Care 15 (Suppl 1), P75 (2011). https://doi.org/10.1186/cc9495

Download citation

  • Published:

  • DOI: https://doi.org/10.1186/cc9495

Keywords