Critical Care Medicine

Adult Critical Care

Arterial pressure-based cardiac output monitoring: a multicenter validation of the third-generation software in septic patients

De Backer D, Marx G, Tan A, et al (Erasme Univ Hosp, Brussels, Belgium; Aachen Univ Hosp, Germany; Queen’s Med Ctr, Honolulu, HI; et al) Intensive Care Med 37:233-240, 2011^§

Abstract

Purpose

Second-generation FloTrac software has been shown to reliably measure cardiac output (CO) in cardiac surgical patients. However, concerns have been raised regarding its accuracy in vasoplegic states. The aim of the present multicenter study was to investigate the accuracy of the third-generation software in patients with sepsis, particularly when total systemic vascular resistance (TSVR) is low.

Methods

Fifty-eight septic patients were included in this prospective observational study in four university-affiliated ICUs. Reference CO was measured by bolus pulmonary thermodilution (iCO) using 3–5 cold saline boluses. Simultaneously, CO was computed from the arterial pressure curve recorded on a computer using the second-generation (CO_G2) and third-generation (CO_G3) FloTrac software. CO was also measured by semi-continuous pulmonary thermodilution (CCO).

Results

A total of 401 simultaneous measurements of iCO, CO_G2, CO_G3, and CCO were recorded. The mean (95%CI) biases between CO_G2 and iCO, CO_G3 and iCO, and CCO and iCO were −10 (−15 to −5)% [−0.8 (−1.1 to −0.4) L/min], 0 (−4 to 4)% [0 (−0.3 to 0.3) L/min], and 9 (6–13)% [0.7 (0.5–1.0) L/min], respectively. The percentage errors were 29 (20–37)% for CO_G2, 30 (24–37)% for CO_G3, and 28 (22–34)% for CCO. The difference between iCO and CO_G2 was significantly correlated with TSVR (r² = 0.37, p < 0.0001). A very weak (r² = 0.05) relationship was also observed for the difference between iCO and CO_G3.

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