J Clin Monit Comput - Cardiac output monitoring in septic shock: evaluation of the third-generation Flotrac-Vigileo.

Tópicos

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Resumo

Continuous cardiac index (CI) monitoring is frequently used in critically ill patients. Few studies have compared the pulse contour-based device FloTrac/Vigileo to pulmonary artery thermodilution (PAC) in terms of accuracy for CI monitoring in septic shock. The aim of our study was to compare the third-generation FloTrac/Vigileo to PAC in septic shock. Eighteen patients with septic shock requiring monitoring by PAC were included in this study. We monitored CI using both FloTrac/Vigileo and continuous thermodilution (PAC-CI). Hemodynamic data were recorded every hour or every 2 min during fluid challenges. The primary endpoint was the global agreement of all CI-paired measurements determined using the Bland-Altman method adapted to replicated data. We tested the linearity of the bias by regression analysis, and compared the reactivity of the 2 techniques during fluid challenges. A receiver operating characteristic (ROC) curve analysis tested the ability of FloTrac/Vigileo to detect concordant and significative CI changes, using PAC-CI as the reference method. Overall, 1,201 paired CI measurements were recorded. The Bland-Altman analysis for global agreement of the 2 techniques showed a bias of -0.1 ? 2.1 L min(-1) m(-2) and a percentage error of 64 %. The overall correlation coefficient between PAC-CI and FloTrac/Vigileo CI was 0.47 (p < 0.01), with r(2) = 0.22. The area under the curve of the ROC curve for detecting concordant and significant changes in CI was 0.72 (0.53; 0.87). In our study, third-generation Flowtrac-Vigileo appears to be too inaccurate to be recommended for CI monitoring in septic shock.

Resumo Limpo

continu cardiac index ci monitor frequent use critic ill patient studi compar puls contourbas devic flotracvigileo pulmonari arteri thermodilut pac term accuraci ci monitor septic shock aim studi compar thirdgener flotracvigileo pac septic shock eighteen patient septic shock requir monitor pac includ studi monitor ci use flotracvigileo continu thermodilut pacci hemodynam data record everi hour everi min fluid challeng primari endpoint global agreement cipair measur determin use blandaltman method adapt replic data test linear bias regress analysi compar reactiv techniqu fluid challeng receiv oper characterist roc curv analysi test abil flotracvigileo detect concord signif ci chang use pacci refer method overal pair ci measur record blandaltman analysi global agreement techniqu show bias l min m percentag error overal correl coeffici pacci flotracvigileo ci p r area curv roc curv detect concord signific chang ci studi thirdgener flowtracvigileo appear inaccur recommend ci monitor septic shock

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