J Clin Monit Comput - Reliability of a new 4th generation FloTrac algorithm to track cardiac output changes in patients receiving phenylephrine.

Tópicos

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Resumo

Phenylephrine is often used to treat intra-operative hypotension. Previous studies have shown that the FloTrac cardiac monitor may overestimate cardiac output (CO) changes following phenylephrine administration. A new algorithm (4th generation) has been developed to improve performance in this setting. We performed a prospective observational study to assess the effects of phenylephrine administration on CO values measured by the 3rd and 4th generation FloTrac algorithms. 54 patients were enrolled in this study. We used the Nexfin, a pulse contour method shown to be insensitive to vasopressor administration, as the reference method. Radial arterial pressures were recorded continuously in patients undergoing surgery. Phenylephrine administration times were documented. Arterial pressure recordings were subsequently analyzed offline using three different pulse contour analysis algorithms: FloTrac 3rd generation (G3), FloTrac 4th generation (G4), and Nexfin (nf). One minute of hemodynamic measurements was analyzed immediately before phenylephrine administration and then repeated when the mean arterial pressure peaked. A total of 157 (4.6 ? 3.2 per patient, range 1-15) paired sets of hemodynamic recordings were analyzed. Phenylephrine induced a significant increase in stroke volume (SV) and CO with the FloTrac G3, but not with FloTrac G4 or Nexfin algorithms. Agreement between FloTrac G3 and Nexfin was: 0.23 ? 1.19 l/min and concordance was 51.1%. In contrast, agreement between FloTrac G4 and Nexfin was: 0.19 ? 0.86 l/min and concordance was 87.2%. In conclusion, the pulse contour method of measuring CO, as implemented in FloTrac 4th generation algorithm, has significantly improved its ability to track the changes in CO induced by phenylephrine.

Resumo Limpo

phenylephrin often use treat intraop hypotens previous studi shown flotrac cardiac monitor may overestim cardiac output co chang follow phenylephrin administr new algorithm th generat develop improv perform set perform prospect observ studi assess effect phenylephrin administr co valu measur rd th generat flotrac algorithm patient enrol studi use nexfin puls contour method shown insensit vasopressor administr refer method radial arteri pressur record continu patient undergo surgeri phenylephrin administr time document arteri pressur record subsequ analyz offlin use three differ puls contour analysi algorithm flotrac rd generat g flotrac th generat g nexfin nf one minut hemodynam measur analyz immedi phenylephrin administr repeat mean arteri pressur peak total per patient rang pair set hemodynam record analyz phenylephrin induc signific increas stroke volum sv co flotrac g flotrac g nexfin algorithm agreement flotrac g nexfin lmin concord contrast agreement flotrac g nexfin lmin concord conclus puls contour method measur co implement flotrac th generat algorithm signific improv abil track chang co induc phenylephrin

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