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Evaluation of cardiac output by 5 arterial pulse contour techniques using trend interchangeability method

View Article: PubMed Central - PubMed

ABSTRACT

Cardiac output measurement with pulse contour analysis is a continuous, mini-invasive, operator-independent, widely used, and cost-effective technique, which could be helpful to assess changes in cardiac output. The 4-quadrant plot and the polar plot have been described to compare the changes between 2 measurements performed under different conditions, and the direction of change by using different methods of measurements. However, the 4-quadrant plot and the polar plot present a number of limitations, with a risk of misinterpretation in routine clinical practice. We describe a new trend interchangeability method designed to objectively define the interchangeability of each change of a variable. Using the repeatability of the reference method, we classified each change as either uninterpretable or interpretable and then as either noninterchangeable, in the gray zone or interchangeable. An interchangeability rate can then be calculated by the number of interchangeable changes divided by the total number of interpretable changes. In this observational study, we used this objective method to assess cardiac output changes with 5 arterial pulse contour techniques (Wesseling's method, LiDCO, PiCCO, Hemac method, and Modelflow) in comparison with bolus thermodilution technique as reference method in 24 cardiac surgery patients. A total of 172 cardiac output variations were available from the 199 data points: 88 (51%) were uninterpretable, according to the first step of the method. The second step of the method, based on the 84 (49%) interpretable variations, showed that only 18 (21%) to 30 (36%) variations were interchangeable regardless of the technique used. None of pulse contour cardiac output technique could be interchangeable with bolus thermodilution to assess changes in cardiac output using the trend interchangeability method in cardiac surgery patients. Future studies may consider using this method to assess interchangeability of changes between different methods of measurements.

No MeSH data available.


Graphical 4-quadrant plot representation of the original data previously published by de Wilde, comparing cardiac output measurement with thermodilution and 5 arterial pulse contour devices: Wesseling's method (A) LiDCO (B), PiCCO (C), Hemac method (D), and Modelflow (E), (N = 172). A specific color is applied to each change: uninterpretable (blue), non-interchangeable (red), in the gray zone of interpretation (orange), and interchangeable (green).
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Figure 6: Graphical 4-quadrant plot representation of the original data previously published by de Wilde, comparing cardiac output measurement with thermodilution and 5 arterial pulse contour devices: Wesseling's method (A) LiDCO (B), PiCCO (C), Hemac method (D), and Modelflow (E), (N = 172). A specific color is applied to each change: uninterpretable (blue), non-interchangeable (red), in the gray zone of interpretation (orange), and interchangeable (green).

Mentions: Original data published by de Wilde et al.[13] and used by Critchley et al.[10] to define the polar plot method were reanalyzed using the new method. According to de Wilde's methods,[13] we used a repeatability of 5% for the 4-cold-bolus pulmonary artery thermodilution technique.[16] A total of 172 CO variations were available from the 199 data points from 24 included patients: 88 (51%) were uninterpretable, according to the first step of the method. The second step of the method, based on the 84 (49%) interpretable variations, showed that only 18/84 (21%) to 30/84 (36%) variations were interchangeable regardless of the technique used. The results obtained with the 4-quadrant plot are shown in Fig. 6 and the results obtained with the simplified method are shown in Fig. 7. No statistical difference was observed between arterial pulse contour techniques (P = 0.130). Data are available in Appendix 3.


Evaluation of cardiac output by 5 arterial pulse contour techniques using trend interchangeability method
Graphical 4-quadrant plot representation of the original data previously published by de Wilde, comparing cardiac output measurement with thermodilution and 5 arterial pulse contour devices: Wesseling's method (A) LiDCO (B), PiCCO (C), Hemac method (D), and Modelflow (E), (N = 172). A specific color is applied to each change: uninterpretable (blue), non-interchangeable (red), in the gray zone of interpretation (orange), and interchangeable (green).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4998299&req=5

Figure 6: Graphical 4-quadrant plot representation of the original data previously published by de Wilde, comparing cardiac output measurement with thermodilution and 5 arterial pulse contour devices: Wesseling's method (A) LiDCO (B), PiCCO (C), Hemac method (D), and Modelflow (E), (N = 172). A specific color is applied to each change: uninterpretable (blue), non-interchangeable (red), in the gray zone of interpretation (orange), and interchangeable (green).
Mentions: Original data published by de Wilde et al.[13] and used by Critchley et al.[10] to define the polar plot method were reanalyzed using the new method. According to de Wilde's methods,[13] we used a repeatability of 5% for the 4-cold-bolus pulmonary artery thermodilution technique.[16] A total of 172 CO variations were available from the 199 data points from 24 included patients: 88 (51%) were uninterpretable, according to the first step of the method. The second step of the method, based on the 84 (49%) interpretable variations, showed that only 18/84 (21%) to 30/84 (36%) variations were interchangeable regardless of the technique used. The results obtained with the 4-quadrant plot are shown in Fig. 6 and the results obtained with the simplified method are shown in Fig. 7. No statistical difference was observed between arterial pulse contour techniques (P = 0.130). Data are available in Appendix 3.

View Article: PubMed Central - PubMed

ABSTRACT

Cardiac output measurement with pulse contour analysis is a continuous, mini-invasive, operator-independent, widely used, and cost-effective technique, which could be helpful to assess changes in cardiac output. The 4-quadrant plot and the polar plot have been described to compare the changes between 2 measurements performed under different conditions, and the direction of change by using different methods of measurements. However, the 4-quadrant plot and the polar plot present a number of limitations, with a risk of misinterpretation in routine clinical practice. We describe a new trend interchangeability method designed to objectively define the interchangeability of each change of a variable. Using the repeatability of the reference method, we classified each change as either uninterpretable or interpretable and then as either noninterchangeable, in the gray zone or interchangeable. An interchangeability rate can then be calculated by the number of interchangeable changes divided by the total number of interpretable changes. In this observational study, we used this objective method to assess cardiac output changes with 5 arterial pulse contour techniques (Wesseling's method, LiDCO, PiCCO, Hemac method, and Modelflow) in comparison with bolus thermodilution technique as reference method in 24 cardiac surgery patients. A total of 172 cardiac output variations were available from the 199 data points: 88 (51%) were uninterpretable, according to the first step of the method. The second step of the method, based on the 84 (49%) interpretable variations, showed that only 18 (21%) to 30 (36%) variations were interchangeable regardless of the technique used. None of pulse contour cardiac output technique could be interchangeable with bolus thermodilution to assess changes in cardiac output using the trend interchangeability method in cardiac surgery patients. Future studies may consider using this method to assess interchangeability of changes between different methods of measurements.

No MeSH data available.