Anesth Pain Med.  2016 Jul;11(3):280-284. 10.17085/apm.2016.11.3.280.

Effects of pulse pressure alterations on cardiac output measurements derived from analysis of arterial pressure waveform

Affiliations
  • 1Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon, Korea. anepark@hanmail.net

Abstract

BACKGROUND
Changes in pulse pressure (PP) may alter the morphology of arterial pressure waveforms, thereby affecting the accuracy of cardiac output (CO) measurements derived from such waveforms. This study evaluated the influence of PP on the accuracy of FloTrac/Vigileoâ„¢ system-measured CO (APCO). Pulmonary artery catheter (PAC) measured stat mode CO (SCO) is used as a reference standard.
METHODS
Hemodynamic variables were measured at various time points in 24 patients. APCO and SCO were compared using Bland-Altman analysis of the overall data pairs. The data pairs were divided into a low PP group and a high PP group, and subgroup analysis was conducted.
RESULTS
The mean APCO (5.3 ± 1.7 L/min) was higher than the mean SCO (5.1 ± 1.6 L/min) for all data pairs (P < 0.001). The Bland-Altman analysis revealed an overall percentage error of 41.7% between the APCO and SCO, which exceeds a 30% limit of agreement. There was a significant relationship between PP and the difference between APCO and SCO (P = 0.031, R = 0.151). In subgroup analysis, APCO and SCO showed reasonable agreement in the low PP group, with a percentage error of 28.2%, but decreased agreement in the high PP group, with a percentage error of 43.2%.
CONCLUSIONS
Changes in PP affect the accuracy of APCO measurements. An acceptable level of agreement between APCO and SCO was observed only in a low range of PP.

Keyword

Arterial pressure measurement; Cardiac output; Cardiovascular; Measurement techniques; Pulse pressure

MeSH Terms

Arterial Pressure*
Blood Pressure*
Cardiac Output*
Catheters
Hemodynamics
Humans
Pulmonary Artery

Figure

  • Fig. 1 Logarithmic correlation analysis of the relationship between pulse pressure and arterial pressure waveform analysis device for cardiac output (APCO)-a pulmonary artery catheter (SCO). PP: pulse pressure.

  • Fig. 2 Bland-Altman analysis for cardiac output (CO) measurements by arterial pressure waveform analysis device for cardiac output (APCO) and a pulmonary artery catheter (SCO) for all data. The bias was 0.26 L/min, and limits of agreement were −1.87 to 2.39 L/min, resulting in an overall percentage error of 41.7%.


Reference

1. Jhanji S, Dawson J, Pearse RM. Cardiac output monitoring: basic science and clinical application. Anaesthesia. 2008; 63:172–81. DOI: 10.1111/j.1365-2044.2007.05318.x. PMID: 18211449.
Article
2. Bowdle TA. Complications of invasive monitoring. Anesthesiol Clin North America. 2002; 20:571–88. DOI: 10.1016/S0889-8537(02)00004-4.
Article
3. Manecke GR. Edwards FloTrac sensor and Vigileo monitor: easy, accurate, reliable cardiac output assessment using the arterial pulse wave. Expert Rev Med Devices. 2005; 2:523–7. DOI: 10.1586/17434440.2.5.523. PMID: 16293062.
Article
4. Biais M, Nouette-Gaulain K, Cottenceau V, Vallet A, Cochard JF, Revel P, et al. Cardiac output measurement in patients undergoing liver transplantation: pulmonary artery catheter versus uncalibrated arterial pressure waveform analysis. Anesth Analg. 2008; 106:1480–6. DOI: 10.1213/ane.0b013e318168b309. PMID: 18420863.
5. Biancofiore G, Critchley LA, Lee A, Yang XX, Bindi LM, Esposito M, et al. Evaluation of a new software version of the FloTrac/Vigileo (version 3.02) and a comparison with previous data in cirrhotic patients undergoing liver transplant surgery. Anesth Analg. 2011; 113:515–22. DOI: 10.1213/ane.0b013e31822401b2.
Article
6. Biancofiore G, Critchley LA, Lee A, Bindi L, Bisà M, Esposito M, et al. Evaluation of an uncalibrated arterial pulse contour cardiac output monitoring system in cirrhotic patients undergoing liver surgery. Br J Anaesth. 2009; 102:47–54. DOI: 10.1093/bja/aen343. PMID: 19059920.
Article
7. Prasser C, Trabold B, Schwab A, Keyl C, Ziegler S, Wiesenack C. Evaluation of an improved algorithm for arterial pressure-based cardiac output assessment without external calibration. Intensive Care Med. 2007; 33:2223–5. DOI: 10.1007/s00134-007-0859-9. PMID: 17898995.
Article
8. Chakravarthy M, Rajeev S, Jawali V. Cardiac index value measurement by invasive, semi-invasive and non invasive techniques: a prospective study in postoperative off pump coronary artery bypass surgery patients. J Clin Monit Comput. 2009; 23:175–80. DOI: 10.1007/s10877-009-9179-7. PMID: 19412657.
Article
9. Greenway CV, Lautt WW. Blood volume, the venous system, preload, and cardiac output. Can J Physiol Pharmacol. 1986; 64:383–7. DOI: 10.1139/y86-062.
Article
10. Kannel WB, Wilson PW, Nam BH, D’Agostino RB, Li J. A likely explanation for the J-curve of blood pressure cardiovascular risk. Am J Cardiol. 2004; 94:380–4. DOI: 10.1016/j.amjcard.2004.04.043. PMID: 15276113.
Article
11. Sakka SG, Kozieras J, Thuemer O, van Hout N. Measurement of cardiac output: a comparison between transpulmonary thermodilution and uncalibrated pulse contour analysis. Br J Anaesth. 2007; 99:337–42. DOI: 10.1093/bja/aem177. PMID: 17611251.
Article
12. Junttila EK, Koskenkari JK, Ohtonen PP, Ala-Kokko TI. Uncalibrated arterial pressure waveform analysis for cardiac output monitoring is biased by low peripheral resistance in patients with intracranial haemorrhage. Br J Anaesth. 2011; 107:581–6. DOI: 10.1093/bja/aer170. PMID: 21693470.
13. Metzelder S, Coburn M, Fries M, Reinges M, Reich S, Rossaint R, et al. Performance of cardiac output measurement derived from arterial pressure waveform analysis in patients requiring high-dose vasopressor therapy. Br J Anaesth. 2011; 106:776–84. DOI: 10.1093/bja/aer066. PMID: 21441548.
Article
14. Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986; 1:307–10. DOI: 10.1016/S0140-6736(86)90837-8.
Article
15. Critchley LA, Critchley JA. A meta-analysis of studies using bias and precision statistics to compare cardiac output measurement techniques. J Clin Monit Comput. 1999; 15:85–91. DOI: 10.1023/A:1009982611386.
16. García-Palmieri MR, Crespo CJ, Mc Gee D, Sempos C, Smit E, Sorlie PD. Wide pulse pressure is an independent predictor of cardiovascular mortality in Puerto Rican men. Nutr Metab Cardiovasc Dis. 2005; 15:71–8. DOI: 10.1016/j.numecd.2004.08.002. PMID: 15871854.
Article
17. Izzo JL Jr. Arterial stiffness and the systolic hypertension syndrome. Curr Opin Cardiol. 2004; 19:341–52. DOI: 10.1097/01.hco.0000126581.89648.10.
Article
18. De Backer D, Marx G, Tan A, Junker C, Van Nuffelen M, Hüter L, et al. Arterial pressure-based cardiac output monitoring: a multicenter validation of the third-generation software in septic patients. Intensive Care Med. 2011; 37:233–40. DOI: 10.1007/s00134-010-2098-8. PMID: 21153399. PMCID: PMC3028067.
Article
19. Kotake Y, Yamada T, Nagata H, Takeda J, Shimizu H. Transient hemodynamic change and accuracy of arterial blood pressure-based cardiac output. Anesth Analg. 2011; 113:272–4. DOI: 10.1213/ANE.0b013e31821b44fc. PMID: 21467564.
Article
20. Nishikawa T, Dohi S. Hemodynamic status susceptible to slowing of heart rate during thermodilution cardiac output determination in anesthetized patients. Crit Care Med. 1990; 18:841–4. DOI: 10.1097/00003246-199008000-00009. PMID: 2379397.
Article
21. de Waal EE, Wappler F, Buhre WF. Cardiac output monitoring. Curr Opin Anaesthesiol. 2009; 22:71–7. DOI: 10.1097/ACO.0b013e32831f44d0. PMID: 19295295.
Article
22. Singh A, Juneja R, Mehta Y, Trehan N. Comparison of continuous, stat, and intermittent cardiac output measurements in patients undergoing minimally invasive direct coronary artery bypass surgery. J Cardiothorac Vasc Anesth. 2002; 16:186–90. DOI: 10.1053/jcan.2002.31063. PMID: 11957168.
Article
23. Lazor MA, Pierce ET, Stanley GD, Cass JL, Halpern EF, Bode RH Jr. Evaluation of the accuracy and response time of STAT-mode continuous cardiac output. J Cardiothorac Vasc Anesth. 1997; 11:432–6. DOI: 10.1016/S1053-0770(97)90050-1.
Article
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