Hadian M, Kim HK, Severyn DA, Pinsky MR.; Crit Care. 2010 Nov 23;14(6):R212.
INTRODUCTION: Arterial pulse pressure analysis techniques for estimating cardiac output (CO) though less invasive than pulmonary artery catheters (PAC) CO estimates have not been simultaneously compared to PAC bolus thermodilution CO (COtd) or continuous CO (CCO) devices.
METHODS: We compared the accuracy, bias and trending ability of LiDCOTM, PiCCOTM and FloTracTM with PAC (COtd, CCO) to simultaneously track CO in a prospective observational study in seventeen post-operative cardiac surgery patients for the first 4 hours following ICU admission. 55 paired simultaneous quadruple CO measurements were made before and after therapeutic interventions (volume, vasopressor/dilator, inotrope).
RESULTS: Mean CO values for PAC, LiDCO, PiCCO and FloTrac were similar (5.6 +/- 1.5, 5.4 +/- 1.6, 5.4 +/- 1.5 and 6.1 +/- 1.9 L/min, respectively). The mean CO bias by each paired method was -0.18 (PAC-LiDCO), 0.24 (PAC-PiCCO), -0.43 (PAC-FloTrac), 0.06 (LiDCO-PiCCO), -0.63 (LiDCO-FloTrac) and -0.67 (PiCCO-FloTrac) L/min, with limits of agreement (1.96 SD, 95% CI) of +/-1.56, +/-2.22, +/-3.37, +/-2.03, +/-2.97 and +/-3.44 L/min, respectively. The instantaneous directional changes between any paired CO measurements displayed 74% (PAC-LiDCO), 72% (PAC-PiCCO), 59% (PAC-FloTrac), 70% (LiDCO-PiCCO), 71% (LiDCO-FloTrac) and 63% (PiCCO-FloTrac) concordance but poor correlation (r2=0.36, 0.11, 0.08, 0.20, 0.23, and 0.11, respectively). For mean CO <5 L/min measured by each paired devices, the bias decreased slightly.
CONCLUSIONS: Although PAC (COTD/CCO), FloTrac, LiDCO and PiCCO display similar mean CO values, they often trend differently in response to therapy and show different inter-device agreement. In the clinically relevant low CO range (<5 L/min) agreement improved slightly. Thus, utility and validation studies using only one CO device may potentially not be extrapolated to equivalency of using another similar device.
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