Cardiac output measurement in patients undergoing liver transplantation: pulmonary artery catheter versus uncalibrated arterial pressure waveform analysis.

Authors:	Matthieu Biais, Karine Nouette-Gaulain, Vincent Cottenceau, Alain Vallet, Jean François Cochard, Philippe Revel, François Sztark
Language:	Eng.
Date:	18-04-2008
Journal:	Anesthesia and analgesia (1526-7598)
Release:	Anesth Analg. 2008 May;106(5):1480-6, table of contents
Abstract:	BACKGROUND: Cardiac output (CO) and invasive hemodynamic measurements are useful during liver transplantation. The pulmonary artery catheter (PAC) is commonly used for these patients, despite the potential complications. Recently, a less invasive device (Vigileo/FloTrac) became available, which estimates CO using arterial pressure waveform analysis without external calibration. In this study, we compared CO obtained with a PAC using automatic thermodilution, instantaneous CO stat-mode (ICO(SM)), and CO obtained with the new device, arterial pressure waveform analysis (APCO) in patients undergoing liver transplantation. METHODS: Twenty sets of simultaneous measurements of APCO and ICO(SM) were determined in sedated and mechanically ventilated patients undergoing liver transplantation. Time points were as follows: after PAC insertion (T1-3), after portal clamping (T4-6), during anhepathy (T7-9), after graft reperfusion (T10-15), and in the postoperative period in the intensive care unit (T15-20). RESULTS: We enrolled 20 patients and 400 measurements were obtained. No data were rejected. Bias between ICO(SM) and APCO was 0.8 L/min, 95% limits of agreement were -1.8 to 3.5 L/min. The percentage error was 43%. Bias between ICO(SM) and APCO was correlated with systemic vascular resistance [r(2) = 0.55, P < 0.0001, y = 15.8-2.2 ln(x)] and subgroup analysis revealed an increase in the bias and in the percentage error in patients with low systemic vascular resistance (Child-Pugh grade B and C patients). There was no difference between the different surgical periods. CONCLUSIONS: Our results suggest that Vigileo/FloTrac CO monitoring data do not agree well with those of automatic thermodilution in patients undergoing liver transplantation, especially in Child-Pugh grade B and C patients with low systemic vascular resistance.
Copyright:	Anesthesia and analgesia Service d'Anesthésie Réanimation I, Hôpital Pellegrin, Place Amélie Raba-Léon, 33076 Bordeaux Cedex, France.
Full text:	Anesthesia and analgesia (DOI) HighWire Press - HTML (needs subscription) Ovid Technologies, Inc. - HTML (needs subscription)
Terms:	Bias (Epidemiology), Blood Pressure, Blood Pressure Monitors, Calibration, Cardiac Output, Catheterization, Swan-Ganz, Compliance, Equipment Design, Female, Humans, Liver Failure, Liver Transplantation, Male, Middle Aged, Monitoring, Intraoperative, Pulsatile Flow, Radial Artery, Reproducibility of Results, Severity of Illness Index, Thermodilution, Time Factors, Transducers, Vascular Resistance