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Comparison of pulmonary artery catheter, echocardiography, and arterial waveform analysis monitoring in predicting the hemodynamic state during and after cardiac surgery

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posted on 2017-07-01, 00:00 authored by Paul Power, Allison Bone, Nick SimpsonNick Simpson, Cheng-Hon Yap, Simon Gower, Michael Bailey
OBJECTIVE: The aim of this trial was to determine whether Flotrac Vigileo™ (FV™) provides a reliable representation of the hemodynamic state of a cardiac surgical patient population when compared to pulmonary artery catheter (PAC) and echocardiography in the peril-operative period. DESIGN: This was a prospective observational trial comparing perioperative hemodynamic states using transesophageal echocardiography (TEE), transthoracic echocardiography (TTE), FV™ and PAC during and post cardiothoracic surgery. SETTING: Tertiary regional hospital Intensive Care Unit (ICU). PARTICIPANTS: 50 consecutive adult cardiothoracic patients with written consent provided. INTERVENTION: Comparison of the perioperative hemodynamic states using echocardiography, FV™ and PAC was performed. Evaluation of the hemodynamic state (HDS) was performed using TEE, TTE, PAC and FV™ during and after cardiac surgery. Data were compared between the three hemodynamic assessment modalities. MAIN OUTCOME MEASURE: Predicted hemodynamic state. RESULTS: FV™ and PAC were shown to correlate poorly with TEE/TTE assessment of the hemodynamic state. Both PAC and FV™ showed significant discordance with echocardiographic assessment of the hemodynamic state. CONCLUSIONS: In this trial, FV™ and PAC were shown to agree poorly with TTE/TEE assessment of the HDS in an adult cardiothoracic population. Agreement between the FV™ and PAC was also poor. Caution is recommended in interpreting isolated hemodynamic monitoring data. All hemodynamic monitoring devices have inherent sources of error. Caution is advised in interpreting any single device or measurement as a gold standard. We suggest that hemodynamic measuring devices such as FV™/PAC may act as triggers for a global hemodynamic assessment including consideration of TTE/TEE.

History

Journal

International journal of critical illness and injury science

Volume

7

Season

Jul-Sep

Pagination

156-162

Location

Mumbai, India

Open access

  • Yes

ISSN

2229-5151

Language

eng

Publication classification

C1 Refereed article in a scholarly journal

Copyright notice

2017, Medknow Publications & Media

Issue

3

Publisher

Medknow Publications

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