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Noninvasive Determination of Vortex Formation Time Using Transesophageal Echocardiography During Cardiac Surgery

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FloTrac/Vigileo(TM) (third generation) and MostCare(®)/PRAM versus echocardiography for cardiac output estimation in

Stefano Romagnoli¹, Zaccaria Ricci, Salvatore M Romano

¹Department of Heart and Vessels, Cardio-Thoracic and Vascular Anaesthesia and Intensive Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.

Journal of Cardiothoracic and Vascular Anesthesia

|September 24, 2013

Abstract

Objective:

To compare the FloTrac/Vigileo(TM) cardiac output (COFT/V) and the MostCare(®)/PRAM cardiac output (COMC/P) versus transthoracic echocardiographic cardiac output estimation (reference method; CO(ECHO)).

Design:

Prospective observational study.

Setting:

Single center, Cardio-Thoracic and Vascular Surgery/Intensive Care Unit.

Participants:

Patients undergoing elective vascular surgery.

Interventions:

Cardiac output measurement with two pulse contour methods: the FloTrac/Vigileo(TM) and the MostCare(®)/PRAM before (T1) and after (T2) fluid loading versus echocardiography (reference method).

Measurements And Main Results:

One hundred fifty-six CO measurements were performed in 26 patients. The data showed poor agreement between CO(ECHO) and CO(FT/V): r(2) = 0.29 (T1) and 0.27 (T2); bias -0.37 (T1) and -0.40 (T2) L/min; limits of agreement from -3.10 to 2.42 (T1) and from -3.0 to 2.2 (T2) L/min. The percentage error was 51.7% (T1) and 49.3% (T2). Conversely, COMC/P resulted in agreement with echocardiography: r(2) = 0.76 (T1) and 0.80 (T2); bias -0.01 (T1) and -0.06 (T2) L/min; limits of agreement from -1.13 to 1.11 (T1) and from -0.90 to 0.80 (T2) L/min, with a PE of 22.4% (T1) and of 17.0% (T2).

Conclusions:

In patients undergoing vascular surgery, the FloTrac/Vigileo(TM) did not demonstrate that it was a reliable system for CO monitoring when compared with echocardiography-derived CO. However, MostCare(®)/PRAM was shown to estimate CO with a good level of agreement with echocardiographic measures.

Keywords:

FloTrac MostCare PRAM Vigileo cardiac output cardiac output monitors goal-directed therapy pulse contour methods vascular surgery

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