Related Experiment Video
Updated: Aug 14, 2026
Spinal Sonography for Ultrasound-Guided Lumbar Neuraxial Anesthesia
Published on: January 31, 2025
Agreement and trending ability between non-invasive and invasive hemodynamic monitoring during cesarean section under
Yongqiang Shi1, Yueji Ma1, Jiawei Cun2
1Department of Anesthesiology and Perioperative Medicine, General Hospital of Ningxia Medical University, Yinchuan, China.
Background:
The uteroplacental circulation lacks autoregulatory capacity and therefore relies predominantly on the maternal cardiac output (CO). Monitoring hemodynamic parameters such as CO can provide guidance for anesthesia decisions during cesarean section. We evaluated the agreement and trending ability of maternal CO, stroke volume (SV), and stroke volume variation (SVV) between two clinically used hemodynamic monitoring technologies, the non-invasive NICAP/NICCO system and the invasive FloTrac/Vigileo system, in patients undergoing elective cesarean section under spinal anesthesia.
Methods:
Forty-five patients were included in the final analysis. Prior to anesthesia, the patients' hemodynamic parameters, including CO, SV, and SVV, were simultaneously monitored using both the NICAP/NICCO and Flotrac/Vigileo. The baseline values and continuous dynamic data of CO, SV, and SVV were collected over a 15-min period following spinal anesthesia and recorded at 20-s intervals. Repeated-measures Bland-Altman analysis, percent error (PE) and ICC (2, 1) were employed to assess the agreement between the two monitoring methods. Trending ability was evaluated using four-quadrant plot analysis.
Results:
The repeated-measures Bland-Altman analysis indicated that the biases of CO, SV, and SVV were -0.89 L/min (95% limits of agreement: -4.08 to 2.29 L/min; PE, 51.24%), -10.53 mL (95% limits of agreement: -46.26 to 25.20 mL; PE, 46.84%), and 2.44% (95% limits of agreement: -6.82 to 11.69%; PE, 77.95%), respectively. The results of the ICC indicated that the values of CO, SV, and SVV were 0.2578 (95% CI: 0.1067 to 0.3772), 0.4682 (95% CI: 0.2397 to 0.6111), and 0.1813 (95% CI: 0.0686 to 0.2779), respectively. Four-quadrant plot analysis demonstrated the concordance rates for CO, SV, and SVV were 44.59, 32.39, and 21.48%, respectively.
Conclusion:
During cesarean section under spinal anesthesia, the non-invasive hemodynamic monitoring employing NICAP/NICCO technology exhibits poor agreement and trending ability with the invasive hemodynamic monitoring utilizing Flotrac/Vigileo technology.
Clinical Trial Registration:
ClinicalTrials.gov, identifier NCT06473818.
