Comparison of Calibrated and Uncalibrated Arterial Pressure-Based Cardiac Output Monitors During Orthotopic Liver Transplantation

Vladimir Krejci; Andrea Vannucci; Alhan Abbas; William Chapman; Ivan M. Kangrga

doi:10.1002/lt.22056

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Comparison of Calibrated and Uncalibrated Arterial Pressure-Based Cardiac Output Monitors During Orthotopic Liver Transplantation

Journal article

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Comparison of Calibrated and Uncalibrated Arterial Pressure-Based Cardiac Output Monitors During Orthotopic Liver Transplantation

Vladimir Krejci, Andrea Vannucci, Alhan Abbas, William Chapman and Ivan M. Kangrga

Liver transplantation, Vol.16(6), pp.773-782

06/01/2010

DOI: 10.1002/lt.22056

PMID: 20517912

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Abstract

Arterial pressure based cardiac output monitors (APCOs) are increasingly used as alternatives to thermodilution. Validation of these evolving technologies in high-risk surgery is still ongoing. In liver transplantation, FloTrac-Vigileo (Edwards Life-sciences) has limited correlation with thermodilution, whereas LiDCO Plus (LiDCO Ltd.) has not been tested intraoperatively. Our goal was to directly compare the 2 proprietary APCO algorithms as alternatives to pulmonary artery catheter thermodilution in orthotopic liver transplantation (OLT). The cardiac index (CI) was measured simultaneously in 20 OLT patients at prospectively defined surgical landmarks with the LiDCO Plus monitor (CIL) and the FloTrac-Vigileo monitor (Cl-V). LiDCO Plus was calibrated according to the manufacturer's instructions. FloTrac-Vigileo did not require calibration. The reference CI was derived from pulmonary artery catheter intermittent thermodilution (CITD). CIV-CITD bias ranged from -1.38 (95% confidence interval = -2.02 to -0.75 L/minute/m(2), P = 0.02) to -2.51 L/minute/m(2) (95% confidence interval = -3.36 to -1.65 L/minute/m(2), P < 0.001), and CIL-CITD bias ranged from -0.65 (95% confidence interval = -1.29 to -0.01 L/minute/m(2), P = 0.047) to -1.48 L/minute/m(2) (95% confidence interval = -2.37 to -0.60 L/minute/m(2), P < 0.01). For both APCOs, bias to CITD was correlated with the systemic vascular resistance index, with a stronger dependence for FloTrac-Vigileo. The capability of the APCOs for tracking changes in CITD was assessed with a 4-quadrant plot for directional changes and with receiver operating characteristic curves for specificity and sensitivity. The performance of both APCOs was poor in detecting increases and fair in detecting decreases in CITD. In conclusion, the calibrated and uncalibrated APCOs perform differently during OLT. Although the calibrated APCO is less influenced by changes in the systemic vascular resistance, neither device can be used interchangeably with thermodilution to monitor cardiac output during liver transplantation. Liver Transpl 16:773-782, 2010. (C) 2010 AASLD.

Gastroenterology & Hepatology

Life Sciences & Biomedicine

Science & Technology

Surgery

Transplantation

Details

Title: Subtitle: Comparison of Calibrated and Uncalibrated Arterial Pressure-Based Cardiac Output Monitors During Orthotopic Liver Transplantation
Creators: Vladimir Krejci - Washington University in St. Louis
Andrea Vannucci - Washington University in St. Louis
Alhan Abbas - Washington University in St. Louis
William Chapman - Washington University in St. Louis
Ivan M. Kangrga - Washington University in St. Louis
Resource Type: Journal article
Publication Details: Liver transplantation, Vol.16(6), pp.773-782
DOI: 10.1002/lt.22056
PMID: 20517912
NLM abbreviation: Liver Transpl
ISSN: 1527-6465
eISSN: 1527-6473
Publisher: Wiley
Number of pages: 10
Grant note: NCT00682110 / Division of Clinical and Translational Research
Language: English
Date published: 06/01/2010
Academic Unit: Anesthesia
Record Identifier: 9984656536002771

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