Arterial pressure waveform analysis versus thermodilution cardiac output measurement during open abdominal aortic aneurysm repair: A prospective observational study

Leonard J. Montenij; Wolfgang F. Buhre; Steven A. De Jong; Jeroen H. Harms; Joost A. Van Herwaarden; Cas L J J Kruitwagen; Eric E C De Waal

doi:10.1097/EJA.0000000000000160

Arterial pressure waveform analysis versus thermodilution cardiac output measurement during open abdominal aortic aneurysm repair: A prospective observational study

Leonard J. Montenij^*, Wolfgang F. Buhre, Steven A. De Jong, Jeroen H. Harms, Joost A. Van Herwaarden, Cas L J J Kruitwagen, Eric E C De Waal

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

BACKGROUND Arterial pressure waveform analysis enables continuous, minimally invasive measurement of cardiac output. Haemodynamic instability compromises the reliability of the technique and a means of maintaining accurate measurement in this circumstance would be useful. OBJECTIVES To investigate the accuracy, precision and trending ability of arterial pressure waveform cardiac output obtained with FloTrac/Vigileo, versus pulmonary artery thermodilution in patients undergoing elective open abdominal aortic aneurysm repair. DESIGN A prospective observational study. SETTING Operating room in a university hospital. PATIENTS Twenty-two patients scheduled for elective, open abdominal aortic aneurysm repair. MAIN OUTCOME MEASURES Bias, limits of agreement and mean error as determined with Bland-Altman analysis between arterial waveform and thermodilution cardiac output assessment at four time points: after induction of anaesthesia (t<inf>1</inf>); after aortic cross-clamping (t<inf>2</inf>); after clamp release (t<inf>3</inf>); and after skin closure (t<inf>4</inf>). Trending ability from t1 to t<inf>2</inf>, t<inf>2</inf> to t<inf>3</inf> and t<inf>3</inf> to t<inf>4</inf>, determined with four-quadrant and polar plot methodology. Clinically acceptable boundaries were defined in advance. RESULTS Bland-Altman analysis revealed a bias of 0.54 l min-1 (thermodilution minus arterial waveform cardiac output) for pooled data, and 0.51 (t<inf>1</inf>), -0.42 (t<inf>2</inf>), 0.98 (t<inf>3</inf>) and 0.98 (t<inf>4</inf>) l min-1 at the different time points. Limits of agreement (LOA) were [-3.0 to 4.0] (pooled), [-2.0 to 3.0] (t<inf>1</inf>), [-3.1 to 2.3] (t<inf>2</inf>), [-2.5 to 4.4] (t<inf>3</inf>) and [-1.7 to 3.7] (t<inf>4</inf>) l min-1, resulting in mean errors of 58% (pooled), 45% (t<inf>1</inf>), 53% (t<inf>2</inf>), 52% (t<inf>3</inf>) and 41% (t<inf>4</inf>). Four-quadrant concordance was 65%. Polar plot analysis resulted in an angular bias of -128, with radial LOA of -60° to 36°. CONCLUSION Bias between arterial waveform and thermodilution cardiac output was within a predefined acceptable range, but the mean error was above the accepted range of 30%. Trending ability was poor. Arterial waveform and thermodilution cardiac outputs are, therefore, not interchangeable in patients undergoing open abdominal aortic aneurysm repair.

Original language	English
Pages (from-to)	13-19
Number of pages	7
Journal	European Journal of Anaesthesiology
Volume	32
Issue number	1
DOIs	https://doi.org/10.1097/EJA.0000000000000160
Publication status	Published - 1 Jan 2015

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Montenij, L. J., Buhre, W. F., De Jong, S. A., Harms, J. H., Van Herwaarden, J. A., Kruitwagen, C. L. J. J., & De Waal, E. E. C. (2015). Arterial pressure waveform analysis versus thermodilution cardiac output measurement during open abdominal aortic aneurysm repair: A prospective observational study. European Journal of Anaesthesiology, 32(1), 13-19. https://doi.org/10.1097/EJA.0000000000000160

@article{e476586d1a49469886436f177263007c,

title = "Arterial pressure waveform analysis versus thermodilution cardiac output measurement during open abdominal aortic aneurysm repair: A prospective observational study",

abstract = "BACKGROUND Arterial pressure waveform analysis enables continuous, minimally invasive measurement of cardiac output. Haemodynamic instability compromises the reliability of the technique and a means of maintaining accurate measurement in this circumstance would be useful. OBJECTIVES To investigate the accuracy, precision and trending ability of arterial pressure waveform cardiac output obtained with FloTrac/Vigileo, versus pulmonary artery thermodilution in patients undergoing elective open abdominal aortic aneurysm repair. DESIGN A prospective observational study. SETTING Operating room in a university hospital. PATIENTS Twenty-two patients scheduled for elective, open abdominal aortic aneurysm repair. MAIN OUTCOME MEASURES Bias, limits of agreement and mean error as determined with Bland-Altman analysis between arterial waveform and thermodilution cardiac output assessment at four time points: after induction of anaesthesia (t1); after aortic cross-clamping (t2); after clamp release (t3); and after skin closure (t4). Trending ability from t1 to t2, t2 to t3 and t3 to t4, determined with four-quadrant and polar plot methodology. Clinically acceptable boundaries were defined in advance. RESULTS Bland-Altman analysis revealed a bias of 0.54 l min-1 (thermodilution minus arterial waveform cardiac output) for pooled data, and 0.51 (t1), -0.42 (t2), 0.98 (t3) and 0.98 (t4) l min-1 at the different time points. Limits of agreement (LOA) were [-3.0 to 4.0] (pooled), [-2.0 to 3.0] (t1), [-3.1 to 2.3] (t2), [-2.5 to 4.4] (t3) and [-1.7 to 3.7] (t4) l min-1, resulting in mean errors of 58% (pooled), 45% (t1), 53% (t2), 52% (t3) and 41% (t4). Four-quadrant concordance was 65%. Polar plot analysis resulted in an angular bias of -128, with radial LOA of -60° to 36°. CONCLUSION Bias between arterial waveform and thermodilution cardiac output was within a predefined acceptable range, but the mean error was above the accepted range of 30%. Trending ability was poor. Arterial waveform and thermodilution cardiac outputs are, therefore, not interchangeable in patients undergoing open abdominal aortic aneurysm repair.",

author = "Montenij, {Leonard J.} and Buhre, {Wolfgang F.} and {De Jong}, {Steven A.} and Harms, {Jeroen H.} and {Van Herwaarden}, {Joost A.} and Kruitwagen, {Cas L J J} and {De Waal}, {Eric E C}",

year = "2015",

month = jan,

day = "1",

doi = "10.1097/EJA.0000000000000160",

language = "English",

volume = "32",

pages = "13--19",

journal = "European Journal of Anaesthesiology",

issn = "0265-0215",

publisher = "Lippincott Williams & Wilkins",

number = "1",

}

Montenij, LJ, Buhre, WF, De Jong, SA, Harms, JH, Van Herwaarden, JA, Kruitwagen, CLJJ & De Waal, EEC 2015, 'Arterial pressure waveform analysis versus thermodilution cardiac output measurement during open abdominal aortic aneurysm repair: A prospective observational study', European Journal of Anaesthesiology, vol. 32, no. 1, pp. 13-19. https://doi.org/10.1097/EJA.0000000000000160

Arterial pressure waveform analysis versus thermodilution cardiac output measurement during open abdominal aortic aneurysm repair: A prospective observational study. / Montenij, Leonard J.; Buhre, Wolfgang F.; De Jong, Steven A. et al.
In: European Journal of Anaesthesiology, Vol. 32, No. 1, 01.01.2015, p. 13-19.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Arterial pressure waveform analysis versus thermodilution cardiac output measurement during open abdominal aortic aneurysm repair

T2 - A prospective observational study

AU - Montenij, Leonard J.

AU - Buhre, Wolfgang F.

AU - De Jong, Steven A.

AU - Harms, Jeroen H.

AU - Van Herwaarden, Joost A.

AU - Kruitwagen, Cas L J J

AU - De Waal, Eric E C

PY - 2015/1/1

Y1 - 2015/1/1

N2 - BACKGROUND Arterial pressure waveform analysis enables continuous, minimally invasive measurement of cardiac output. Haemodynamic instability compromises the reliability of the technique and a means of maintaining accurate measurement in this circumstance would be useful. OBJECTIVES To investigate the accuracy, precision and trending ability of arterial pressure waveform cardiac output obtained with FloTrac/Vigileo, versus pulmonary artery thermodilution in patients undergoing elective open abdominal aortic aneurysm repair. DESIGN A prospective observational study. SETTING Operating room in a university hospital. PATIENTS Twenty-two patients scheduled for elective, open abdominal aortic aneurysm repair. MAIN OUTCOME MEASURES Bias, limits of agreement and mean error as determined with Bland-Altman analysis between arterial waveform and thermodilution cardiac output assessment at four time points: after induction of anaesthesia (t1); after aortic cross-clamping (t2); after clamp release (t3); and after skin closure (t4). Trending ability from t1 to t2, t2 to t3 and t3 to t4, determined with four-quadrant and polar plot methodology. Clinically acceptable boundaries were defined in advance. RESULTS Bland-Altman analysis revealed a bias of 0.54 l min-1 (thermodilution minus arterial waveform cardiac output) for pooled data, and 0.51 (t1), -0.42 (t2), 0.98 (t3) and 0.98 (t4) l min-1 at the different time points. Limits of agreement (LOA) were [-3.0 to 4.0] (pooled), [-2.0 to 3.0] (t1), [-3.1 to 2.3] (t2), [-2.5 to 4.4] (t3) and [-1.7 to 3.7] (t4) l min-1, resulting in mean errors of 58% (pooled), 45% (t1), 53% (t2), 52% (t3) and 41% (t4). Four-quadrant concordance was 65%. Polar plot analysis resulted in an angular bias of -128, with radial LOA of -60° to 36°. CONCLUSION Bias between arterial waveform and thermodilution cardiac output was within a predefined acceptable range, but the mean error was above the accepted range of 30%. Trending ability was poor. Arterial waveform and thermodilution cardiac outputs are, therefore, not interchangeable in patients undergoing open abdominal aortic aneurysm repair.

AB - BACKGROUND Arterial pressure waveform analysis enables continuous, minimally invasive measurement of cardiac output. Haemodynamic instability compromises the reliability of the technique and a means of maintaining accurate measurement in this circumstance would be useful. OBJECTIVES To investigate the accuracy, precision and trending ability of arterial pressure waveform cardiac output obtained with FloTrac/Vigileo, versus pulmonary artery thermodilution in patients undergoing elective open abdominal aortic aneurysm repair. DESIGN A prospective observational study. SETTING Operating room in a university hospital. PATIENTS Twenty-two patients scheduled for elective, open abdominal aortic aneurysm repair. MAIN OUTCOME MEASURES Bias, limits of agreement and mean error as determined with Bland-Altman analysis between arterial waveform and thermodilution cardiac output assessment at four time points: after induction of anaesthesia (t1); after aortic cross-clamping (t2); after clamp release (t3); and after skin closure (t4). Trending ability from t1 to t2, t2 to t3 and t3 to t4, determined with four-quadrant and polar plot methodology. Clinically acceptable boundaries were defined in advance. RESULTS Bland-Altman analysis revealed a bias of 0.54 l min-1 (thermodilution minus arterial waveform cardiac output) for pooled data, and 0.51 (t1), -0.42 (t2), 0.98 (t3) and 0.98 (t4) l min-1 at the different time points. Limits of agreement (LOA) were [-3.0 to 4.0] (pooled), [-2.0 to 3.0] (t1), [-3.1 to 2.3] (t2), [-2.5 to 4.4] (t3) and [-1.7 to 3.7] (t4) l min-1, resulting in mean errors of 58% (pooled), 45% (t1), 53% (t2), 52% (t3) and 41% (t4). Four-quadrant concordance was 65%. Polar plot analysis resulted in an angular bias of -128, with radial LOA of -60° to 36°. CONCLUSION Bias between arterial waveform and thermodilution cardiac output was within a predefined acceptable range, but the mean error was above the accepted range of 30%. Trending ability was poor. Arterial waveform and thermodilution cardiac outputs are, therefore, not interchangeable in patients undergoing open abdominal aortic aneurysm repair.

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U2 - 10.1097/EJA.0000000000000160

DO - 10.1097/EJA.0000000000000160

M3 - Article

C2 - 25303970

AN - SCOPUS:84927771868

SN - 0265-0215

VL - 32

SP - 13

EP - 19

JO - European Journal of Anaesthesiology

JF - European Journal of Anaesthesiology

IS - 1

ER -

Arterial pressure waveform analysis versus thermodilution cardiac output measurement during open abdominal aortic aneurysm repair: A prospective observational study

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