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Comparison of calibrated and uncalibrated arterial pressure-based cardiac output monitors during orthotopic liver transplantation

2010; Lippincott Williams & Wilkins; Volume: 16; Issue: 6 Linguagem: Inglês

10.1002/lt.22056

1527-6473

Vladimír Krejčí, Andrea Vannucci, Alhan Abbas, William C. Chapman, Ivan Kangrga,

Renal function and acid-base balance

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 Lifesciences) 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 (CIV). 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/m2, P = 0.02) to −2.51 L/minute/m2 (95% confidence interval = −3.36 to −1.65 L/minute/m2, P < 0.001), and CIL-CITD bias ranged from −0.65 (95% confidence interval = −1.29 to −0.01 L/minute/m2, P = 0.047) to −1.48 L/minute/m2 (95% confidence interval = −2.37 to −0.60 L/minute/m2, 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. © 2010 AASLD.