TY - JOUR
T1 - Cardiac Index Validation Using the Pressure Recording Analytic Method in Unstable Patients
AU - Zangrillo, Alberto
AU - Maj, Giulia
AU - Monaco, Fabrizio
AU - Scandroglio, Anna Mara
AU - Nuzzi, Massimiliano
AU - Plumari, Valentina
AU - Virzo, Isotta
AU - Bignami, Elena
AU - Casiraghi, Giuseppina
AU - Landoni, Giovanni
PY - 2010/4
Y1 - 2010/4
N2 - Objective: The authors investigated the accuracy and precision of the pressure recording analytic method (PRAM) in cardiac index measurement compared with thermodilution in unstable patients, a setting in which minimally invasive monitoring devices often fail. Design: Criterion standard. Setting: Intensive care unit. Patients: Thirty-two consecutive patients with low cardiac output syndrome treated with an intra-aortic balloon pump and/or high doses of inotropic drugs but without atrial fibrillation were studied after cardiac surgery. Interventions: None. Pulmonary and radial artery catheters were already in situ for clinical reasons. Measurements and Main Results: Four patients (12.5%) were excluded from the study because of artifacts caused by under- or overdamping of the arterial pressure monitoring system. The authors performed 3 injections of the thermal indicator in 5 minutes through the pulmonary artery catheter. Mean cardiac index values of 12 consecutive beats were considered for the PRAM. A significant correlation was found between the cardiac index assessed by thermodilution and PRAM (r = 0.72, p <0.001). The mean bias between the 2 techniques was 0.072 ± 0.41 L/min/m2 with lower and upper 95% limits of confidence of -0.089 and 0.233 L/min/m2, respectively. The percentage error was 30%. Sufficient agreement between the two techniques was evidenced by the Bland-Altman plot with only two points above the limits of agreement. Conclusions: This study showed that PRAM, a minimally invasive method for cardiac index assessment, is clinically useful even in unstable patients such as those receiving intra-aortic balloon pump and/or ongoing high doses of a inotropic drugs because of a low cardiac output syndrome but without atrial fibrillation.
AB - Objective: The authors investigated the accuracy and precision of the pressure recording analytic method (PRAM) in cardiac index measurement compared with thermodilution in unstable patients, a setting in which minimally invasive monitoring devices often fail. Design: Criterion standard. Setting: Intensive care unit. Patients: Thirty-two consecutive patients with low cardiac output syndrome treated with an intra-aortic balloon pump and/or high doses of inotropic drugs but without atrial fibrillation were studied after cardiac surgery. Interventions: None. Pulmonary and radial artery catheters were already in situ for clinical reasons. Measurements and Main Results: Four patients (12.5%) were excluded from the study because of artifacts caused by under- or overdamping of the arterial pressure monitoring system. The authors performed 3 injections of the thermal indicator in 5 minutes through the pulmonary artery catheter. Mean cardiac index values of 12 consecutive beats were considered for the PRAM. A significant correlation was found between the cardiac index assessed by thermodilution and PRAM (r = 0.72, p <0.001). The mean bias between the 2 techniques was 0.072 ± 0.41 L/min/m2 with lower and upper 95% limits of confidence of -0.089 and 0.233 L/min/m2, respectively. The percentage error was 30%. Sufficient agreement between the two techniques was evidenced by the Bland-Altman plot with only two points above the limits of agreement. Conclusions: This study showed that PRAM, a minimally invasive method for cardiac index assessment, is clinically useful even in unstable patients such as those receiving intra-aortic balloon pump and/or ongoing high doses of a inotropic drugs because of a low cardiac output syndrome but without atrial fibrillation.
KW - cardiac index
KW - cardiac surgery
KW - hemodynamic monitoring
KW - pressure recording analytic method (PRAM)
KW - pulse contour analysis
KW - unstable patients
KW - validation
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U2 - 10.1053/j.jvca.2009.09.019
DO - 10.1053/j.jvca.2009.09.019
M3 - Article
C2 - 20005131
AN - SCOPUS:77950020487
VL - 24
SP - 265
EP - 269
JO - Journal of Cardiothoracic and Vascular Anesthesia
JF - Journal of Cardiothoracic and Vascular Anesthesia
SN - 1053-0770
IS - 2
ER -