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Anesth Analg 2008; 106:1480-1486
© 2008 International Anesthesia Research Society
doi: 10.1213/ane.0b013e318168b309
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TECHNOLOGY, COMPUTING, AND SIMULATION

Cardiac Output Measurement in Patients Undergoing Liver Transplantation: Pulmonary Artery Catheter Versus Uncalibrated Arterial Pressure Waveform Analysis

Biais Matthieu, MD, Nouette-Gaulain Karine, MD, PhD, Cottenceau Vincent, MD, Vallet Alain, MD, Cochard Jean François, MD, Revel Philippe, MD, and Sztark François, MD, PhD

From the Service d'Anesthésie Réanimation I, Hôpital Pellegrin, Centre Hospitalo-Universitaire de Bordeaux, Place Amélie Raba-Léon, Bordeaux Cedex, France.

Address correspondence and reprint requests to François Sztark, MD, PhD, Service d'Anesthésie Réanimation I, Hôpital Pellegrin, Place Amélie Raba-Léon, 33076 Bordeaux Cedex, France. Address e-mail to francois.sztark{at}chu-bordeaux.fr.

BACKGROUND: Cardiac output (CO) and invasive hemodynamic measurements are useful during liver transplantation. The pulmonary artery catheter (PAC) is commonly used for these patients, despite the potential complications. Recently, a less invasive device (Vigileo®/FloTracTM) became available, which estimates CO using arterial pressure waveform analysis without external calibration. In this study, we compared CO obtained with a PAC using automatic thermodilution, instantaneous CO stat-mode (ICOSM), and CO obtained with the new device, arterial pressure waveform analysis (APCO) in patients undergoing liver transplantation.

METHODS: Twenty sets of simultaneous measurements of APCO and ICOSM were determined in sedated and mechanically ventilated patients undergoing liver transplantation. Time points were as follows: after PAC insertion (T1–3), after portal clamping (T4–6), during anhepathy (T7–9), after graft reperfusion (T10–15), and in the postoperative period in the intensive care unit (T15–20).

RESULTS: We enrolled 20 patients and 400 measurements were obtained. No data were rejected. Bias between ICOSM and APCO was 0.8 L/min, 95% limits of agreement were –1.8 to 3.5 L/min. The percentage error was 43%. Bias between ICOSM and APCO was correlated with systemic vascular resistance [r2 = 0.55, P < 0.0001, y = 15.8–2.2 ln(x)] and subgroup analysis revealed an increase in the bias and in the percentage error in patients with low systemic vascular resistance (Child-Pugh grade B and C patients). There was no difference between the different surgical periods.

CONCLUSIONS: Our results suggest that Vigileo/FloTrac CO monitoring data do not agree well with those of automatic thermodilution in patients undergoing liver transplantation, especially in Child-Pugh grade B and C patients with low systemic vascular resistance.






Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2008 by the International Anesthesia Research Society.