Effect of norepinephrine dosage and calibration frequency on accuracy of pulse contour-derived cardiac output.docVIP

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Effect of norepinephrine dosage and calibration frequency on accuracy of pulse contour-derived cardiac output.doc

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Effect of norepinephrine dosage and calibration frequency on accuracy of pulse contour-derived cardiac output

Gruenewaldetal.CriticalCare2011,15:R22 /content/15/1/R22 RESEARCH OpenAccess Effectofnorepinephrinedosageandcalibration frequencyonaccuracyofpulsecontour-derived cardiacoutput MatthiasGruenewald1*,PatrickMeybohm1,JochenRenner1,OleBroch1,AmkeCaliebe2,NorbertWeiler1, MarkusSteinfath1,JensScholz1,BertholdBein1 Abstract Introduction:Continuouscardiacoutputmonitoringisusedforearlydetectionofhemodynamicinstabilityand guidanceoftherapyincriticallyillpatients.Recently,theaccuracyofpulsecontour-derivedcardiacoutput(PCCO) hasbeenquestionedindifferentclinicalsituations.Inthisstudy,weexaminedagreementbetweenPCCOand transcardiopulmonarythermodilutioncardiacoutput(COTCP)incriticallyillpatients,withspecialemphasison norepinephrine(NE)administrationandthetimeintervalbetweencalibrations. Methods:Thisprospective,observationalstudywasperformedwithasampleof73patients(meanage,63± 13 years)requiringinvasivehemodynamicmonitoringonanon-cardiacsurgeryintensivecareunit.PCCOwas recordedimmediatelybeforecalibrationbyCOTCP.Bland-Altmananalysiswasperformedondatasubsets comparingagreementbetweenPCCOandCOTCP accordingtoNEdosageandthetimeintervalbetween calibrationsupto24hours.Further,centralarterystiffnesswascalculatedonthebasisofthepulsepressureto strokevolumerelationship. Results:Atotalof330datapairswereanalyzed.Foralldatapairs,themeanCOTCP (±SD )was8.2± 2.0L/min. PCCOhadameanbiasof0.16L/minwithlimitsofagreementof-2.81to3.15L/min(percentageerror,38%)when comparedtoCOTCP.WhereasthebiasbetweenPCCOandCOTCP wasnotsignificantlydifferentbetweenNE dosagecategoriesorcategoriesoftimeelapsedbetweencalibrations,interchangeability(percentageerror30%) betweenmethodswaspresentonlyinthehighNEdosagesubgroup(≥0.1μg/kg/min),asthepercentageerrors were40%,47%and28%inthenoNE,NE0.1andNE≥0.1μg/kg/minsubgroups,respectively.PCCOwasnot interchangeablewithCOTCP insubgroupsofdifferentcalibrationintervals.ThehighNEdosagegroupshowed significantlyincreasedcentralarterystiffness. Conclusions:Thisstu