Assessment of changes in cardiac index and fluid responsiveness: a comparison of Nexfin and transpulmonary thermodilution
Background The Nexfin device uses non‐invasive photoplethysmography to monitor cardiac output and respiratory variations in pulse pressure and stroke volume. The aim of this study was to compare rapid changes in cardiac index after fluid challenge between Nexfin and bolus transpulmonary thermodiluti...
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| Veröffentlicht in: | Acta anaesthesiologica Scandinavica 2013-07, Vol.57 (6), p.704-712 |
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| creator | FISCHER, M. -O. COUCORAVAS, J. TRUONG, J. ZHU, L. GÉRARD, J. -L. HANOUZ, J. -L. FELLAHI, J. -L. |
| description | Background
The Nexfin device uses non‐invasive photoplethysmography to monitor cardiac output and respiratory variations in pulse pressure and stroke volume. The aim of this study was to compare rapid changes in cardiac index after fluid challenge between Nexfin and bolus transpulmonary thermodilution and the ability to predict fluid responsiveness of dynamic indices given by Nexfin.
Methods
Simultaneous comparative cardiac index were collected from transpulmonary thermodilution and Nexfin before and after fluid challenge in 45 patients following conventional cardiac surgery. Correlations, Bland–Altman analyses and percentage errors were calculated. Pulse pressure variations and stroke volume variations before fluid challenge were collected to assess their discrimination in predicting fluid responsiveness.
Results
Eight (18%) patients were excluded. A weak positive relationship was found between rapid changes in cardiac index after fluid challenge given by both technologies (n = 37, r = 0.39, P = 0.019). Bias, precision and limits of agreements were 0.20 l/min/m2 (95% confidence interval (CI) 0.02–0.40), 0.57 l/min/m2 and ± 1.12 l/min/m2 before fluid challenge, and 0.01 l/min/m2 (95% CI −0.24 to 0.26), 0.74 l/min/m2 and ± 1.45 l/min/m2 after fluid challenge. Percentage errors between Nexfin and transpulmonary thermodilution were 55% and 58% before and after fluid challenge, respectively. Pulse pressure variations and stroke volume variations given by Nexfin were not discriminant to predict fluid responsiveness: areas under receiver operating characteristics curves 0.57 (95% CI 0.40–0.73) and 0.50 (0.33–0.67), respectively.
Conclusions
The Nexfin cannot be used to measure rapid changes in cardiac index following fluid challenge and to predict fluid responsiveness after cardiac surgery. |
| doi_str_mv | 10.1111/aas.12108 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_proquest_miscellaneous_1366575888</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2989865411</sourcerecordid><originalsourceid>FETCH-LOGICAL-i3838-6ca8712b4ba8fc7aeb80cba9eeff8c394f5ddad8d7313df452845e055b76b253</originalsourceid><addsrcrecordid>eNpdkUFvFCEUx4nR2LX14BcwJF68TDsMw8B42zR2a2xWkzat8UIYeFjqDExhxu5-e9lu7UEuPMLv9wLvj9A7Uh6TvE6USsekIqV4gRaEtm3RMN68RIuyLEnBCK8O0JuU7vKR1m37Gh1UlFWENGSBtsuUIKUB_ISDxfpW-V-QsPNYq2ic0rk0sMHKG2z72RkcIY3BJ_cHfBY_YYV1GEYVXQp-12ING5v1nTBF5dM490PwKm7xdAtxCMb18-SCP0KvrOoTvH3aD9HV2eer0_Pi4tvqy-nyonBUUFE0WglOqq7ulLCaK-hEqTvVAlgrNG1ry4xRRhhOCTW2ZpWoGZSMdbzpKkYP0cd92zGG-xnSJAeXNPS98hDmJAlt8rSYECKjH_5D78IcfX7cjmKMCyZopt4_UXM3gJFjdEP-nfw30wyc7IEH18P2-Z6UcheWzGHJx7Dkcnn5WGSj2BsuTbB5NlT8LRtOOZM365X8-XV9tqq-_5DX9C_oJpgM</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1365578583</pqid></control><display><type>article</type><title>Assessment of changes in cardiac index and fluid responsiveness: a comparison of Nexfin and transpulmonary thermodilution</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><creator>FISCHER, M. -O. ; COUCORAVAS, J. ; TRUONG, J. ; ZHU, L. ; GÉRARD, J. -L. ; HANOUZ, J. -L. ; FELLAHI, J. -L.</creator><creatorcontrib>FISCHER, M. -O. ; COUCORAVAS, J. ; TRUONG, J. ; ZHU, L. ; GÉRARD, J. -L. ; HANOUZ, J. -L. ; FELLAHI, J. -L.</creatorcontrib><description>Background
The Nexfin device uses non‐invasive photoplethysmography to monitor cardiac output and respiratory variations in pulse pressure and stroke volume. The aim of this study was to compare rapid changes in cardiac index after fluid challenge between Nexfin and bolus transpulmonary thermodilution and the ability to predict fluid responsiveness of dynamic indices given by Nexfin.
Methods
Simultaneous comparative cardiac index were collected from transpulmonary thermodilution and Nexfin before and after fluid challenge in 45 patients following conventional cardiac surgery. Correlations, Bland–Altman analyses and percentage errors were calculated. Pulse pressure variations and stroke volume variations before fluid challenge were collected to assess their discrimination in predicting fluid responsiveness.
Results
Eight (18%) patients were excluded. A weak positive relationship was found between rapid changes in cardiac index after fluid challenge given by both technologies (n = 37, r = 0.39, P = 0.019). Bias, precision and limits of agreements were 0.20 l/min/m2 (95% confidence interval (CI) 0.02–0.40), 0.57 l/min/m2 and ± 1.12 l/min/m2 before fluid challenge, and 0.01 l/min/m2 (95% CI −0.24 to 0.26), 0.74 l/min/m2 and ± 1.45 l/min/m2 after fluid challenge. Percentage errors between Nexfin and transpulmonary thermodilution were 55% and 58% before and after fluid challenge, respectively. Pulse pressure variations and stroke volume variations given by Nexfin were not discriminant to predict fluid responsiveness: areas under receiver operating characteristics curves 0.57 (95% CI 0.40–0.73) and 0.50 (0.33–0.67), respectively.
Conclusions
The Nexfin cannot be used to measure rapid changes in cardiac index following fluid challenge and to predict fluid responsiveness after cardiac surgery.</description><identifier>ISSN: 0001-5172</identifier><identifier>EISSN: 1399-6576</identifier><identifier>DOI: 10.1111/aas.12108</identifier><identifier>PMID: 23521161</identifier><identifier>CODEN: AANEAB</identifier><language>eng</language><publisher>England: Blackwell Publishing Ltd</publisher><subject>Aged ; Aged, 80 and over ; Area Under Curve ; Blood Pressure ; Body Surface Area ; Cardiac Output ; Cardiac Surgical Procedures ; Cardiopulmonary Bypass ; Critical Care - methods ; Endpoint Determination ; Female ; Fluid Therapy ; Humans ; Male ; Middle Aged ; Photoplethysmography - instrumentation ; Postoperative Care - instrumentation ; Postoperative Care - methods ; Predictive Value of Tests ; ROC Curve ; Sensitivity and Specificity ; Stroke Volume ; Thermodilution - methods ; Treatment Outcome</subject><ispartof>Acta anaesthesiologica Scandinavica, 2013-07, Vol.57 (6), p.704-712</ispartof><rights>2013 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd</rights><rights>2013 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.</rights><rights>Copyright © 2013 The Acta Anaesthesiologica Scandinavica Foundation</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Faas.12108$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Faas.12108$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23521161$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>FISCHER, M. -O.</creatorcontrib><creatorcontrib>COUCORAVAS, J.</creatorcontrib><creatorcontrib>TRUONG, J.</creatorcontrib><creatorcontrib>ZHU, L.</creatorcontrib><creatorcontrib>GÉRARD, J. -L.</creatorcontrib><creatorcontrib>HANOUZ, J. -L.</creatorcontrib><creatorcontrib>FELLAHI, J. -L.</creatorcontrib><title>Assessment of changes in cardiac index and fluid responsiveness: a comparison of Nexfin and transpulmonary thermodilution</title><title>Acta anaesthesiologica Scandinavica</title><addtitle>Acta Anaesthesiol Scand</addtitle><description>Background
The Nexfin device uses non‐invasive photoplethysmography to monitor cardiac output and respiratory variations in pulse pressure and stroke volume. The aim of this study was to compare rapid changes in cardiac index after fluid challenge between Nexfin and bolus transpulmonary thermodilution and the ability to predict fluid responsiveness of dynamic indices given by Nexfin.
Methods
Simultaneous comparative cardiac index were collected from transpulmonary thermodilution and Nexfin before and after fluid challenge in 45 patients following conventional cardiac surgery. Correlations, Bland–Altman analyses and percentage errors were calculated. Pulse pressure variations and stroke volume variations before fluid challenge were collected to assess their discrimination in predicting fluid responsiveness.
Results
Eight (18%) patients were excluded. A weak positive relationship was found between rapid changes in cardiac index after fluid challenge given by both technologies (n = 37, r = 0.39, P = 0.019). Bias, precision and limits of agreements were 0.20 l/min/m2 (95% confidence interval (CI) 0.02–0.40), 0.57 l/min/m2 and ± 1.12 l/min/m2 before fluid challenge, and 0.01 l/min/m2 (95% CI −0.24 to 0.26), 0.74 l/min/m2 and ± 1.45 l/min/m2 after fluid challenge. Percentage errors between Nexfin and transpulmonary thermodilution were 55% and 58% before and after fluid challenge, respectively. Pulse pressure variations and stroke volume variations given by Nexfin were not discriminant to predict fluid responsiveness: areas under receiver operating characteristics curves 0.57 (95% CI 0.40–0.73) and 0.50 (0.33–0.67), respectively.
Conclusions
The Nexfin cannot be used to measure rapid changes in cardiac index following fluid challenge and to predict fluid responsiveness after cardiac surgery.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Area Under Curve</subject><subject>Blood Pressure</subject><subject>Body Surface Area</subject><subject>Cardiac Output</subject><subject>Cardiac Surgical Procedures</subject><subject>Cardiopulmonary Bypass</subject><subject>Critical Care - methods</subject><subject>Endpoint Determination</subject><subject>Female</subject><subject>Fluid Therapy</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Photoplethysmography - instrumentation</subject><subject>Postoperative Care - instrumentation</subject><subject>Postoperative Care - methods</subject><subject>Predictive Value of Tests</subject><subject>ROC Curve</subject><subject>Sensitivity and Specificity</subject><subject>Stroke Volume</subject><subject>Thermodilution - methods</subject><subject>Treatment Outcome</subject><issn>0001-5172</issn><issn>1399-6576</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkUFvFCEUx4nR2LX14BcwJF68TDsMw8B42zR2a2xWkzat8UIYeFjqDExhxu5-e9lu7UEuPMLv9wLvj9A7Uh6TvE6USsekIqV4gRaEtm3RMN68RIuyLEnBCK8O0JuU7vKR1m37Gh1UlFWENGSBtsuUIKUB_ISDxfpW-V-QsPNYq2ic0rk0sMHKG2z72RkcIY3BJ_cHfBY_YYV1GEYVXQp-12ING5v1nTBF5dM490PwKm7xdAtxCMb18-SCP0KvrOoTvH3aD9HV2eer0_Pi4tvqy-nyonBUUFE0WglOqq7ulLCaK-hEqTvVAlgrNG1ry4xRRhhOCTW2ZpWoGZSMdbzpKkYP0cd92zGG-xnSJAeXNPS98hDmJAlt8rSYECKjH_5D78IcfX7cjmKMCyZopt4_UXM3gJFjdEP-nfw30wyc7IEH18P2-Z6UcheWzGHJx7Dkcnn5WGSj2BsuTbB5NlT8LRtOOZM365X8-XV9tqq-_5DX9C_oJpgM</recordid><startdate>201307</startdate><enddate>201307</enddate><creator>FISCHER, M. -O.</creator><creator>COUCORAVAS, J.</creator><creator>TRUONG, J.</creator><creator>ZHU, L.</creator><creator>GÉRARD, J. -L.</creator><creator>HANOUZ, J. -L.</creator><creator>FELLAHI, J. -L.</creator><general>Blackwell Publishing Ltd</general><general>Wiley Subscription Services, Inc</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7T5</scope><scope>7TK</scope><scope>H94</scope><scope>7X8</scope></search><sort><creationdate>201307</creationdate><title>Assessment of changes in cardiac index and fluid responsiveness: a comparison of Nexfin and transpulmonary thermodilution</title><author>FISCHER, M. -O. ; COUCORAVAS, J. ; TRUONG, J. ; ZHU, L. ; GÉRARD, J. -L. ; HANOUZ, J. -L. ; FELLAHI, J. -L.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-i3838-6ca8712b4ba8fc7aeb80cba9eeff8c394f5ddad8d7313df452845e055b76b253</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Area Under Curve</topic><topic>Blood Pressure</topic><topic>Body Surface Area</topic><topic>Cardiac Output</topic><topic>Cardiac Surgical Procedures</topic><topic>Cardiopulmonary Bypass</topic><topic>Critical Care - methods</topic><topic>Endpoint Determination</topic><topic>Female</topic><topic>Fluid Therapy</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Photoplethysmography - instrumentation</topic><topic>Postoperative Care - instrumentation</topic><topic>Postoperative Care - methods</topic><topic>Predictive Value of Tests</topic><topic>ROC Curve</topic><topic>Sensitivity and Specificity</topic><topic>Stroke Volume</topic><topic>Thermodilution - methods</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>FISCHER, M. -O.</creatorcontrib><creatorcontrib>COUCORAVAS, J.</creatorcontrib><creatorcontrib>TRUONG, J.</creatorcontrib><creatorcontrib>ZHU, L.</creatorcontrib><creatorcontrib>GÉRARD, J. -L.</creatorcontrib><creatorcontrib>HANOUZ, J. -L.</creatorcontrib><creatorcontrib>FELLAHI, J. -L.</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Acta anaesthesiologica Scandinavica</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>FISCHER, M. -O.</au><au>COUCORAVAS, J.</au><au>TRUONG, J.</au><au>ZHU, L.</au><au>GÉRARD, J. -L.</au><au>HANOUZ, J. -L.</au><au>FELLAHI, J. -L.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Assessment of changes in cardiac index and fluid responsiveness: a comparison of Nexfin and transpulmonary thermodilution</atitle><jtitle>Acta anaesthesiologica Scandinavica</jtitle><addtitle>Acta Anaesthesiol Scand</addtitle><date>2013-07</date><risdate>2013</risdate><volume>57</volume><issue>6</issue><spage>704</spage><epage>712</epage><pages>704-712</pages><issn>0001-5172</issn><eissn>1399-6576</eissn><coden>AANEAB</coden><abstract>Background
The Nexfin device uses non‐invasive photoplethysmography to monitor cardiac output and respiratory variations in pulse pressure and stroke volume. The aim of this study was to compare rapid changes in cardiac index after fluid challenge between Nexfin and bolus transpulmonary thermodilution and the ability to predict fluid responsiveness of dynamic indices given by Nexfin.
Methods
Simultaneous comparative cardiac index were collected from transpulmonary thermodilution and Nexfin before and after fluid challenge in 45 patients following conventional cardiac surgery. Correlations, Bland–Altman analyses and percentage errors were calculated. Pulse pressure variations and stroke volume variations before fluid challenge were collected to assess their discrimination in predicting fluid responsiveness.
Results
Eight (18%) patients were excluded. A weak positive relationship was found between rapid changes in cardiac index after fluid challenge given by both technologies (n = 37, r = 0.39, P = 0.019). Bias, precision and limits of agreements were 0.20 l/min/m2 (95% confidence interval (CI) 0.02–0.40), 0.57 l/min/m2 and ± 1.12 l/min/m2 before fluid challenge, and 0.01 l/min/m2 (95% CI −0.24 to 0.26), 0.74 l/min/m2 and ± 1.45 l/min/m2 after fluid challenge. Percentage errors between Nexfin and transpulmonary thermodilution were 55% and 58% before and after fluid challenge, respectively. Pulse pressure variations and stroke volume variations given by Nexfin were not discriminant to predict fluid responsiveness: areas under receiver operating characteristics curves 0.57 (95% CI 0.40–0.73) and 0.50 (0.33–0.67), respectively.
Conclusions
The Nexfin cannot be used to measure rapid changes in cardiac index following fluid challenge and to predict fluid responsiveness after cardiac surgery.</abstract><cop>England</cop><pub>Blackwell Publishing Ltd</pub><pmid>23521161</pmid><doi>10.1111/aas.12108</doi><tpages>9</tpages></addata></record> |
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| ispartof | Acta anaesthesiologica Scandinavica, 2013-07, Vol.57 (6), p.704-712 |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Aged Aged, 80 and over Area Under Curve Blood Pressure Body Surface Area Cardiac Output Cardiac Surgical Procedures Cardiopulmonary Bypass Critical Care - methods Endpoint Determination Female Fluid Therapy Humans Male Middle Aged Photoplethysmography - instrumentation Postoperative Care - instrumentation Postoperative Care - methods Predictive Value of Tests ROC Curve Sensitivity and Specificity Stroke Volume Thermodilution - methods Treatment Outcome |
| title | Assessment of changes in cardiac index and fluid responsiveness: a comparison of Nexfin and transpulmonary thermodilution |
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