Oesophageal Doppler and calibrated pulse contour analysis are not interchangeable within a goal-directed haemodynamic algorithm in major gynaecological surgery
Evidence for the benefit of an intraoperative use of a goal-directed haemodynamic management has grown. We compared the oesophageal Doppler monitor (ODM, CardioQ-ODM™) with a calibrated pulse contour analysis (PCA, PiCCO2™) with regard to assessment of stroke volume (SV) changes after volume adminis...
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| Veröffentlicht in: | British journal of anaesthesia : BJA 2014-11, Vol.113 (5), p.822-831 |
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| container_title | British journal of anaesthesia : BJA |
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| creator | Feldheiser, A. Hunsicker, O. Krebbel, H. Weimann, K. Kaufner, L. Wernecke, K.-D. Spies, C. |
| description | Evidence for the benefit of an intraoperative use of a goal-directed haemodynamic management has grown. We compared the oesophageal Doppler monitor (ODM, CardioQ-ODM™) with a calibrated pulse contour analysis (PCA, PiCCO2™) with regard to assessment of stroke volume (SV) changes after volume administration within a goal-directed haemodynamic algorithm during non-cardiac surgery.
The data were obtained prospectively in patients with metastatic ovarian carcinoma undergoing cytoreductive surgery. During surgery, fluid challenges were performed as indicated by the goal-directed haemodynamic algorithm guided by the ODM. Monitors were compared regarding precision and trending. Clinical characteristics associated with trending were studied by extended regression analysis.
A total of 762 fluid challenges were performed in 41 patients resulting in 1524 paired measurements. The precision of ODM and PCA was 5.7% and 6.0% (P=0.80), respectively. Polar plot analysis revealed a poor trending between ODM and PCA with an angular bias of −7.1°, radial limits of agreement of −58.1° to 43.8°, and an angular concordance rate of 67.8%. Dose of norepinephrine (NE) (scaled 0.1 µg kg−1 min−1) [adjusted odds ratio (OR) 0.606 (95% confidence interval, CI: 0.404–0.910); P=0.016] and changes in mean arterial pressure (MAP) to a fluid challenge (scaled 10%) [adjusted OR 0.733 (95% CI: 0.635–0.845); P |
| doi_str_mv | 10.1093/bja/aeu241 |
| format | Article |
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The data were obtained prospectively in patients with metastatic ovarian carcinoma undergoing cytoreductive surgery. During surgery, fluid challenges were performed as indicated by the goal-directed haemodynamic algorithm guided by the ODM. Monitors were compared regarding precision and trending. Clinical characteristics associated with trending were studied by extended regression analysis.
A total of 762 fluid challenges were performed in 41 patients resulting in 1524 paired measurements. The precision of ODM and PCA was 5.7% and 6.0% (P=0.80), respectively. Polar plot analysis revealed a poor trending between ODM and PCA with an angular bias of −7.1°, radial limits of agreement of −58.1° to 43.8°, and an angular concordance rate of 67.8%. Dose of norepinephrine (NE) (scaled 0.1 µg kg−1 min−1) [adjusted odds ratio (OR) 0.606 (95% confidence interval, CI: 0.404–0.910); P=0.016] and changes in mean arterial pressure (MAP) to a fluid challenge (scaled 10%) [adjusted OR 0.733 (95% CI: 0.635–0.845); P<0.001] were associated with trending between ODM and PCA, whereas there was no relation to type of i.v. solution.
Despite a similar precision, ODM and PCA were not interchangeable with regard to measuring SV changes within a goal-directed haemodynamic algorithm. A decrease in interchangeability coincided with increasing NE levels and greater changes of MAP to a fluid challenge.</description><identifier>ISSN: 0007-0912</identifier><identifier>EISSN: 1471-6771</identifier><identifier>DOI: 10.1093/bja/aeu241</identifier><identifier>PMID: 25107544</identifier><language>eng</language><publisher>England: Elsevier Ltd</publisher><subject>Algorithms ; Calibration ; Echocardiography, Transesophageal - methods ; Female ; goal-directed therapy ; Gynecologic Surgical Procedures - methods ; Gynecologic Surgical Procedures - mortality ; haemodynamic monitoring ; Hemodynamics - physiology ; Humans ; Middle Aged ; Monitoring, Intraoperative - instrumentation ; Monitoring, Intraoperative - methods ; oesophageal Doppler ; Ovarian Neoplasms - surgery ; Prospective Studies ; Pulse - statistics & numerical data ; pulse contour analysis ; Stroke Volume - physiology ; trending</subject><ispartof>British journal of anaesthesia : BJA, 2014-11, Vol.113 (5), p.822-831</ispartof><rights>2014 The Author(s)</rights><rights>The Author 2014. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c368t-7f5049511cb73fada07bc09e5e5a967620c34fd0e397c74a1fb9f855066eb4a43</citedby><cites>FETCH-LOGICAL-c368t-7f5049511cb73fada07bc09e5e5a967620c34fd0e397c74a1fb9f855066eb4a43</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25107544$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Feldheiser, A.</creatorcontrib><creatorcontrib>Hunsicker, O.</creatorcontrib><creatorcontrib>Krebbel, H.</creatorcontrib><creatorcontrib>Weimann, K.</creatorcontrib><creatorcontrib>Kaufner, L.</creatorcontrib><creatorcontrib>Wernecke, K.-D.</creatorcontrib><creatorcontrib>Spies, C.</creatorcontrib><title>Oesophageal Doppler and calibrated pulse contour analysis are not interchangeable within a goal-directed haemodynamic algorithm in major gynaecological surgery</title><title>British journal of anaesthesia : BJA</title><addtitle>Br J Anaesth</addtitle><description>Evidence for the benefit of an intraoperative use of a goal-directed haemodynamic management has grown. We compared the oesophageal Doppler monitor (ODM, CardioQ-ODM™) with a calibrated pulse contour analysis (PCA, PiCCO2™) with regard to assessment of stroke volume (SV) changes after volume administration within a goal-directed haemodynamic algorithm during non-cardiac surgery.
The data were obtained prospectively in patients with metastatic ovarian carcinoma undergoing cytoreductive surgery. During surgery, fluid challenges were performed as indicated by the goal-directed haemodynamic algorithm guided by the ODM. Monitors were compared regarding precision and trending. Clinical characteristics associated with trending were studied by extended regression analysis.
A total of 762 fluid challenges were performed in 41 patients resulting in 1524 paired measurements. The precision of ODM and PCA was 5.7% and 6.0% (P=0.80), respectively. Polar plot analysis revealed a poor trending between ODM and PCA with an angular bias of −7.1°, radial limits of agreement of −58.1° to 43.8°, and an angular concordance rate of 67.8%. Dose of norepinephrine (NE) (scaled 0.1 µg kg−1 min−1) [adjusted odds ratio (OR) 0.606 (95% confidence interval, CI: 0.404–0.910); P=0.016] and changes in mean arterial pressure (MAP) to a fluid challenge (scaled 10%) [adjusted OR 0.733 (95% CI: 0.635–0.845); P<0.001] were associated with trending between ODM and PCA, whereas there was no relation to type of i.v. solution.
Despite a similar precision, ODM and PCA were not interchangeable with regard to measuring SV changes within a goal-directed haemodynamic algorithm. A decrease in interchangeability coincided with increasing NE levels and greater changes of MAP to a fluid challenge.</description><subject>Algorithms</subject><subject>Calibration</subject><subject>Echocardiography, Transesophageal - methods</subject><subject>Female</subject><subject>goal-directed therapy</subject><subject>Gynecologic Surgical Procedures - methods</subject><subject>Gynecologic Surgical Procedures - mortality</subject><subject>haemodynamic monitoring</subject><subject>Hemodynamics - physiology</subject><subject>Humans</subject><subject>Middle Aged</subject><subject>Monitoring, Intraoperative - instrumentation</subject><subject>Monitoring, Intraoperative - methods</subject><subject>oesophageal Doppler</subject><subject>Ovarian Neoplasms - surgery</subject><subject>Prospective Studies</subject><subject>Pulse - statistics & numerical data</subject><subject>pulse contour analysis</subject><subject>Stroke Volume - physiology</subject><subject>trending</subject><issn>0007-0912</issn><issn>1471-6771</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNptkcFu1DAQhi0EotvChQdAPiKkUDux4_qIWtoiVeqlnK2JM8l65djBTkD7NLxqvUrhxGkO8_n7Nf4J-cDZF850c9kd4BJwrQV_RXZcKF61SvHXZMcYUxXTvD4j5zkfGOOq1vItOaslZ0oKsSN_HjHHeQ8jgqc3cZ49Jgqhpxa86xIs2NN59RmpjWGJ62kJ_phdppCQhrhQFxZMdg-hODqP9Ldb9i5QoGMEX_UuoT1Z9oBT7I8BJmcp-DGmwk3lNZ3gEBMdywpt9HF0JZvmNY2Yju_ImwFK_PuXeUF-3H57ur6vHh7vvl9_fahs014tlRokE1pybjvVDNADU51lGiVK0K1qa2YbMfQMG62sEsCHTg9XUrK2xU6AaC7Ip807p_hzxbyYyWWL3kPAuGbDW95oUQJ4QT9vqE0x54SDmZObIB0NZ-ZUiCmFmK2QAn988a7dhP0_9G8DBRAbgOW6Xw6TydZhsLh9nOmj-5_3GRQ0nhQ</recordid><startdate>201411</startdate><enddate>201411</enddate><creator>Feldheiser, A.</creator><creator>Hunsicker, O.</creator><creator>Krebbel, H.</creator><creator>Weimann, K.</creator><creator>Kaufner, L.</creator><creator>Wernecke, K.-D.</creator><creator>Spies, C.</creator><general>Elsevier Ltd</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201411</creationdate><title>Oesophageal Doppler and calibrated pulse contour analysis are not interchangeable within a goal-directed haemodynamic algorithm in major gynaecological surgery</title><author>Feldheiser, A. ; Hunsicker, O. ; Krebbel, H. ; Weimann, K. ; Kaufner, L. ; Wernecke, K.-D. ; Spies, C.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c368t-7f5049511cb73fada07bc09e5e5a967620c34fd0e397c74a1fb9f855066eb4a43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Algorithms</topic><topic>Calibration</topic><topic>Echocardiography, Transesophageal - methods</topic><topic>Female</topic><topic>goal-directed therapy</topic><topic>Gynecologic Surgical Procedures - methods</topic><topic>Gynecologic Surgical Procedures - mortality</topic><topic>haemodynamic monitoring</topic><topic>Hemodynamics - physiology</topic><topic>Humans</topic><topic>Middle Aged</topic><topic>Monitoring, Intraoperative - instrumentation</topic><topic>Monitoring, Intraoperative - methods</topic><topic>oesophageal Doppler</topic><topic>Ovarian Neoplasms - surgery</topic><topic>Prospective Studies</topic><topic>Pulse - statistics & numerical data</topic><topic>pulse contour analysis</topic><topic>Stroke Volume - physiology</topic><topic>trending</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Feldheiser, A.</creatorcontrib><creatorcontrib>Hunsicker, O.</creatorcontrib><creatorcontrib>Krebbel, H.</creatorcontrib><creatorcontrib>Weimann, K.</creatorcontrib><creatorcontrib>Kaufner, L.</creatorcontrib><creatorcontrib>Wernecke, K.-D.</creatorcontrib><creatorcontrib>Spies, C.</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>British journal of anaesthesia : BJA</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Feldheiser, A.</au><au>Hunsicker, O.</au><au>Krebbel, H.</au><au>Weimann, K.</au><au>Kaufner, L.</au><au>Wernecke, K.-D.</au><au>Spies, C.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Oesophageal Doppler and calibrated pulse contour analysis are not interchangeable within a goal-directed haemodynamic algorithm in major gynaecological surgery</atitle><jtitle>British journal of anaesthesia : BJA</jtitle><addtitle>Br J Anaesth</addtitle><date>2014-11</date><risdate>2014</risdate><volume>113</volume><issue>5</issue><spage>822</spage><epage>831</epage><pages>822-831</pages><issn>0007-0912</issn><eissn>1471-6771</eissn><abstract>Evidence for the benefit of an intraoperative use of a goal-directed haemodynamic management has grown. We compared the oesophageal Doppler monitor (ODM, CardioQ-ODM™) with a calibrated pulse contour analysis (PCA, PiCCO2™) with regard to assessment of stroke volume (SV) changes after volume administration within a goal-directed haemodynamic algorithm during non-cardiac surgery.
The data were obtained prospectively in patients with metastatic ovarian carcinoma undergoing cytoreductive surgery. During surgery, fluid challenges were performed as indicated by the goal-directed haemodynamic algorithm guided by the ODM. Monitors were compared regarding precision and trending. Clinical characteristics associated with trending were studied by extended regression analysis.
A total of 762 fluid challenges were performed in 41 patients resulting in 1524 paired measurements. The precision of ODM and PCA was 5.7% and 6.0% (P=0.80), respectively. Polar plot analysis revealed a poor trending between ODM and PCA with an angular bias of −7.1°, radial limits of agreement of −58.1° to 43.8°, and an angular concordance rate of 67.8%. Dose of norepinephrine (NE) (scaled 0.1 µg kg−1 min−1) [adjusted odds ratio (OR) 0.606 (95% confidence interval, CI: 0.404–0.910); P=0.016] and changes in mean arterial pressure (MAP) to a fluid challenge (scaled 10%) [adjusted OR 0.733 (95% CI: 0.635–0.845); P<0.001] were associated with trending between ODM and PCA, whereas there was no relation to type of i.v. solution.
Despite a similar precision, ODM and PCA were not interchangeable with regard to measuring SV changes within a goal-directed haemodynamic algorithm. A decrease in interchangeability coincided with increasing NE levels and greater changes of MAP to a fluid challenge.</abstract><cop>England</cop><pub>Elsevier Ltd</pub><pmid>25107544</pmid><doi>10.1093/bja/aeu241</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | British journal of anaesthesia : BJA, 2014-11, Vol.113 (5), p.822-831 |
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| subjects | Algorithms Calibration Echocardiography, Transesophageal - methods Female goal-directed therapy Gynecologic Surgical Procedures - methods Gynecologic Surgical Procedures - mortality haemodynamic monitoring Hemodynamics - physiology Humans Middle Aged Monitoring, Intraoperative - instrumentation Monitoring, Intraoperative - methods oesophageal Doppler Ovarian Neoplasms - surgery Prospective Studies Pulse - statistics & numerical data pulse contour analysis Stroke Volume - physiology trending |
| title | Oesophageal Doppler and calibrated pulse contour analysis are not interchangeable within a goal-directed haemodynamic algorithm in major gynaecological surgery |
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