British journal of anaesthesia · 2026
Agreement of minimally invasive pulse wave analysis with pulmonary artery and transpulmonary thermodilution cardiac output measurements in perioperative and intensive care medicine: a systematic review and meta-analysis.
СтатьяСистематический обзорМетаанализНазвание и аннотация: Перевод в очереди
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Flick Moritz, Müller Dominik X, Bergholz Alina, Sierzputowski Pawel, Eichlseder Michael, Saad Rami, Greiwe Gillis, Kouz Karim, Hapfelmeier Alexander, Saugel Bernd
Аннотация
BACKGROUND: Cardiac output monitoring is recommended for high-risk surgical patients and critically ill patients with circulatory shock. We performed a systematic review and meta-analysis of clinical studies published since 2010 that compared minimally invasive pulse wave analysis-derived cardiac output or cardiac index measurements with reference measurements by pulmonary artery thermodilution or transpulmonary thermodilution in adult surgical or critically ill patients.
METHODS: In a random-effects meta-analysis, we calculated pooled estimates of the percentage error, mean difference and standard deviation, and 95% limits of agreement separately for studies reporting cardiac output or cardiac index. Subgroup analyses were performed by patient population and test device.
RESULTS: We included 92 studies divided into 113 data sets with a total of 3111 patients. For 71 data sets reporting cardiac output, the pooled percentage error (95% confidence interval [95% CI]) was 44.0% (38.2%-49.8%) with a mean difference (standard deviation) of -0.1 (1.3) L min-1 with 95% limits of agreement of -2.6 to 2.4 L min-1 (I2=9.8%). For 42 data sets reporting cardiac index, the pooled percentage error was 49.1% (40.6%-57.6%) with a mean difference of -0.1 (0.9) L min-1 m-2 with 95% limits of agreement of -1.8 to 1.6 L min-1 m-2 (I2=7.9%). The percentage error varied substantially across patient populations and devices. Overall risk of bias was low.
CONCLUSIONS: The pooled percentage error between minimally invasive pulse wave analysis-derived cardiac output measurements of 44.0% (cardiac output) and 49.1% (cardiac index) in adult surgical or critically ill patients exceeds the 30% threshold for clinically acceptable agreement. However, the percentage error varied depending on the patient population and device used.
TRIAL REGISTRATION: PROSPERO (CRD420251090806; submitted July 17, 2025).
METHODS: In a random-effects meta-analysis, we calculated pooled estimates of the percentage error, mean difference and standard deviation, and 95% limits of agreement separately for studies reporting cardiac output or cardiac index. Subgroup analyses were performed by patient population and test device.
RESULTS: We included 92 studies divided into 113 data sets with a total of 3111 patients. For 71 data sets reporting cardiac output, the pooled percentage error (95% confidence interval [95% CI]) was 44.0% (38.2%-49.8%) with a mean difference (standard deviation) of -0.1 (1.3) L min-1 with 95% limits of agreement of -2.6 to 2.4 L min-1 (I2=9.8%). For 42 data sets reporting cardiac index, the pooled percentage error was 49.1% (40.6%-57.6%) with a mean difference of -0.1 (0.9) L min-1 m-2 with 95% limits of agreement of -1.8 to 1.6 L min-1 m-2 (I2=7.9%). The percentage error varied substantially across patient populations and devices. Overall risk of bias was low.
CONCLUSIONS: The pooled percentage error between minimally invasive pulse wave analysis-derived cardiac output measurements of 44.0% (cardiac output) and 49.1% (cardiac index) in adult surgical or critically ill patients exceeds the 30% threshold for clinically acceptable agreement. However, the percentage error varied depending on the patient population and device used.
TRIAL REGISTRATION: PROSPERO (CRD420251090806; submitted July 17, 2025).