Disagreement between pulse contour analysis and transpulmonary thermodilution for cardiac output monitoring after routine therapeutic interventions in ICU patients with acute circulatory failure.

BACKGROUND AND

OBJECTIVE

The present prospective study was aimed at assessing the reliability of the pulse contour method for measuring cardiac output (CO) after different routinely used therapeutic interventions that can influence vascular compliance and systemic vascular resistances in ICU patients (fluid challenges, changes in norepinephrine or dobutamine infusion rates and changes in ventilatory settings).

METHODS

In ICU patients requiring CO monitoring, transpulmonary thermodilution CO (COTD) and pulse contour CO (COPC) were measured with a PiCCO device after therapeutic manoeuvre-free periods (≤ and >1 h) and after therapeutic interventions without recalibration.

RESULTS

Three hundred fifty-two sets of CO measurement pairs in 63 ICU patients were performed. The biases (and percentage errors) between COPC and COTD for the overall paired measurement, therapeutic manoeuvre-free periods and therapeutic manoeuvres were 0.20 ± 1.09 (33%), -0.01 ± 0.93 (29%) and 0.37 ± 1.18 (34%), respectively. The percentage errors were 36 and 39% for fluid challenges and changes in norepinephrine infusion rate, respectively.

CONCLUSION

In ICU patients requiring therapeutic interventions, COPC is frequently in disagreement with COTD.