• Cornelis Slagt, Mochamat Helmi, Ignacio Malagon, and A B Johan Groeneveld.
• From the Department of Anesthesiology and Intensive Care, Zaans Medical Centre, Zaandam (CS), Department of Intensive Care, Erasmus Medical Centre, Rotterdam, The Netherlands (MH, ABJG), NIHR Respiratory and Allergy Clinical Research Facility, University Hospital South Manchester NHS Foundation Trust, Manchester, UK (IM).
• Eur J Anaesthesiol. 2015 Jan 1;32(1):5-12.

BackgroundCardiac output (CO) measurement is often required in critically ill patients. The performances of newer, less invasive techniques require evaluation in patients with severe sepsis and septic shock.ObjectivesTo compare calibrated arterial pressure waveform analysis-derived CO (COap, VolumeView/EV1000) and the uncalibrated form (COfv, FloTrac/Vigileo) with transpulmonary thermodilution derived CO (COtptd).DesignA prospective, observational, single-centre study.SettingICU of a general teaching hospital.PatientsTwenty consecutive patients with severe sepsis or septic shock requiring haemodynamic monitoring by VolumeView/EV1000 and receiving mechanical ventilation.InterventionConnection of FloTrac/Vigileo to radial artery catheter already in situ.Main Outcome MeasuresRadial (COfv) and femoral (COap) arterial waveform-derived CO measurements were compared with COtptd with respect to bias, precision, limits of agreement and percentage error, and the percentage error in the course of time since the last calibration of COap by COtptd.ResultsIn comparing COap with COtptd (n = 267 paired measurements), the bias was 0.02 and limits of agreement were -2.49 to 2.52 l min, with a percentage error of 31%. The percentage error between COap and COtptd remained less than 30% until 8 h after calibration. In comparing COfv with COtptd (n = 301), the bias was -0.86 l min and limits of agreement were -4.48 to 2.77 l min, with a percentage error of 48%. The biases of COap and COfv correlated with systemic vascular resistance [r = 0.13 (P = 0.029) and r = 0.42 (P < 0.001), respectively]. Clinically significant changes in COap and COfv correlated positively with COtptd at r = 0.51 (P < 0.001) and r = 0.64 (P < 0.001), respectively.ConclusionThere was moderate agreement when measuring CO with either arterial waveform analysis technique. Compared with the uncalibrated COfv, the recently introduced calibrated arterial pressure waveform analysis-derived COap was more accurate and less dependent on vascular tone for up to 8 hours after callibation when monitoring CO in patients with severe sepsis and septic shock. The COap and COfv methods have poor to moderate CO-tracking abilities.

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