• P Schraverus, M M Kuijpers, J Coumou, C A Boly, C Boer, and S van Kralingen.
• Department of Anaesthesiology, VU University Medical Centre and Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands.
• Anaesthesia. 2016 Dec 1; 71 (12): 1449-1455.

AbstractMorbidly obese patients are at increased risk of intra-operative haemodynamic instability, which may necessitate intensive monitoring. Non-invasive monitoring is increasingly used to measure cardiac output; however, it is unknown whether the weight-based algorithm utilised in these devices is applicable to patients with morbid obesity. We compared the level of agreement and trending ability of non-invasive cardiac output measurements (Nexfin® ) with the gold-standard thermodilution technique in 30 morbidly obese patients undergoing laparoscopic surgery. Bland-Altman analysis revealed a mean (SD) bias of 0.60 (1.62) l.min-1 (limits of agreement -2.67 to 3.86 l.min-1 ) and the precision error was 46%. Polar plot analysis resulted in an angular bias of 2.61°, radial limits of agreement of -60.08° to 49.82° and angular concordance rate was 77%. Both agreement and trending were outside the Critchley criteria for the comparison of cardiac output devices with a gold-standard. Nexfin has an unacceptable level of agreement compared with thermodilution for cardiac output measurement in morbidly obese patients.© 2016 The Association of Anaesthetists of Great Britain and Ireland.

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