• Romain Barthélémy, Arthur Neuschwander, Fatou Dramé, Maximilien Redouté, David Ditchi, Jules Stern, Alexandre Mebazaa, Romain Pirracchio, and Benjamin G Chousterman.
• From the Department of Anaesthesia, Burn, and Critical Care, Saint-Louis Lariboisière University Hospital (RB, FD, MR, JS, AM, BGC), Department of Anaesthesia and Critical Care, European Hospital Georges-Pompidou, APHP (AN, DD, RP), Paris Diderot University, Sorbonne Paris Cité (AM, BGC), Inserm U942 (AM), Paris Descartes University, Sorbonne Paris Cité (RP), Inserm U1153 (RP) and Inserm U1160, Paris, France (BGC).
• Eur J Anaesthesiol. 2019 Feb 1; 36 (2): 135-143.

BackgroundThe ability of the pressure recording analytical method (PRAM) in tracking change in cardiac output (ΔCO) after a fluid challenge in ICU needs to be evaluated with the most contemporary comparison methods recommended by experts.ObjectiveOur objective was to report the trending ability of PRAM in tracking ΔCO after a fluid challenge in ICU and to compare this with oesophageal Doppler monitoring (ODM).DesignProspective, observational study.SettingHôpital Lariboisière and Hôpital Européen George Pompidou, Paris, France, from April 2016 to December 2017.PatientsCritically ill patients admitted to ICU with monitoring of CO monitored by ODM and invasive arterial pressure.InterventionΔCO after fluid challenge was simultaneously registered with ODM and PRAM connected to the arterial line.Main Outcome MeasurePolar statistics (mean angular bias, radial limits of agreement and polar concordance rate) and clinical concordance evaluation (error grid and clinical concordance rate). Predictors of bias were determined.ResultsSixty-eight fluid challenge were administered in 49 patients. At the time of fluid challenge, almost all were mechanically ventilated (99%), with 85% receiving norepinephrine. Admission diagnosis was septic shock in 70% of patients. Patients had a Sequential Organ Failure Assessment score of 10 [7 to 12] and a median Simplified Acute Physiology Score II of 61 [49 to 69]. Relative ΔCO bias was 7.8° (6.3°) with radial limits of agreement of ±41.7°, polar concordance rate 80% and clinical concordance rate 74%. ΔCO bias was associated with baseline bias (P = 0.007). Baseline bias was associated with radial location of the arterial line (P = 0.03).ConclusionWhen compared with ODM, PRAM has insufficient performance to track ΔCO induced by fluid challenge in ICU patients. Baseline bias is an independent predictor of trending bias.Trial RegistrationIRB 00010254-2016-033.

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