• Int J Crit Illn Inj Sci · Jul 2017

    Comparison of pulmonary artery catheter, echocardiography, and arterial waveform analysis monitoring in predicting the hemodynamic state during and after cardiac surgery.

    • Paul Power, Allison Bone, Nicholas Simpson, Cheng-Hon Yap, Simon Gower, and Michael Bailey.
    • Intensive Care Unit, University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia.
    • Int J Crit Illn Inj Sci. 2017 Jul 1; 7 (3): 156-162.

    ObjectiveThe aim of this trial was to determine whether Flotrac Vigileo™ (FV™) provides a reliable representation of the hemodynamic state of a cardiac surgical patient population when compared to pulmonary artery catheter (PAC) and echocardiography in the peril-operative period.DesignThis was a prospective observational trial comparing perioperative hemodynamic states using transesophageal echocardiography (TEE), transthoracic echocardiography (TTE), FV™ and PAC during and post cardiothoracic surgery.SettingTertiary regional hospital Intensive Care Unit (ICU).Participants50 consecutive adult cardiothoracic patients with written consent provided.InterventionComparison of the perioperative hemodynamic states using echocardiography, FV™ and PAC was performed. Evaluation of the hemodynamic state (HDS) was performed using TEE, TTE, PAC and FV™ during and after cardiac surgery. Data were compared between the three hemodynamic assessment modalities.Main Outcome MeasurePredicted hemodynamic state.ResultsFV™ and PAC were shown to correlate poorly with TEE/TTE assessment of the hemodynamic state. Both PAC and FV™ showed significant discordance with echocardiographic assessment of the hemodynamic state.ConclusionsIn this trial, FV™ and PAC were shown to agree poorly with TTE/TEE assessment of the HDS in an adult cardiothoracic population. Agreement between the FV™ and PAC was also poor. Caution is recommended in interpreting isolated hemodynamic monitoring data. All hemodynamic monitoring devices have inherent sources of error. Caution is advised in interpreting any single device or measurement as a gold standard. We suggest that hemodynamic measuring devices such as FV™/PAC may act as triggers for a global hemodynamic assessment including consideration of TTE/TEE.

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