Poster Presentations: Tuesday, October 25, 2011 |

Measurement of Cardiac Output in Patients With Septic Shock Using Arterial Pressure Waveform Analysis in Comparison With the Pulmonary Artery Catheter: A Pilot Study FREE TO VIEW

Gan Liang Tan, MD; Ping Wah Chan, MMed; Huck Chin Chew, MMed; Ghee Chee Phua, MMed; Chian Min Loo, MMed
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Singapore General Hospital, Singapore, Singapore

Chest. 2011;140(4_MeetingAbstracts):435A. doi:10.1378/chest.1112169
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PURPOSE: New semi-invasive device (Flotrac/VigileoTM) has been shown to measure cardiac output (CO) reliably in patients undergoing cardiac surgery. However, there are limited data to support its use in patients with low systemic vascular resistance, such as septic shock or liver failure. The aim of the study is to investigate the accuracy of this device in comparison with pulmonary artery catheter (PAC) using bolus pulmonary thermodilution in patients with sepsis. This abstract reports our preliminary findings in the first 13 patients.

METHODS: This is a prospective, observational pilot study over a period of 2 years. Thirteen patients with a diagnosis of septic shock were included. The cardiac index (cardiac output indexed to the body surface area, CI) was computed from the arterial pressure curve using the third-generation Flotrac software. Reference CI was measured simultaneously by bolus pulmonary thermodilution.

RESULTS: A total of 73 simultaneous measurements of CI were recorded. Mean CI measured by PAC was 3.42 L/min/m2 (range 1.28 to 6.26 L/min/m2), and was 3.22 L/min/m2 (range 1.80 to 5.40 L/min/m2) when measured by Flotrac. CI measured by Flotrac was weakly correlated to CI measured by PAC (r = 0.41, p = 0.000). Bias was -0.19 L/min/m2 and precision was ± 1.00 L/min/m2, resulting in an overall percentage error of 58.7%.

CONCLUSIONS: Our preliminary results suggest only a weak correlation between CI measured by Flotrac and, the standard of care, pulmonary artery thermodilution. In addition, there was a clinically unacceptable percentage error.

CLINICAL IMPLICATIONS: Development of less invasive device which can be reliably used in hemodynamic monitoring in septic shock patients is needed.

DISCLOSURE: The following authors have nothing to disclose: Gan Liang Tan, Ping Wah Chan, Huck Chin Chew, Ghee Chee Phua, Chian Min Loo

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