Do cardiac output monitoring devices demonstrate acceptable agreement and trending compared to reference methods in adult ICU patients with septic shock?
Most cardiac output monitors demonstrate poor agreement with reference methods in septic shock, highlighting the need for future studies to assess precision, time response, and trending ability rather than relying solely on Bland-Altman analysis.
To evaluate the interchangeability of cardiac output (CO) monitoring devices compared to reference methods in adult ICU patients with septic shock, we systematically searched electronic databases through January 2025 for prospective studies comparing CO monitors with pulmonary artery catheter (PAC), transpulmonary thermodilution (TPTD), or echocardiography. Eligible studies included Bland-Altman analysis and, when available, trending assessment via polar or 4-quadrant plots, precision, and time response. Agreement was defined as percentage error (PE) 80%). Of 15 datasets reporting trending, only three achieved concordance ≥ 90%. Most CO monitors demonstrate poor agreement with reference methods in septic shock. However, their true clinical utility remains unclear, as usual validation frameworks-centered on Bland-Altman analysis-overlook metrics that matter most to intensivists. Precision, time response, and trending ability are critical for real-time decision-making but were rarely assessed. Future studies must incorporate these parameters to meaningfully evaluate device performance at the bedside. PROSPERO registration: CRD42024509384.
Lamarche-Fontaneto et al. (Sat,) studied this question.