Key result
The non-calibrated Modelflow method had the lowest mean squared error (bias 0.30, 2SD 0.69 l/min) compared to thermodilution, suggesting the best performance among the three systems.
Why the study?
Do minimally invasive cardiac output monitoring systems (FloTrac-Vigileo, Modelflow, HemoSonic) accurately measure cardiac output compared to thermodilution in postoperative cardiac surgical patients?
Observational (n=13)
Do minimally invasive cardiac output monitoring systems (FloTrac-Vigileo, Modelflow, HemoSonic) accurately measure cardiac output compared to thermodilution in postoperative cardiac surgical patients?
Effect estimate: bias (2SD) 0.33 (0.90) for FloTrac-Vigileo, 0.30 (0.69) for Modelflow, and -0.41 (1.11) for HemoSonic
The non-calibrated Modelflow pulse contour method demonstrated the best performance for minimally invasive cardiac output monitoring compared to thermodilution in postoperative cardiac surgical patients.
New CO monitors need further validation before use; leaves open reliability versus thermodilution in cardiac surgical patients.
We evaluated cardiac output (CO) using three new methods - the auto-calibrated FloTrac-Vigileo (CO(ed)), the non-calibrated Modelflow (CO(mf) ) pulse contour method and the ultra-sound HemoSonic system (CO(hs)) - with thermodilution (CO(td)) as the reference. In 13 postoperative cardiac surgical patients, 104 paired CO values were assessed before, during and after four interventions: (i) an increase of tidal volume by 50%; (ii) a 10 cm H(2)O increase in positive end-expiratory pressure; (iii) passive leg raising and (iv) head up position. With the pooled data the difference (bias (2SD)) between CO(ed) and CO(td), CO(mf) and CO(td) and CO(hs) and CO(td) was 0.33 (0.90), 0.30 (0.69) and -0.41 (1.11) l.min(-1), respectively. Thus, Modelflow had the lowest mean squared error, suggesting that it had the best performance. CO(ed) significantly overestimates changes in cardiac output while CO(mf) and CO(hs) values are not significantly different from those of CO(td). Directional changes in cardiac output by thermodilution were detected with a high score by all three methods.
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Wilde et al. (2009) conducted an observational in postoperative cardiac surgical patients (n=13). Minimally invasive cardiac output monitoring systems (FloTrac-Vigileo, Modelflow, HemoSonic) vs. Thermodilution was evaluated on Difference (bias (2SD)) in cardiac output compared to thermodilution (bias (2SD) 0.33 (0.90) for FloTrac-Vigileo, 0.30 (0.69) for Modelflow, and -0.41 (1.11) for HemoSonic). The non-calibrated Modelflow method had the lowest mean squared error (bias 0.30, 2SD 0.69 l/min) compared to thermodilution, suggesting the best performance among the three systems.
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