Agreement and trending ability between non-invasive and invasive hemodynamic monitoring during cesarean section under spinal anesthesia: a prospective observational study

Background The uteroplacental circulation lacks autoregulatory capacity and therefore relies predominantly on the maternal cardiac output (CO). Monitoring hemodynamic parameters such as CO can provide guidance for anesthesia decisions during cesarean section. We evaluated the agreement and trending ability of maternal CO, stroke volume (SV), and stroke volume variation (SVV) between two clinically used hemodynamic monitoring technologies, the non-invasive NICAP/NICCO system and the invasive FloTrac/Vigileo system, in patients undergoing elective cesarean section under spinal anesthesia. Methods Forty-five patients were included in the final analysis. Prior to anesthesia, the patients’ hemodynamic parameters, including CO, SV, and SVV, were simultaneously monitored using both the NICAP/NICCO and Flotrac/Vigileo. The baseline values and continuous dynamic data of CO, SV, and SVV were collected over a 15-min period following spinal anesthesia and recorded at 20-s intervals. Repeated-measures Bland–Altman analysis, percent error (PE) and ICC (2, 1) were employed to assess the agreement between the two monitoring methods. Trending ability was evaluated using four-quadrant plot analysis. Results The repeated-measures Bland–Altman analysis indicated that the biases of CO, SV, and SVV were −0.89 L/min (95% limits of agreement: −4.08 to 2.29 L/min; PE, 51.24%), −10.53 mL (95% limits of agreement: −46.26 to 25.20 mL; PE, 46.84%), and 2.44% (95% limits of agreement: −6.82 to 11.69%; PE, 77.95%), respectively. The results of the ICC indicated that the values of CO, SV, and SVV were 0.2578 (95% CI: 0.1067 to 0.3772), 0.4682 (95% CI: 0.2397 to 0.6111), and 0.1813 (95% CI: 0.0686 to 0.2779), respectively. Four-quadrant plot analysis demonstrated the concordance rates for CO, SV, and SVV were 44.59, 32.39, and 21.48%, respectively. Conclusion During cesarean section under spinal anesthesia, the non-invasive hemodynamic monitoring employing NICAP/NICCO technology exhibits poor agreement and trending ability with the invasive hemodynamic monitoring utilizing Flotrac/Vigileo technology. Clinical trial registration ClinicalTrials.gov , identifier NCT06473818